Acute restoration of sinus rhythm.



   


    Pharmacological cardioversion restores sinus rhythm in approximately 50% of patients with recent-onset AF. In the short-term, electrical cardioversion restores sinus rhythm quicker and more effectively than pharmacological cardioversion and is associated with shorter hospitalization. Pharmacological cardioversion, conversely, does not require sedation or fasting.
    Flecainide and propafenone are effective for pharmacological cardioversion,  but their use is restricted to patients without structural heart disease. Ibutilide is an alternative where available, but carries a risk of torsades de pointes. Vernakalant can be given to patients with mild heart failure (NYHA Class I or II), including those with ischaemic heart disease, provided they do not present with hypotension or severe aortic stenosis. 


     Amiodarone can be used in patients with heart failure and in patients with ischaemic heart disease (although patients with severe heart failure were excluded from most of the AF cardioversion trials). Amiodarone also slows heart rate by 10–12 b.p.m. after 8–12 h when given intravenously. Both amiodarone and flecainide appear more effective than sotalol in restoring sinus rhythm.


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