Therapy

Consider conversion to sinus rhythm ^a  

Why?

• Rhythm control using amiodarone and DC cardioversion leads to better exercise tolerance than rate control using diltiazem had , but did not clearly improve improvement in symptoms or quality of life. ^a
• Though rhythm control maintains more patients in sinus rhythm, hospital admissions and medication adverse effects are more common. ^a
• However one attempt at DC cardioversion is more cost-effective than starting anti-thrombotic therapy immediately. ^a

Rhythm control keeps more patients in sinus rhythm but leads to more hospital admissions and adverse effects

Patient	Treatment	Comparison	Outcome	CER	RRR (95% CI)	NNT (95% CI)
persistent AF a	rhythm control using DC cardioversion and amiodarone	rate control using diltiazem	atrial fibrillation at 1 year	90%	51% (40% to 60%)	2 (2 to 3)
			hospital admission at 1 year	24%	-190% (-300% to -100%)	-2 (-3 to -2)
			discontinuation of medication at 1 year		-36% (-71% to -8%)	-9 (-82 to -5)
			at least 1 adverse effect at 1 year		-79% (-210% to -5%)	-6 (-22 to -3)