Stiell IG, Sivilotti LA, Taljaard M, et al. - The present study was conducted to compare conversion to sinus rhythm between pharmacological cardioversion followed by electrical cardioversion (drug–shock), and electrical cardioversion alone (shock-only) and researchers further correlated the effectiveness of two pad positions for electrical cardioversion. A total of 396 individuals were recruited in this study between July 18, 2013, and Oct 17, 2018, at 11 academic hospital emergency departments in Canada. For patients in the emergency department with acute atrial fibrillation, both the drug–shock and shock-only strategies were highly effective, rapid, and safe in restoring sinus rhythm, avoiding the need for a return to the hospital. No significant difference was found between the anterolateral and anteroposterior pad positions for electrical cardioversion. Immediate rhythm control leads to excellent outcomes for individuals in the emergency department with acute atrial fibrillation.