title: Cardioversion of acute atrial fibrillation in the emergency department: a prospective randomised trial.
abstract: BACKGROUND
  Strategies to restore sinus rhythm in patients with atrial fibrillation (AF) lasting less than 48 h with haemodynamic stability remain controversial. The aim of this study was to test the hypothesis that electrical cardioversion (EC) would be more effective and safer in converting acute AF to sinus rhythm, compared with intravenous propafenone treatment.
  
  
  METHODS
  In the emergency department (ED) of Valduce Hospital, a single-centre randomised trial was conducted to compare EC with pharmacological cardioversion (PC) to restore the sinus rhythm in selected patients with acute AF. A total of 247 patients was enrolled (121 in the EC group and 126 in the PC group).
  
  
  RESULTS
  EC was more successful than PC in restoring sinus rhythm. Successful cardioversion was achieved in 108 out of 121 patients in the EC group (89.3%) and 93 out of 126 patients in the PC group (73.8%) (HR in the EC group, 0.34; 95% CI 0.17 to 0.68; p=0.02). The time patients spent in the ED undergoing treatment was significantly lower in the EC group compared with the PC group (median (range), 180 (120-900) vs 420 (120-1400) min; p<0.001).
  
  
  CONCLUSIONS
  EC was more effective in patients with acute AF and resulted in a shorter length of stay in the ED than PC. Adverse events were small in number and transient in both groups of patients. Clinical trials registration number NCT00933634.
authors.affiliation: Emergency Department, Valduce Hospital, Via Dante 11, 22100 Como, Italy. andreabellone@libero.it
authors.forename: Andrea
authors.initials: A
authors.lastname: Bellone
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Etteri
authors.forename: Marco
authors.initials: M
authors.lastname: Vettorello
authors.forename: Chiara
authors.initials: C
authors.lastname: Bonetti
authors.forename: Dante
authors.initials: D
authors.lastname: Clerici
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Gini
authors.forename: Carlo
authors.initials: C
authors.lastname: Maino
authors.forename: Massimo
authors.initials: M
authors.lastname: Mariani
authors.forename: Anna
authors.initials: A
authors.lastname: Natalizi
authors.forename: Italo
authors.initials: I
authors.lastname: Nessi
authors.forename: Alessandro
authors.initials: A
authors.lastname: Rampoldi
authors.forename: Livio
authors.initials: L
authors.lastname: Colombo
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D000889:Anti-Arrhythmia Agents / Q000008:administration & dosage; D001281:Atrial Fibrillation / Q000628:therapy*; D004554:Electric Countershock; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007275:Injections, Intravenous; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011405:Propafenone / Q000008:administration & dosage; D011446:Prospective Studies
chemical_list: D000889:Anti-Arrhythmia Agents; D011405:Propafenone