General principles of acute rhythm control for atrial fibrillation

Rhythm control is used to restore sinus rhythm and to improve symptoms in patients with atrial fibrillation. It can be helpful for patients who:

• have recently been diagnosed with atrial fibrillation (less than 12 months from diagnosis)Kirchhof, 2020
• remain symptomatic despite adequate rate control therapy
• have a reduced left ventricular ejection fraction that might be due to atrial fibrillationMarrouche, 2018.

For acute rhythm control, electrical or pharmacological cardioversion is an effective option to restore sinus rhythm for a patient with atrial fibrillation; the choice is dependent on the individual. Electrical cardioversion has a higher success rate of achieving sinus rhythm than pharmacological cardioversion. Antiarrhythmic drugs approximately double the rate of achieving sinus rhythm compared to placebo.