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External versus internal cardioversion for atrial fibrillation: a meta-analysis of randomized controlled trials

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Abstract

Background

Patients with atrial fibrillation (AF) often require rhythm control strategy for amelioration of symptoms. It is unclear if there is any difference between external cardioversion (ECV) and internal cardioversion (ICV) for successful conversion of AF to normal sinus rhythm.

Methods

We performed a meta-analysis of published randomized controlled trials (RCTs) evaluating success of cardioversion using ECV versus ICV.

Results

In the pooled analysis of 5 RCTS, there was no difference in success of cardioversion using ECV versus ICV (OR 1.69, 95% CI 0.24–11.83, p = 0.6). In the subgroup analysis, there was no difference between ECV and direct electrode ICV (OR 0.41, 95% CI 0.09–1.83, p = 0.24). However, ECV was significantly better compared with ICV using ICD (OR 11.97, 95% CI 1.87–76.73, p = 0.009).

Conclusions

There was no difference between ECV versus ICV in effectiveness for termination of AF. Larger well-designed randomized controlled trials are needed to confirm our findings.

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Authors and Affiliations

  1. Jersey City Medical Center, Jersey City, NJ, USA

    Gaurav Aggarwal & Mary Abed

  2. Yale University School of Medicine, New Haven, CT, USA

    Mahesh Anantha-Narayanan

  3. Unitypoint Clinic, Des Moines, IA, USA

    Julian Robles & Saurabh Aggarwal

  4. Mount Sinai Medical Center, New York, NY, USA

    Dhrubajyoti Bandyopadhyay

  5. Cincinnati Children’s Hospital, Cincinnati, OH, USA

    Brandon Michael Henry

  6. Division of Cardiology, Department of Medicine, Creighton University School of Medicine, 7500 Mercy Road, Omaha, NE, USA

    Venkata Alla

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  1. Gaurav Aggarwal
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Aggarwal, G., Anantha-Narayanan, M., Robles, J. et al. External versus internal cardioversion for atrial fibrillation: a meta-analysis of randomized controlled trials. J Interv Card Electrophysiol 61, 445–451 (2021). https://doi.org/10.1007/s10840-020-00836-5

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  • DOI: https://doi.org/10.1007/s10840-020-00836-5

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