Cardioversion of atrial fibrillation and atrial flutter revisited: current evidence and practical guidance for a common procedure

Axel Brandes; Harry J G M Crijns; Michiel Rienstra; Paulus Kirchhof; Erik L Grove; Kenneth Bruun Pedersen; Isabelle C Van Gelder

doi:10.1093/europace/euaa057

Cardioversion of atrial fibrillation and atrial flutter revisited: current evidence and practical guidance for a common procedure

Europace. 2020 Aug 1;22(8):1149-1161. doi: 10.1093/europace/euaa057.

Authors

Axel Brandes^{1

2}, Harry J G M Crijns³, Michiel Rienstra⁴, Paulus Kirchhof⁵, Erik L Grove^{6

7}, Kenneth Bruun Pedersen¹, Isabelle C Van Gelder^{1

2

4}

Affiliations

¹ Department of Cardiology, Odense University Hospital, J.B. Winsløws Vej 4, 5000 Odense C, Denmark.
² Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark.
³ Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, Maastricht, The Netherlands.
⁴ Department of Cardiology, University of Groningen, University Medical Centre, Groningen, The Netherlands.
⁵ Institute of Cardiovascular Sciences, College of Medical and Dental Sciences, University of Birmingham, UHB and Sandwell & West Birmingham Hospitals, NHS Trusts, Birmingham, UK.
⁶ Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.
⁷ Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark.

Abstract

Cardioversion is widely used in patients with atrial fibrillation (AF) and atrial flutter when a rhythm control strategy is pursued. We sought to summarize the current evidence on this important area of clinical management of patients with AF including electrical and pharmacological cardioversion, peri-procedural anticoagulation and thromboembolic complications, success rate, and risk factors for recurrence to give practical guidance.

Keywords: Anticoagulation; Atrial fibrillation; Atrial flutter; Electrical cardioversion; Pharmacological cardioversion; Thromboembolism.

MeSH terms

Anticoagulants / therapeutic use
Atrial Fibrillation* / diagnosis
Atrial Fibrillation* / therapy
Atrial Flutter* / diagnosis
Atrial Flutter* / therapy
Electric Countershock
Humans
Risk Factors
Thromboembolism* / etiology
Thromboembolism* / prevention & control

Substances

Anticoagulants