Anticoagulation for Cardioversion of Atrial Fibrillation

We read with great interest the article by Schlicht et al¹ entitled "Physician Practices Regarding Anticoagulation and Cardioversion of Atrial Fibrillation." However, whether the reported data are representative for the United States is unclear, since Schlicht and colleagues' investigation was restricted to 1 hospital and only 55 patients. Other reports about anticoagulation for atrial fibrillation in different clinical settings also indicate a wide discrepancy between the evidence of clinical trials and daily practice,^2,3 with the methological limitations of a survey that probably lead to overestimation of the use of anticoagulation.

Data from a prospective, multicenter cardioversion registry of 61 cardiology clinics⁴ show that anticoagulation for cardioversion and chronic atrial fibrillation is also underused in Germany despite adoption of the guidelines of the American College of Chest Physicians (ACCP) in Europe.⁵ Between July and December 1994, a total of 1152 patients in whom cardioversion of atrial fibrillation