0
Editorials |

Medical Cardioversion of Atrial Fibrillation

Martin A. Alpert, MD, FCCP
Author and Funding Information

Affiliations: Mobile, AL
 ,  Dr. Alpert is from the Division of Cardiology, University of South Alabama College of Medicine.

Correspondence to: Martin A. Alpert, MD, FCCP, Suite 10C, University of South Alabama Medical Center, 2451 Fillingim St, Mobile, AL 36617



Chest. 2000;117(6):1529-1531. doi:10.1378/chest.117.6.1529
Text Size: A A A
Published online

Extract

In managing patients with atrial fibrillation (AF), the clinician is confronted with a series of complex tasks and decisions that directly influence the choice of therapy. These include identifying and treating the underlying causes and precipitating factors; achieving ventricular rate control; determining eligibility and choosing optimal timing and methodology for cardioversion (including appropriate anticoagulation); proceeding with medical or electrocardioversion in eligible patients; choosing appropriate candidates for long-term antiarrhythmic drug therapy, and selecting the optimal agent in such individuals; identifying patients who may benefit from catheter-based, surgical, or device therapy; and ensuring optimal anticoagulation in those with chronic or paroxysmal AF. In their article “Amiodarone as a First Choice Drug for Restoring Sinus Rhythm in Patients With Atrial Fibrillation: A Randomized Controlled Study” in this issue of CHEST (see page 1538), Vardas and colleagues focus on the issue of medical cardioversion with IV and oral amiodarone. This editorial addresses the significance of their findings within the greater context of medical cardioversion of AF. Before considering the role of antiarrhythmic drug therapy in medical cardioversion, it is important to emphasize that AF of recent onset is associated with a high frequency of spontaneous cardioversion. Reportedly, 44 to 78% of patients whose duration of AF is < 24 h will spontaneously convert to sinus rhythm. This frequency decreases progressively when the duration of AF is > 24 h, and is ≤ 16% when the duration is > 1 month. Although treatment of precipitating factors may account for spontaneous cardioversion in some cases, the absence of electrophysiologic remodeling of the atria with shorter durations and its presence with longer durations probably plays a more important role. The high rate of spontaneous cardioversion in patients with AF of recent onset has contributed to the misconception that atrioventricular nodal blocking drugs (digitalis, β-blockers, heart rate-modifying calcium channel blockers) are associated with medical cardioversion. In fact, these drugs, which are quite valuable in achieving ventricular rate control, have not been shown in placebo-controlled studies to restore sinus rhythm.

First Page Preview

View Large
First page PDF preview

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Figures

Tables

References

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Related Content

Customize your page view by dragging & repositioning the boxes below.

Find Similar Articles
CHEST Journal Articles
Guidelines
  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543