Cardiac Arrhythmia

COCHRANE SYSTEMATIC REVIEW: Antiarrhythmics for maintaining sinus rhythm after cardioversion of atrial fibrillation
Implications for practice: Some antiarrhythmics can be considered for sinus rhythm maintenance post cardioversion.
Review Overview: Several class IA, IC and III drugs, as well as class II drugs (beta-blockers), are moderately effective in maintaining sinus rhythm after conversion of atrial fibrillation. However, they increase adverse events, including pro-arrhythmia, and some of them (disopyramide, quinidine and sotalol) may increase mortality. Possible benefits on clinically relevant outcomes (stroke, embolism, heart failure) remain to be established.
LINK to Cochrane Library: Issue 3, 2015

COCHRANE SYSTEMATIC REVIEW: UPDATE: Effectiveness of the Valsalva Manoeuvre for reversion of supraventricular tachycardia Effectiveness of the Valsalva Manoeuvre for reversion of supraventricular tachycardia
Implications for practice: Valsalva’s maneuver can have some effectiveness.
Review Overview: Three studies involving a total of 316 participants were included in this review. Analysis of the results showed that reversion success lies somewhere between 19.4% and 54.3%. We could not calculate the likelihood and severity of side effects (adverse events) as the studies provided insufficient information to perform this analysis. Potential side effects have been reported in other articles on the subject; these have included hypotension (sudden lowering of blood pressure) or syncope (brief loss of consciousness). No side effects were reported in the three studies reviewed here. In the three studies, reversion was achieved on completion of each VM. Overall, the VM appears to be a simple, non-invasive method of stopping abnormal heart rhythm, but its safety and overall effectiveness are difficult to quantify. Further research is required to improve the evidence surrounding this practice.
LINK to Cochrane Library: Issue 2, 2015

COCHRANE SYSTEMATIC REVIEW: Anaesthetic and sedative agents used for electrical cardioversion
Implications for practice: These common agents for sedation seem adequate for cardioversion procedures.
Review Overview: We included 23 studies with 1250 participants that compared one drug with one or more other drugs. Of these comparisons, 19 studies compared propofol with another drug. Seven of these compared propofol with etomidate (four of which combined the drugs with remifentanil or fentanyl), five midazolam, six thiopentone and two sevoflurane. Three studies compared etomidate with thiopentone, and three etomidate with midazolam. Two studies compared thiopentone with midazolam, one thiopentone with diazepam and one midazolam with diazepam. Few studies reported statistically significant results for our relevant outcomes, and most study authors concluded that both, or all, agents compared in individual studies were adequate for cardioversion procedures. It is our opinion that at present, there is no evidence to suggest that current anaesthetic practice for cardioversion should change.
LINK to Cochrane Library: Issue 3, 2015