Conversion of Persistent Atrial Fibrillation to Sinus Rhythm by DC Shock: Is It Still in Use Two Years After AFFIRM?

  • Valeria Calvi
  • Salvatore Timineri


The AFFIRM trial compared a rhythm-control option, which included cardioversion and maintenance of sinus rhythm (SR), to a rate-control option, without cardioversion and with control of ventricular rate, in patients with atrial fibrillation (AF). The 4,060 patients with AF and risk factors for stroke or death who were enrolled in the study were randomized to one of the two therapeutic options. At the conclusion of the study, no differences were found between the two groups with respect to death or composite morbidity; an increase in the number of hospitalizations was found in the rhythm control group (80.1 vs 73%) and, surprisingly, the strategy of maintaining sinus rhythm did not lead to a lower rate of ischemic stroke. It was concluded that, along with anticoagulation, controlling ventricular rate is as effective in preventing morbidity and mortality in patients with AF as traditional antiarrhythmic strategies [1]–[3].


Atrial Fibrillation Sinus Rhythm Persistent Atrial Fibrillation Rhythm Control Electrical Cardioversion 
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Copyright information

© Springer-Verlag Italia 2007

Authors and Affiliations

  • Valeria Calvi
    • 1
  • Salvatore Timineri
    • 1
  1. 1.Cardiology ClinicUniversity of Catania, Ferrarotto HospitalCataniaItaly

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