Value of cardioversion in chronic atrial fibrillation

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Abstract
Forty cases of chronic atrial fibrillation associated with serious heart disease underwent cardioversion with restoration of sinus rhythm in 35. Sixteen continued in regular rhythm for 4 months or longer. Eleven of the 16 patients (27% of the total series of 40) showed significant clinical benefit: 8 had an increased effort tolerance; 7 showed subsidence of cardiac failure; and 1 had a cessation of thrombo-embolism. Cardioversion was of no demonstrable clinical value in the other 24 patients who either failed to revert to sinus rhythm or did not maintain the normal rhythm for a significant length of time. Factors associated with early recurrence of fibrillation or failure to convert to sinus rhythm were patient age over 55 years, and marked cardiomegaly. The single factor associated with the persistence of sinus rhythm was the requirement for defibrillation of a capacitor discharge not exceeding 300 watt-sec. It was concluded that cardioversion can, at times, produce sustained sinus rhythm with substantial benefit for patients having heart disease refractory to other therapy.

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