INTRODUCTION: 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. Acute atrial 
fibrillation resolves spontaneously within 24-48 hours in over 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 October 2007 (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 28 systematic reviews, RCTs, or observational 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, digoxin, diltiazem, direct 
current cardioversion, flecainide, propafenone, quinidine, sotalol, timolol, and 
verapamil.