Acute direct current cardioversion: how 'dangerous' is it?

Abstract

This editorial refers to ‘Arrhythmic complications after electrical cardioversion of acute atrial fibrillation: TheFinCV study’ by T. Gronberg et al ., on page 1432. Atrial fibrillation (AF) of <48 h can, according to the ESC Guidelines, be acutely cardioverted, if the physician is convinced that the patient is certain about the time of arrhythmia onset.1 Cardioversion can be performed either by a direct current (DC) shock or by various pharmacological means. Within Europe, there are large variations regarding which method is used.2 In Scandinavian countries, DC cardioversion is the dominant (∼90%) method, whereas pharmacological conversion is mostly used in southern Europe. There are no prospective head-to-head studies comparing efficacy, safety, and long-term risks of these two methods. In this issue of the Journal , Gronberg et al .3 present data from a large retrospective cohort of almost 7000 acute DC cardioversions in patients with AF. Although this study is retrospective, which always carries its limitations, the database is large and well-described. The authors correctly point out that the retrospective nature of the …