Cardioversion for atrial fibrillation: the views of consultant physicians,geriatricians and cardiologists

Background and aims: atrial fibrillation (AF) increases the risk of stroke and also has adverse haemodynamic consequences. Cardioversion of AF to sinu s rhythm may obviate the need for long-term anticoagulation and improve car diovascular haemodynamics, but is probably underused. We therefore investig ated the views of hospital consultants about cardioversion for AE Methods: 336 postal questionnaires were sent to all 186 consultant physicia ns, 54 cardiologists and 96 geriatricians in Scotland, followed by one remi nder letter to non-responders. Results: 71% of questionnaires were returned. Cardiologists referred 18% of AF patients for cardioversion, while physicians referred 11% and geriatric ians 5%. Cardiologists had better access to cardioversion facilities and we re less likely to consider an enlarged left atrium and organic heart diseas e to be contra-indications to cardioversion. Anticoagulation was given for less than 3 weeks before cardioversion by 9% of cardiologists, 39% of physi cians and 65% of geriatricians (P < 0.001), and for less than 3 weeks after cardioversion by 17% of cardiologists, 45% of physicians and 47% of geriat ricians (P = 0.7). Summary: the wide variation in practice both between and within the differe nt specialties suggests that consensus guidelines based on the best availab le evidence should be developed.