E-ISSN 1658-7820
 
2026, Vol: 10, Issue: 9
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Review Article
Online Published: 09 Sep 2026
 


Outcomes of early versus delayed cardioversion in atrial fibrillation presenting to the emergency department: a systematic review

Eman Ghazi Bakr Darwish, Shatha Nasser Khalid Alburayh, Abdulaziz Mohammed Alhomaidi.


Abstract
The issue of when to cardiovert atrial fibrillation (AF) is controversial. Early cardioversion can help decrease symptom burden and atrial remodeling, whereas delayed or wait-and-see approaches can enable spontaneous conversion and decrease the number of procedures. This systematic review aimed to assess the safety, effectiveness, and resource implications of early versus delayed cardioversion in various populations of AF. A systematic review of randomized trials, observational cohorts, and large administrative datasets of early and delayed cardioversion of patients with paroxysmal, persistent, or recent-onset AF was conducted. The extracted data included study design, population characteristics, early and late cardioversion, AF recurrence, adverse events, length of stay, and resource utilization. A total of 21,587 patients were included in six studies. Delayed strategies proved to be no worse than early cardioversion in rhythm control at short-term follow-up, and 63%-69% of patients spontaneously converted. Studies did not show any significant differences in mortality, thromboembolism, or stroke. Early or emergency cardioversion was linked to reduced AF recurrence, better symptom scores, decreased atrial remodeling, and shorter time to ablation, but delayed cardioversion was linked to reduced cost, length of stay, and risk of acute heart failure. Late-onset AF and stable AF respond well to delayed strategies, but early cardioversion can be better in persistent AF or more at-risk hospitalized patients to minimize recurrence and other adverse hemodynamic impacts. Timing protocols should be standardized, and prospective studies on long-term outcomes should be conducted.

Key words: Outcomes, cardioversion, atrial fibrillation, emergency department, systematic review


 
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How to Cite this Article
Pubmed Style

Darwish EGB, Alburayh SNK, Alhomaidi AM. Outcomes of early versus delayed cardioversion in atrial fibrillation presenting to the emergency department: a systematic review. IJMDC. 2026; 10(9): 2822-2829. doi:10.24911/IJMDC.51-1783015977

Web Style

Darwish EGB, Alburayh SNK, Alhomaidi AM. Outcomes of early versus delayed cardioversion in atrial fibrillation presenting to the emergency department: a systematic review. https://www.ijmdc.com/?mno=326465 [Access: September 19, 2026]. doi:10.24911/IJMDC.51-1783015977

AMA (American Medical Association) Style

Darwish EGB, Alburayh SNK, Alhomaidi AM. Outcomes of early versus delayed cardioversion in atrial fibrillation presenting to the emergency department: a systematic review. IJMDC. 2026; 10(9): 2822-2829. doi:10.24911/IJMDC.51-1783015977


Vancouver/ICMJE Style

Darwish EGB, Alburayh SNK, Alhomaidi AM. Outcomes of early versus delayed cardioversion in atrial fibrillation presenting to the emergency department: a systematic review. IJMDC. (2026), [cited September 19, 2026]; 10(9): 2822-2829. doi:10.24911/IJMDC.51-1783015977


Harvard Style

Darwish, E. G. B., Alburayh, . S. N. K. & Alhomaidi, . A. M. (2026) Outcomes of early versus delayed cardioversion in atrial fibrillation presenting to the emergency department: a systematic review. IJMDC, 10 (9), 2822-2829. doi:10.24911/IJMDC.51-1783015977


Turabian Style

Darwish, Eman Ghazi Bakr, Shatha Nasser Khalid Alburayh, and Abdulaziz Mohammed Alhomaidi. 2026. Outcomes of early versus delayed cardioversion in atrial fibrillation presenting to the emergency department: a systematic review. International Journal of Medicine in Developing Countries, 10 (9), 2822-2829. doi:10.24911/IJMDC.51-1783015977


Chicago Style

Darwish, Eman Ghazi Bakr, Shatha Nasser Khalid Alburayh, and Abdulaziz Mohammed Alhomaidi. "Outcomes of early versus delayed cardioversion in atrial fibrillation presenting to the emergency department: a systematic review." International Journal of Medicine in Developing Countries 10 (2026), 2822-2829. doi:10.24911/IJMDC.51-1783015977


MLA (The Modern Language Association) Style

Darwish, Eman Ghazi Bakr, Shatha Nasser Khalid Alburayh, and Abdulaziz Mohammed Alhomaidi. "Outcomes of early versus delayed cardioversion in atrial fibrillation presenting to the emergency department: a systematic review." International Journal of Medicine in Developing Countries 10.9 (2026), 2822-2829. Print. doi:10.24911/IJMDC.51-1783015977


APA (American Psychological Association) Style

Darwish, E. G. B., Alburayh, . S. N. K. & Alhomaidi, . A. M. (2026) Outcomes of early versus delayed cardioversion in atrial fibrillation presenting to the emergency department: a systematic review. International Journal of Medicine in Developing Countries, 10 (9), 2822-2829. doi:10.24911/IJMDC.51-1783015977




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    About International Journal of Medicine in Developing Countries

    International Journal of Medicine in Developing Countries is a peer-reviewed, open-access international medical journal. Journal Title Internat ... Read more.



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