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Cardioversion of acute atrial fibrillation in the emergency department: a prospective randomised trial
  1. Andrea Bellone1,
  2. Massimiliano Etteri1,
  3. Marco Vettorello2,
  4. Chiara Bonetti1,
  5. Dante Clerici1,
  6. Giancarlo Gini1,
  7. Carlo Maino1,
  8. Massimo Mariani1,
  9. Anna Natalizi1,
  10. Italo Nessi1,
  11. Alessandro Rampoldi1,
  12. Livio Colombo3
  1. 1Emergency Department, Valduce Hospital, Como, Italy
  2. 2Emergency Department, Niguarda Ca' Granda Hospital, Milan, Italy
  3. 3Emergency Department, San Paolo Hospital, Milan, Italy
  1. Correspondence to Dr Andrea Bellone, Emergency Department, Valduce Hospital, Via Dante 11, 22100 Como, Italy, andreabellone{at}


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.

  • Arrythmiaatrial fibrillationcardiac careelectrical cardioversionemergency care systemsemergency departmentsmanagementprocedural sedationpropafenone

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  • Competing interests None.

  • Patient consent Obtained.

  • Ethics approval This study was conducted with the approval of the ethics committee of Valduce Hospital.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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