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Review
. 2023 Feb 1;12(3):1165.
doi: 10.3390/jcm12031165.

Electric Cardioversion vs. Pharmacological with or without Electric Cardioversion for Stable New-Onset Atrial Fibrillation: A Systematic Review and Meta-Analysis

Paritosh Prasai  1 , Dhan Bahadur Shrestha  2 , Eltaib Saad  1 , Angkawipa Trongtorsak  1 , Aarya Adhikari  3 , Suman Gaire  2 , Prakash Raj Oli  4 , Jurgen Shtembari  2 , Pabitra Adhikari  1 , Yub Raj Sedhai  5 , Muhammad Sikander Akbar  6 , Islam Y Elgendy  7 , Ghanshyam Shantha  8
Affiliations
Review

Electric Cardioversion vs. Pharmacological with or without Electric Cardioversion for Stable New-Onset Atrial Fibrillation: A Systematic Review and Meta-Analysis

Paritosh Prasai et al. J Clin Med. .

Abstract

Background: There is no clear consensus on the preference for pharmacological cardioversion (PC) in comparison to electric cardioversion (EC) for hemodynamically stable new-onset atrial fibrillation (NOAF) patients presenting to the emergency department (ED).

Methods: A systematic review and meta-analysis was conducted to assess PC (whether being followed by EC or not) vs. EC in achieving cardioversion for hemodynamically stable NOAF patients. PubMed, PubMed Central, Embase, Scopus, and Cochrane databases were searched to include relevant studies until 7 March 2022. The primary outcome was the successful restoration of sinus rhythm, and secondary outcomes included emergency department (ED) revisits with atrial fibrillation (AF), hospital readmission rate, length of hospital stay, and cardioversion-associated adverse events.

Results: A total of three randomized controlled trials (RCTs) and one observational study were included. There was no difference in the rates of successful restoration to sinus rhythm (88.66% vs. 85.25%; OR 1.14, 95% CI 0.35-3.71; n = 868). There was no statistical difference across the two groups for ED revisits with AF, readmission rates, length of hospital stay, and cardioversion-associated adverse effects, with the exception of hypotension, whose incidence was lower in the EC group (OR 0.11, 95% CI 0.04-0.27: n = 727).

Conclusion: This meta-analysis suggests that there is no difference in successful restoration of sinus rhythm with either modality among patients with hemodynamically stable NOAF.

Keywords: cardioversion; electrical cardioversion; new-onset atrial fibrillation; pharmacological cardioversion.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Risk of bias assessment of randomized controlled trials [2,11,12].
Figure 2
Figure 2
PRISMA 2020 flow diagram for the systematic review.
Figure 3
Figure 3
Forest plot showing cardioversion across electrical and chemical followed by electrical cardioversion group using random effect model [2,3,11,12].
Figure 4
Figure 4
Forest plot showing ED visit rate across electrical and chemical followed by electrical cardioversion group using random effect model [2,3,11].
Figure 5
Figure 5
Forest plot showing readmission rate across electrical and chemical followed by electrical cardioversion group using fixed effect model [2,3,11].
Figure 6
Figure 6
Forest plot showing significant hypotension across electrical and chemical followed by electrical cardioversion group using fixed effect model among RCTs [2,3,11].
See this image and copyright information in PMC

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