Electrical Cardioversion of Atrial Fibrillation Is Safe and Effective in the ED

In a prospective study at a single emergency department (ED) in Italy, researchers randomized 246 stable adult patients with atrial fibrillation of <48 hours duration to receive either electrical cardioversion or pharmacological cardioversion with intravenous propafenone. Patients were excluded if they received daily antiarrhythmic therapy or had valvular disease, atrial fibrillation due to acute coronary syndrome, electrolyte disturbances, sepsis, fever, hypothermia, untreated hyperthyroidism, or a CHADS₂ score ≥2. Patients in the electrical cardioversion group underwent propofol sedation and then received synchronized biphasic shocks of 100–150–200 J, as needed. Patients in the pharmacological arm received intravenous propafenone (2 mg/kg…