Pharmacological Cardioversion Versus Electrical Cardioversion in the Acute Treatment of Atrial Fibrillation in the Emergency Department: The Recufa-Hula Register

<b>Background:</b> Strategies to restore sinus rhythm in hemodynamically stable patients with atrial fibrillation (AF) admitted to the emergency department (ED) are the focus of debate. The present study was carried out to compare pharmacological cardioversion (PC) and electrical cardioversion (EC) in terms of their efficacy in converting to sinus rhythm. <b>Methods:</b> A retrospective, analytical observational study was carried out in patients seen in the ED over four consecutive years with episodes of uncomplicated AF. Two rhythm control strategies were evaluated: PC (followed or not by EC) and EC. Demographic and clinical variables were also compiled for both groups. <b>Results:</b> A total of 401 cardioversion procedures in 284 patients were analyzed. The mean patient age was 62.81 years (standard deviation [SD] 12.07), and 67.4% were male. PC was carried out in 160 subjects (56.3%), with a success rate of 76.8%, and EC was performed in 98 patients (34.5%), with a success rate of 94.9%. Significant differences between the two strategies were found for the primary objective (cardioversion to sinus rhythm), with the EC group presenting the best results (<i>p</i> = 0.0001). <b>Conclusions:</b> EC is safe and more effective in converting to sinus rhythm. The efficacy of PC alone is limited, and additional procedures for rhythm control are often required.