By M. A. Allessie, F. J. Chorro, M. C. E. F. Wijffels, F. Mast, R. Dorland (auth.), Antonio Raviele MD (eds.)
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A randomized, double-blinded trial. Ann Intern Med 106:503-506 Laupacis A, Albers GW, Dalen JE, Dunn MI, Feinberg W, Jacobson AK (1995} Antithrombotic therapy in atrial fibrillation. Chest 108 (suppl):325S-359S Metcalfe MJ, Smith F, Jennings K, Patterson M (1988) Does cardioversion of atrial fibrillation result in myocardial damage?. Br Med J 290:1364-1368 Van Gelder IC, Crijns HJ, Van Gilst WH, Verwer R, Lie KI (1991) Prediction of uneventful cardioversion and maintenance of sinus rhythm from direct-current electrical cardioversion of chronic atrial fibrillation and flutter.
A placebo-controlled, randomized, double-blind, crossover study. Ann Intern Med 105:655-659 Hammil SC, Me Laran CJ, Wood DL, Osborne MJ, Gersh BJ, Holmes DR (1987) Double blind study of intravenous propafenone for paroxysmal supraventricular reentrant tachycardia. JAm Coll Cardiol9:1364-1368 Ludmer PL, Me Cowan NE, Antman EM, Friedman PL (1987) Efficacy of propafenone in Wolff-Parkinson-White syndrome: electrophysiologic findings and long-term follow-up. JAm Coll Cardiol9:1357-1363 Dubuc M, Kus T, Campa MA, Lambert C, Rosengarten M, Shenasa M (1989) Electrophysiologic effects of intravenous propafenone in Wolff-Parkinson-White syndrome.
In highly selected patients, when a pharmacological approach fails and an external DC shock also fails or is contraindicated, an attempt at internal cardioversion may be carried out. This technique is newborn and still performed on an experimental basis, but it is very promising, with a high success rate even in long-lasting AF and with a safe profile [22]. Clinical Implications Comparison of the clinical effects of the two therapeutic strategies to restore sinus rhythm, the pharmacological and the electrical one, is difficult if not impossible: they both are effective and sufficiently safe.