INTRODUCTION: Acute atrial fibrillation is rapid, irregular, and chaotic atrial 
activity of recent onset. Various definitions of acute atrial fibrillation have 
been used in the literature, but for the purposes of this review we have 
included studies where atrial fibrillation may have occurred up to 7 days 
previously. Risk factors for acute atrial fibrillation include increasing age, 
cardiovascular disease, alcohol, diabetes, and lung disease. Acute atrial 
fibrillation increases the risk of stroke and heart failure. The condition 
resolves spontaneously within 24 to 48 hours in more than 50% of people; 
however, many people will require interventions to control heart rate or restore 
sinus rhythm.
METHODS AND OUTCOMES: We conducted a systematic review and aimed to answer the 
following clinical questions: What are the effects of interventions to prevent 
embolism, for conversion to sinus rhythm, and to control heart rate in people 
with recent-onset atrial fibrillation (within 7 days) who are haemodynamically 
stable? We searched: Medline, Embase, The Cochrane Library, and other important 
databases up to April 2014 (Clinical Evidence reviews are updated periodically; 
please check our website for the most up-to-date version of this review). We 
included harms alerts from relevant organisations such as the US Food and Drug 
Administration (FDA) and the UK Medicines and Healthcare products Regulatory 
Agency (MHRA).
RESULTS: We found 26 studies that met our inclusion criteria. We performed a 
GRADE evaluation of the quality of evidence for interventions.
CONCLUSIONS: In this systematic review, we present information relating to the 
effectiveness and safety of the following interventions: amiodarone, 
antithrombotic treatment before cardioversion, atenolol, bisoprolol, carvedilol, 
digoxin, diltiazem, direct current cardioversion, flecainide, metoprolol, 
nebivolol, propafenone, sotalol, timolol, and verapamil.