Cochrane Summaries

Trusted evidence. Informed decisions. Better health.

Electrical stimulation for restoring normal heart rhythm in those with irregular heart rhythms (atrial fibrillation or flutter)

Mead GE, Elder A, Flapan AD, Cordina J
Published Online: 
21 January 2009

Atrial fibrillation is an irregular heart rhythm starting from the upper chambers of the heart. It has a negative effect on the circulatory system and can lead to strokes. People are, therefore, often put on long-term blood thinners (either anti-coagulants or antiplatelet drugs), and may sometimes be prescribed drugs to prevent the heart beating too quickly (this is known as a 'rate control' strategy). An alternative approach is to attempt to restore normal heart rhythm using a direct current electrical shock (electrical cardioversion); this procedure requires hospital admission. This review found three completed controlled studies that compared electrical cardioversion with the usual treatment of 'rate control'. People who were given electrical treatment had a small but not significant increase in risk of having a stroke. Three aspects of quality of life (physical functioning, physical role function and vitality) were significantly better in the people given electrical treatment compared to those given 'rate control' when measured at a follow-up of about two years. No other differences between the two strategies were identified. On the basis of the available evidence, we cannot recommend a routine policy of electrical cardioversion over rate control for patients with sustained atrial fibrillation.

Health topics: