Atrial fibrillation electrical cardioversion
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Atrial Fibrillation Microchapters | |
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Atrial fibrillation electrical cardioversion On the Web | |
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Directions to Hospitals Treating Atrial fibrillation electrical cardioversion | |
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Risk calculators and risk factors for Atrial fibrillation electrical cardioversion | |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Patients with hemodynamic instability should undergo electrical cardioversion (also known as direct-current or DC cardioversion) and treatment with parenteral agents to slow the heart rate down.
Electrical Cardioversion
The following scenarios warrant urgent DC cardioversion:
- The presence of cardiogenic shock or hypotension
- Decompensated heart failure
- Refractory ischemia, ischemic EKG changes
ACCF/AHA/HRS 2011 Guidelines- Direct-Current Cardioversion of Atrial Fibrillation and Flutter (DO NOT EDIT) [1][2]
| Class I |
| "1. When a rapid ventricular response does not respond promptly to pharmacological measures for patients with AF with ongoing myocardial ischemia, symptomatic hypotension, angina, or HF, immediate R-wave synchronized direct-current cardioversion is recommended. (Level of Evidence: C) " |
| "2. Immediate direct-current cardioversion is recommended for patients with AF involving pre-excitation when very rapid tachycardia or hemodynamic instability occurs. (Level of Evidence: B) " |
| "3. Cardioversion is recommended in patients without hemodynamic instability when symptoms of AF are unacceptable to the patient. In case of early relapse of AF after cardioversion, repeated direct-current cardioversion attempts may be made following administration of antiarrhythmic medication. (Level of Evidence: C) " |
| Class III (Harm) |
| "1. Frequent repetition of direct-current cardioversion is not recommended for patients who have relatively short periods of sinus rhythm between relapses of AF after multiple cardioversion procedures despite prophylactic antiarrhythmic drug therapy. (Level of Evidence: C) " |
| "2. Electrical cardioversion is contraindicated in patients with digitalis toxicity or hypokalemia. (Level of Evidence: C) " |
| Class IIa |
| "1.Direct-current cardioversion can be useful to restore sinus rhythm as part of a long-term management strategy for patients with AF. (Level of Evidence: B) " |
| "2. Patient preference is a reasonable consideration in the selection of infrequently repeated cardioversion for the management of symptomatic or recurrent AF. (Level of Evidence: C) " |
ACCF/AHA/HRS 2011 Guidelines- Pharmacological Enhancement of Direct-Current Cardioversion (DO NOT EDIT) [1][2]
| Class IIa |
| "1.Pretreatment with amiodarone, flecainide, ibutilide, propafenone, or sotalol can be useful to enhance the success of direct-current cardioversion and prevent recurrent atrial fibrillation.(Level of Evidence: B) " |
| "2. In patients who relapse to AF after successful cardioversion, it can be useful to repeat the procedure following prophylactic administration of antiarrhythmic medication. (Level of Evidence: C) " |
| Class IIb |
| "1.For patients with persistent AF, administration of beta blockers, disopyramide, diltiazem, dofetilide, procainamide, or verapamil may be considered, although the efficacy of these agents to enhance the success of direct-current cardioversion or to prevent early recurrence of AF is uncertain. (Level of Evidence: C) " |
| "2. Out-of-hospital initiation of antiarrhythmic medications may be considered in patients without heart disease to enhance the success of cardioversion of AF. (Level of Evidence: C) " |
| "3. Out-of-hospital administration of antiarrhythmic medications may be considered to enhance the success of cardioversion of AF in patients with certain forms of heart disease once the safety of the drug has been verified for the patient. (Level of Evidence: C) " |
References
- ↑ 1.0 1.1 Fuster V, Rydén LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA et al. (2006) ACC/AHA/ESC 2006 Guidelines for the Management of Patients with Atrial Fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation): developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. Circulation 114 (7):e257-354. DOI:10.1161/CIRCULATIONAHA.106.177292 PMID: 16908781
- ↑ 2.0 2.1 Fuster V, Rydén LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA et al. (2011) 2011 ACCF/AHA/HRS focused updates incorporated into the ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. Circulation 123 (10):e269-367. DOI:10.1161/CIR.0b013e318214876d PMID: 21382897