Fourteen trials (2,765 patients, range 46 to 376) were included in the review: eight were prospective randomised controlled trials (RCTs), four were prospective non-RCTs and two were retrospective non-RCTs. Follow-up ranged from 24 hours to six months.
Conversion to sinus rhythm and time to conversion: Four out of five trials showed that direct current cardioversion was statistically significantly more effective in restoring sinus rhythm when compared to pharmacological drugs or conservative management.
Flecainide and propafenone showed statistically significant higher conversion rates and shorter time to conversion compared to amiodarone (three trials). A fourth trial showed that amiodarone was superior to magnesium in terms of conversion rates.
Length of stay (four trials) and discharge rate (five trials): Discharge rates in studies that assessed direct current cardioversion were inconsistent but showed short length of stay (three trials).
Readmissions and recurrences (five trials): Readmission rates related to atrial fibrillation varied from 0% at two hours to 26% to 28% at two months. There were no statistically significant differences in recurrence related to atrial fibrillation among the different treatments.
Adverse events were generally rare and not serious for all treatments.
Findings from single trials were also reported in the review.