?url_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Adc&rft.title=Pharmacological+cardioversion+for+atrial+fibrillation+and+flutter*&rft.creator=Cordina%2C+J&rft.creator=Mead%2C+G&rft.subject=Indian+Pacing+and+Electrophysiology+Journal&rft.description=Atrial+fibrillation+is+the+commonest+cardiac+dysrhythmia.++It+is+associated+with+significant+morbidity+and+mortality.++There+are+two+approaches+to+the+management+of+atrial+fibrillation%3A+controlling+the+ventricular+rate+or+converting+to+sinus+rhythm+in+the+expectation+that+this+would+abolish+its+adverse+effects.%0A%0A++++++++++++The+objective+of+this+review+was+to+assess+the+effects+of+pharmacological+cardioversion+of+atrial+fibrillation+in+adults+on+the+annual+risk+of+stroke%2C+peripheral+embolism%2C+and+mortality.++%0A%0A++++++++++++We+made+a+thorough+search+for+existing+evidence+in+the+following+databases%3A+the+Cochrane+Controlled+Trials+Register++(Issue+3%2C+2002)%2C+MEDLINE+(2000+to+2002)%2C+EMBASE+(1998+to+2002)%2C+CINAHL++(1982+to+2002)%2C+Web+of+Science+(1981+to+2002).++We+also+handsearched+the+following+journals%3A+Circulation+(1997+to+2002)%2C+Heart+(1997+to+2002)%2C++European+Heart+Journal+(1997-2002)%2C+Journal+of+the+American+College+of+Cardiology+(1997-2002)+and+selected+abstracts+published+on+the+web+site+of+the+North+American+Society+of+Pacing+and+Electrophysiology+(2001%2C+2002).++We+selected+trials+based+on+the+following+criteria%3A+randomised+controlled+trials+or+controlled+clinical++trials+of+pharmacological+cardioversion+versus+rate+control+in+adults+(%3E18++years)+with+acute%2C+paroxysmal+or+sustained+atrial+fibrillation+or+atrial+flutter%2C+of+any+duration+and+of+any+aetiology.++%0A%0A++++++++++++We+identified+two+completed+studies+AFFIRM+(n%3D4060)+and+PIAF+(n%3D252).+We+found+no+difference+in+mortality+between+rhythm+control+and+rate+control+-+relative+risk+1.14+(95%25+confidence+interval+1.00+to+1.31).++Both+studies+show+significantly+higher+rates+of+hospitalisation+and+adverse+events+in+the+rhythm+control+group+and+no+difference+in+quality+of+life+between+the+two+treatment+groups.+In+AFFIRM+there+was+a+similar+incidence+of+ischaemic+stroke%2C+bleeding+and+systemic+embolism+in+the+two+groups.+Certain+malignant+dysrhythmias+were+significantly+more+likely+to+occur+in+the+rhythm+control+group.+There+were+similar+scores+of+cognitive+assessment+in+both+groups.+In+PIAF%2C+cardioverted+patients+enjoyed+an+improved+exercise+tolerance+but+there+was+no+overall+benefit+in+terms+of+symptom+control+or+quality+of+life.%0A%0A++++++++++++There+is+no+evidence+that+pharmacological+cardioversion+of+atrial+fibrillation+to+sinus+rhythm+is+superior+to+rate+control.+Rhythm+control+is+associated+with+more+adverse+effects+and+increased+hospitalisation.+It+does+not+reduce+the+risk+of+stroke.+These+conclusions+cannot+be+generalised+to+all+people+with+atrial+fibrillation+as+most+of+the+patients+included+in+these+studies+were+relatively+older+(%3E60+years)+with+significant+cardiovascular+risk+factors.%0A&rft.publisher=Indian+Pacing+and+Electrophysiology+Group&rft.contributor=Singh%2C+Balbir&rft.contributor=Lokhandwala%2C+Yash&rft.contributor=Francis%2C+Johnson&rft.contributor=Gupta%2C+Anup&rft.date=2006-01&rft.type=Journal+(Paginated)&rft.type=PeerReviewed&rft.format=text%2Fhtml&rft.identifier=http%3A%2F%2Fcogprints.org%2F4675%2F1%2Fcordina.htm&rft.format=application%2Fpdf&rft.identifier=http%3A%2F%2Fcogprints.org%2F4675%2F2%2Fcordina.pdf&rft.identifier=++Cordina%2C+J+and+Mead%2C+G++(2006)+Pharmacological+cardioversion+for+atrial+fibrillation+and+flutter*.++%5BJournal+(Paginated)%5D+++++&rft.relation=http%3A%2F%2Fcogprints.org%2F4675%2F