Effectiveness and costs of chemical versus electrical cardioversion of atrial fibrillation

• Published in: International journal of cardiology Vol. 88; no. 2; pp. 157 - 166
• Main Authors: de Paola, Angelo A.V., Figueiredo, Edilberto, Sesso, Ricardo, Veloso, Henrique H., Nascimento, Luiz Olympio T.
• Format: Journal Article
• Language: English
• Published: Shannon Elsevier Ireland Ltd 01.04.2003; Elsevier Science
• Subjects: Adult; Aged; Anti-Arrhythmia Agents - adverse effects; Anti-Arrhythmia Agents - economics; Anti-Arrhythmia Agents - therapeutic use; Antiarrhythmic drug; Atrial fibrillation; Atrial Fibrillation - physiopathology; Atrial Fibrillation - therapy; Biological and medical sciences; Cardiac arrhythmia; Cost-Benefit Analysis - economics; Cost-effectiveness; Diseases of the cardiovascular system; Electric Countershock - adverse effects; Electric Countershock - economics; Electrical cardioversion; Electrocardiography; Female; Health Care Costs; Humans; Length of Stay - economics; Male; Medical sciences; Middle Aged; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Severity of Illness Index; Treatment Outcome; Cardiac arrhythmia; Electrical cardioversion; Antiarrhythmic drug; Cost-effectiveness; Atrial fibrillation; Human; Intensive cardiocirculatory care; Costs; Arrhythmia; Treatment efficiency; Multicenter study; Instrumentation therapy; Cardiovascular disease; Antiarrhythmic agent; Excitability disorder; Chemotherapy; Treatment; Heart disease; Health economy; Defibrillation; Therapeutic protocol; Public health; Comparative study
• ISSN: 0167-5273; 1874-1754
• DOI: 10.1016/S0167-5273(02)00380-7

Background: Atrial fibrillation is the most common sustained cardiac arrhythmia and has an important impact on costs of medical assistance. Traditional interventions to convert atrial fibrillation to sinus rhythm are antiarrhythmic drugs and external electrical cardioversion. However, the best option for starting the cardioversion is not well established. Methods: In a multicentre randomised trial of 139 patients with persistent atrial fibrillation lasting less than 6 months, we compared the effectiveness and the cost-effectiveness ratio of initial treatment with chemical or electrical cardioversion. Subjects who did not achieve sinus rhythm with chemical cardioversion were considered to undergo electrical cardioversion and vice-versa. Results: The efficacy of the initial attempt for cardioversion was similar with chemical or electrical cardioversion (74 vs. 73%, P=0.95). However, the strategy of starting with antiarrhythmic drugs was more effective than with electrical procedure (96 vs. 84%, P=0.0016). Initiating with chemical cardioversion was also less expensive than with electrical cardioversion (US$1240 vs. US$1917; P=0.002). Life-threatening complications occurred only during chemical cardioversion (5%), all of them in patients with structural heart disease. Conclusions: In patients with persistent atrial fibrillation of less than 6 months, initial chemical or electrical cardioversion appear to be similar but the strategy of starting the cardioversion with antiarrhythmic drugs is more effective and less expensive than starting with the electrical procedure. Patients with structural heart disease undergoing chemical cardioversion seem to be more susceptible to severe complications.