![]() clinically non-self-terminating) AF is represented by the 1-1-1-1-1 rule ( Figure 2). Timing of recurrences after cardioversion of persistent atrial fibrillation 13 Even in patients with implanted defibrillators, ECV seems preferable to internal cardioversion performed with the ICD. 12 In patients with an implanted pacemaker or implantable cardioverter-defibrillator (ICD), damage to the system can be avoided by biphasic ECV in the antero-posterior paddle position. 11 Starting with the maximum shock energy available seems more effective than escalating shock energies. 10 An antero-posterior electrode position ( Figure 1) restores sinus rhythm better compared to antero-apical. 9 Electrical cardioversion is more effective when using a biphasic defibrillator, and around 40% of patients are pre-treated with an AAD at their ECV. midazolam and/or propofol and continuous blood pressure monitoring and oximetry during the procedure. 7, 8Įlectrical cardioversion can be performed safely under short sedation with i.v. ![]() 1, 6 Compared to AF, ECV is more effective in AFL, also requiring less energy. ![]() in principle self-terminating) AF to sinus rhythm in 50–70% of cases within a few hours, when sodium channel blockers (mainly propafenone or flecainide) or vernakalant are used, while these drugs rarely convert AF of longer duration. 1 Pharmacological cardioversion mainly converts recent-onset or paroxysmal (i.e. We also give some practical advice for this widely used therapy.Įlectrical and pharmacological cardioversionĮlectrical cardioversion terminates AF in over 90% of cases and is the treatment of choice in severely haemodynamically compromised patients with new-onset AF or AFL. This review summarizes the current scientific evidence for undertaking ECV and PCV, the occurrence of thromboembolic events with cardioversion, image-guiding of cardioversion, and antithrombotic therapy when performing cardioversion. Nevertheless, several important points must be considered before embarking on this treatment, among others the need for cardioversion, 5 the mode (ECV or PCV) and timing of cardioversion, assessment of the individual peri-procedural thromboembolic risk of the patient, anticoagulant therapy, and peri-procedural or subsequent long-term therapy with AADs. 3, 4 These procedures are readily available and easy to perform with a high overall success rate. 2 The first reports on PCV of AF using quinidine were published in the late 1940s, while ECV of AF by synchronized DC shock was introduced in the early 1960s. 1 Electrical cardioversion may also be appropriate as a one-time diagnostic shock in supposedly asymptomatic patients with persistent AF to evaluate, whether they nevertheless show improved exercise tolerance during sinus rhythm. Cardioversion, either by a synchronized direct current (DC) electrical shock (electrical cardioversion, ECV) or by the application of antiarrhythmic drugs (AADs pharmacological cardioversion, PCV), is an integral part of the management of atrial fibrillation (AF) and atrial flutter (AFL) in symptomatic patients who require a rhythm control strategy.
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