Intervention Review

Electrical cardioversion for atrial fibrillation and flutter

  1. Gillian E Mead1,*,
  2. Andrew Elder2,
  3. Andrew D Flapan3,
  4. John Cordina4

Editorial Group: Cochrane Heart Group

Published Online: 21 JAN 2009

Assessed as up-to-date: 19 MAY 2005

DOI: 10.1002/14651858.CD002903.pub2

Database Title

Additional Information

How to Cite

Mead GE, Elder A, Flapan AD, Cordina J. Electrical cardioversion for atrial fibrillation and flutter. Cochrane Database of Systematic Reviews 2005, Issue 3. Art. No.: CD002903. DOI: 10.1002/14651858.CD002903.pub2.

Author Information

  1. 1

    University of Edinburgh, School of Clinical Sciences and Community Health, Edinburgh, UK

  2. 2

    Royal Victoria Hospital, Edinburgh, UK

  3. 3

    Royal Infirmary of Edinburgh, Department of Cardiology, Edinburgh, UK

  4. 4

    Victoria Hospital, Ward 11, Kirkcaldy, UK

*Gillian E Mead, School of Clinical Sciences and Community Health, University of Edinburgh, Room F1424, Royal Infirmary, Little France Crescent, Edinburgh, EH16 4SA, UK. gillian.e.mead@ed.ac.uk. gmead@staffmail.ed.ac.uk.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 21 JAN 2009

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Atrial fibrillation increases stroke risk and adversely affects cardiovascular haemodynamics. Electrical cardioversion may, by restoring sinus rhythm, improve cardiovascular haemodynamics, reduce the risk of stroke, and obviate the need for long-term anticoagulation.

Objectives

To assess the effects of electrical cardioversion of atrial fibrillation or flutter on the risk of thromboembolic events, strokes and mortality (primary outcomes), the rate of cognitive decline, quality of life, the use of anticoagulants and the risk of re-hospitalisation (secondary outcomes) in adults (>18 years).

Search methods

We searched the Cochrane CENTRAL Register of Controlled Trials (1967 to May 2004), MEDLINE (1966 to May 2004), Embase (1980 to May 2004), CINAHL (1982 to May 2004), proceedings of the American College of Cardiology (published in Journal of the American College of Cardiology 1983 to 2003), www.trialscentral.org, www.controlled-trials.com and reference lists of articles. We hand-searched the indexes of the Proceedings of the British Cardiac Society published in British Heart Journal (1980 to 1995) and in Heart (1995 to 2002); proceedings of the European Congress of Cardiology and meetings of the Joint Working Groups of the European Society of Cardiology (published in European Heart Journal 1983-2003); scientific sessions of the American Heart Association (published in Circulation 1990-2003). Personal contact was made with experts.

Selection criteria

Randomised controlled trial or controlled clinical trials of electrical cardioversion plus 'usual care' versus 'usual care' only, where 'usual care' included any combination of anticoagulants, antiplatelet drugs and drugs for 'rate control'. We excluded trials which used pharmacological cardioversion as the first intervention, and trials of new onset atrial fibrillation after cardiac surgery. There were no language restrictions.

Data collection and analysis

For dichotomous data, odds ratios were calculated; and for continuous data, the weighted mean difference was calculated.

Main results

We found three completed trials of electrical cardioversion (rhythm control) versus rate control, recruiting a total of 927 participants (Hot Cafe; RACE; STAF) and one ongoing trial (J-RHYTHM). There was no difference in mortality between the two strategies (OR 0.83; CI 0.48 to 1.43). There was a trend towards more strokes in the rhythm control group (OR 1.9; 95% CI 0.99 to 3.64). At follow up, three domains of quality of life (physical functioning, physical role function and vitality) were significantly better in the rhythm control group (RACE 2002; STAF 2003).

Authors' conclusions

Electrical cardioversion (rhythm control) led to a non-significant increase in stroke risk but improved three domains of quality of life.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Electrical stimulation for restoring normal heart rhythm in those with irregular heart rhythms (atrial fibrillation or flutter)

