Therapy

Consider conversion to sinus rhythm ^a using DC cardioversion ^c followed by amiodarone ^b

Why?

• Most patients with chronic AF who receive DC cardioversion will revert to sinus rhythm immediately (86%: 95% CI: 79% to 93%). At 2 years, 41% will still be in sinus rhythm (95% CI: 31% to 51%), though most require repeat cardioversions. ^c
• 60% of patients who receive DC cardioversion, followed by amiodarone are still in sinus rhythm at 12 months (95% CI: 51% to 69%). Around 10% stop due to side-effects. ^b
• The most cost-effective strategies for treating patients with non-valvular atrial fibrillation are (in decreasing cost and decreasing effectiveness) ^a
  • DC cardioversion, amiodarone and warfarin
  • DC cardioversion, amiodarone and aspirin, swapping to warfarin if AF recurs
  • DC cardioversion and aspirin, swapping to warfarin if AF recurs
    
    
  • If patients have few or no AF symptoms: DC cardioversion followed by aspirin or warfarin alone if AF recurs is best
  • If patients are at high-risk of amiodarone pulmonary toxicity or adverse effects: DC cardioversion followed by warfarin if AF recurs is best