Cisneros Clavijo Paulina Elizabeth, Zambrano Mila Mishell Estefania, Cervantes Ruiz Cesar Antonio, Ramirez Calvillo David Sebastian, Alvarado Rangel Leonardo, Robles Gutiérrez Daniel Alexander, Ramirez Arbelaez Carlos Antonio, Mares Cárdenas Hannia Sarali, Aguirre Castro Sophia Alejandra
Endovascular Surgery, Enrique Garcés Hospital, Quito, ECU.
Hemodynamics and General and Interventional Cardioangiology, Pontifical Catholic University of Ecuador, Quito, ECU.
Cureus. 2025 Jun 25;17(6):e86747. doi: 10.7759/cureus.86747. eCollection 2025 Jun.
Atrial fibrillation (AF) is the most frequently encountered arrhythmia in emergency departments (EDs), often requiring urgent rhythm control when rate control fails. This systematic review and meta-analysis compare electrical cardioversion (ECV) and pharmacological cardioversion (PCV) in adult patients with both new-onset AF (NOAF) and refractoryAF, defined in the included studies as AF unresponsive to initial rate control and necessitating immediate rhythm intervention due to ongoing symptoms or hemodynamic instability. A comprehensive literature search was conducted in PubMed, Google Scholar and Cochrane Library. Eligible studies included randomized or observational trials comparing ECV and PCV in emergency settings. Screening and selection were performed independently and in duplicate. Eight studies (n=1,561) were included. ECV generally showed higher rhythm restoration rates, especially in persistent AF (e.g., 59.1% vs 12.5%; p=0.002). However, the pooled odds ratio (OR) was 1.31 (95% confidence interval (CI): 0.55-3.13; p=0.55), indicating no significant difference. Wide CIs and high heterogeneity (I²=88%) reflect imprecision and possible underpowering. Findings in persistent AF were not from a predefined subgroup analysis and should be interpreted cautiously. Three studies assessed discharge rates; pooled analysis showed no significant difference (OR=0.66, 95% CI: 0.24-1.79; p=0.42; I²=77%), despite individual studies favoring ECV for earlier discharge. Both strategies were safe, with no deaths or major complications. Safety assessments included hypotension, bradyarrhythmias, and procedural complications. Minor adverse events were rare and transient. In conclusion, ECV and PCV are both effective and safe for managing refractory AF in emergency settings. Clinical choice should consider patient-specific factors and provider experience.
心房颤动（AF）是急诊科最常遇到的心律失常，当心率控制失败时通常需要紧急节律控制。本系统评价和荟萃分析比较了电复律（ECV）和药物复律（PCV）在新发房颤（NOAF）和难治性房颤成年患者中的效果，在纳入研究中难治性房颤定义为对初始心率控制无反应且由于持续症状或血流动力学不稳定而需要立即进行节律干预的房颤。在PubMed、谷歌学术和考克兰图书馆进行了全面的文献检索。符合条件的研究包括在急诊环境中比较ECV和PCV的随机或观察性试验。筛选和选择由两人独立重复进行。纳入了八项研究（n=1561）。ECV通常显示出更高的节律恢复率，尤其是在持续性房颤中（例如，59.1%对12.5%；p=0.002）。然而，合并优势比（OR）为1.31（95%置信区间（CI）：0.55-3.13；p=0.55），表明无显著差异。宽置信区间和高异质性（I²=88%）反映了结果的不精确性和可能的检验效能不足。持续性房颤的研究结果并非来自预定义的亚组分析，应谨慎解释。三项研究评估了出院率；汇总分析显示无显著差异（OR=0.66，95%CI：0.24-1.79；p=0.42；I²=77%），尽管个别研究倾向于ECV可更早出院。两种策略均安全，无死亡或重大并发症。安全性评估包括低血压、缓慢性心律失常和操作并发症。轻微不良事件罕见且为一过性。总之，ECV和PCV在急诊环境中治疗难治性房颤均有效且安全。临床选择应考虑患者的具体因素和医疗服务提供者的经验。