Atrial fibrillation is an irregular heart rhythm starting from the upper chambers of the heart. It has a negative effect on the circulatory system and can lead to strokes. People are, therefore, often put on long-term blood thinners (either anti-coagulants or antiplatelet drugs), and may sometimes be prescribed drugs to prevent the heart beating too quickly (this is known as a 'rate control' strategy). An alternative approach is to attempt to restore normal heart rhythm using a direct current electrical shock (electrical cardioversion); this procedure requires hospital admission. This review found three completed controlled studies that compared electrical cardioversion with the usual treatment of 'rate control'. People who were given electrical treatment had a small but not significant increase in risk of having a stroke. Three aspects of quality of life (physical functioning, physical role function and vitality) were significantly better in the people given electrical treatment compared to those given 'rate control' when measured at a follow-up of about two years. No other differences between the two strategies were identified. On the basis of the available evidence, we cannot recommend a routine policy of electrical cardioversion over rate control for patients with sustained atrial fibrillation.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

電器整流術於心房撲動/顫動

心房顫動會增加中風之機會，並進一步影響心臟血液動力學，藉由電器整流術，可增加恢復竇性節律之機會，改善心臟血液動力學，減少中風機會，以及停止長時期使用抗血液凝集藥物。

目標

本實驗藉由改變血栓性中風發生之機率、死亡 (首要結果) 、心衰竭惡化之速率、生活品質、抗血液凝集藥物之使用，以及再入院之機會 (次要結果)，來評估電器整流術於成人(大於18歲)之成果。

搜尋策略

本實驗資料收集包含 Cohrane CENTRAL Register of Controlled Trails (1967至2004/05)、MEDLINE (1966至2004/05)、Embase (1980至2004/05)、CINAHL (1982至2004/05)、Proceedings of the American Collage of Cardiology (刊登於Journal of the American Collage of Cardiology 1983至2003)、網頁 (www.trialscentral.org and www.controlledtrials.com)，以及本文中所引用之論文。 另外本文章也引用index of the Proceedings of the British Cardiac Society published in British Heart Journal (1980至1995)、 in Heart (1995至2002)、Proceedings of the European Congress of Cardiology and meetings of the Joint Working Groups of the European Society of Cardiology (刊登於European Heart Journal 1983至2003)、Scientific sessions of the American Heart Association (刊登於Circulation 1990至2003)。我們亦與這方面的專家們進行接觸。

選擇標準

本研究將病人隨機分為兩組，其中一組施行電器整流術，併抗凝血以及心律調節之藥物，而另ㄧ組則單純給予抗凝血、以及心律調節之藥物，在研究個案中，我們首先需排除某些族群之病人，包括一開始就給於整流藥物，或者是發生於心臟手術後之心房顫動。本實驗並沒有語言之限制。

資料收集與分析

對於獨立的數據，我們藉由機會預測來分析。另一方面，對於連續的數據，我們則藉由中位分佈曲線來分析。

主要結論

本研究分析三個有關於電器整流術 (心節律控制) 與降低心速率之實驗，囊括927個參與者 (Hot Cafe; RACE; STAF)，還有1個正在研究的實驗 (JRHYTHM)。其中，關於死亡率這一方面，這兩組是沒有差別的 (危險指標是0.64，與95%信賴區間，由0.48至1.43)，但是心節律控制這一組，有較高的中風發生之趨勢 (危險指標是1.9，與95%信賴區間，由0.99至3.64)；另外關於生活品質 (身體的機能、功能以及活力) 這一方面，施行電器整流術的病人，則有較好之生活品質(RACE 2002; STAF 2003)。

作者結論

電器整流術 (心節律控制) 並不會顯著增加中風之危險性，但對於生活品質 (身體的機能、功能以及活力)，則有較大的改善空間。

翻譯人

本摘要由臺北榮民總醫院項國威翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

電器整流術是藉由電氣刺激，使不規則之心律 (心房顫動或撲動)，恢復成規則之心臟節律。 心房顫動是一種，源自於心臟上方位置之不規則心跳，它對於循環系統，有負面的影響，而且會增加中風之機會。患有心房顫動之病人，通常需給予長期的血液稀釋劑 (包括抗凝血劑或抗血小板凝集之藥物)。同時，在某些情況下，我們同時需給予一些藥物，來避免心律過快 (這就是所謂的心律控制)。現在對於這一類病人，出現了另一種方法，就是藉由使用直接的電刺激 (電器整流術) 來恢復正常之心律節奏。這一種方法一般需要住院治療。 而本論文探討了，3個有關於電器整流術，以及給予藥物治療之病人。結論顯示，接受電器整流術的病人，雖然會增加中風之機會，但機率不是明顯增加,，另一方面，依照追蹤兩年的數據結論顯示，電器整流術對於生活品質，會有較大之的改善 (包括身體的機能、功能以及活力)。另外，在其他方面，這兩組的病人是沒有差別的。但是，依照現有的資料，我們仍不建議，持續性心房顫動的病人，都接受電器整流術的治療。

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