Evaluation of a protocol to select patients of all ages for cardioversion from atrial fibrillation

Objective: to audit the success of a decision protocol to select patients for cardioversion from atrial fibrillation or flutter by recording the success of cardioversion and the maintenance of sinus rhythm over a 2-year period. Design: retrospective case notes review. Setting: a teaching hospital coronary care unit and cardiology department. Patients: 227 consecutive patients were considered for cardioversion from atrial fibrillation or flutter from 1989 to 1992; 128 fulfilled the selection criteria. Main outcome measures: successful cardioversion and maintenance of sinus rhythm after cardioversion. Results: 116 (91%) patients selected by application of the guidelines were successfully cardioverted. The probabilities of maintaining sinus rhythm at 6, 12 and 24 months were 0.92, 0.88 and 0.73 respectively. Conclusion: careful selection of patients in atrial fibrillation identities a group in whom cardioversion is likely to be safe and successful regardless of age.