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Rhythm control strategies include antiarrhythmic drugs, electrical cardioversion (ECV), and catheter ablation. Catheter ablation of AF is more effective in restoring and maintaining sinus rhythm compared to antiarrhythmic drugs, but it is expensive and invasive. So, catheter ablation is recommended as second-line treatment after failure of or intolerance to antiarrhythmic drug therapy.5) ECV is the delivery of energy that is synchronized to the QRS complex during the cardiac cycle. Since external ECV was introduced into clinical practice in the early 1960s,6) it has become a routine procedure to restore sinus rhythm in patients with persistent AF. Currently, ECV of AF is recommended in symptomatic patients with persistent or long-standing persistent AF as part of rhythm control therapy.5)

External Electrical Cardioversion is an Easy and Safe Intervention for Rhythm Control in Persistent Atrial Fibrillation