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| colspan="3" align="center" bgcolor="#ABCDEF" | Conduction
{| class="infobox" style="float:right;"
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| [[File:Siren.gif|30px|link=Atrial fibrillation resident survival guide]]|| <br> || <br>
| <small>Sinus rhythm</small> [[Image:Heart conduct sinus.gif|none|230px]]
| [[Atrial fibrillation resident survival guide|'''Resident'''<br>'''Survival'''<br>'''Guide''']]
| <small>Atrial fibrillation</small> [[Image:Heart conduct atrialfib.gif|none|230px]]  
|}
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{{Infobox_Disease |
{{Atrial fibrillation}}
  Name          = Atrihttp://miles.wikidoc.org/skins/common/images/button_bold.pngal fibrillation |
{{CMG}}; '''Associate Editor(s)-In-Chief:''' {{CZ}}; [[Varun Kumar, M.B.B.S.]] {{Anahita}}
  Image          = SinusRhythmLabels.png  |
  Caption        = The P waves, which represent depolarization of the atria, are irregular or absent during atrial fibrillation. |
  DiseasesDB    = 1065 |
  ICD10          = {{ICD10|I|48||i|30}} |
  ICD9          = {{ICD9|427.31}} |
  ICDO          = |
  OMIM          = |
  MedlinePlus    = 000184 |
  eMedicineSubj  = med |
  eMedicineTopic = 184 |
  eMedicine_mult = {{eMedicine2|emerg|46}} |
}}
{{SI}}
{{WikiDoc Cardiology Network Infobox}}
{{CMG}}


'''Associate Editor-In-Chief:''' {{CZ}}
==Overview==
 
[[Cardioversion]] is a [[medical procedure]] by which an abnormally [[fast heart rate]] ([[tachycardia]]) or [[cardiac arrhythmia]] is converted to a [[Electrical conduction system of the heart|normal rhythm]]. When [[heart rate|rate control]] is not successful enough or when it is not able to improve the [[symptoms]] of [[patients]] [[cardioversion|rhythm control]] (either [[pharmacology|pharmacological]] or electrical) should be considered. [[Atrial fibrillation electrical cardioversion|Electrical cardioversion]] involves the restoration of normal [[heart rhythm]] through the application of a [[defibrillator]]. The [[pharmacology|pharmalogical]] method is performed with usage of [[medications]], such as [[amiodarone]], [[dronedarone]], [[procainamide]], [[ibutilide]], [[propafenone]] or [[flecainide]]. Whichever method of [[cardioversion]] is used, approximately 50% of [[patients]] [[relapse]] within one year, although the continued daily use of [[mouth|oral]] [[antiarrhythmic drugs]] may extend this period.
{{Editor Join}}
 
'''Synonyms and related keywords''': AF, Afib, fib


==Cardioversion==
==Cardioversion==
{{main|Cardioversion}}
*When [[heart rate|rate control]] is not successful enough or when it is not able to improve the [[symptoms]] of [[patients]] [[cardioversion|rhythm control]] (either [[pharmacology|pharmacological]] or electrical) should be considered. <ref name="pmid34020968">{{cite journal| author=Perry M, Kemmis Betty S, Downes N, Andrews N, Mackenzie S, Guideline Committee| title=Atrial fibrillation: diagnosis and management-summary of NICE guidance. | journal=BMJ | year= 2021 | volume= 373 | issue= | pages= n1150 | pmid=34020968 | doi=10.1136/bmj.n1150 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=34020968  }} </ref>
Rhythm control methods include electrical and chemical [[cardioversion]]:<ref name="pmid16908781"/>
*[[cardioversion|Rhythm control]] methods include electrical and [[Chemical substance|chemical]] [[cardioversion]] ([[pharmacology|pharmacological]]):<ref name="pmid16908781">Fuster V, Rydén LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA et al. (2006) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=16908781 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. [http://dx.doi.org/10.1161/CIRCULATIONAHA.106.177292 DOI:10.1161/CIRCULATIONAHA.106.177292] PMID: [http://pubmed.gov/16908781 16908781]</ref><ref name='Shea2002'>{{cite journal|title=Cardioversion|journal= Circulation|year=2002|first=Julie B.|last=Shea|coauthors=William H. Maisel|volume=106|issue=22|pages=e176–8|doi=10.1161/01.CIR.0000040586.24302.B9|url=http://circ.ahajournals.org/cgi/content/full/106/22/e176|format=|accessdate=|pmid=12451016 }}</ref><ref>{{cite journal |author=Singh BN, Connolly SJ, Crijns HJ, ''et al'' |title=Dronedarone for maintenance of sinus rhythm in atrial fibrillation or flutter |journal=N. Engl. J. Med. |volume=357 |issue=10 |pages=987–99 |year=2007 |pmid=17804843 |doi=10.1056/NEJMoa054686}}</ref>
* ''Electrical cardioversion'' involves the restoration of normal heart rhythm through the application of a DC electrical shock.
** [[Atrial fibrillation electrical cardioversion|Electrical cardioversion]] involves the restoration of normal [[heart rhythm]] through the application of a [[defibrillator]].
* ''Chemical cardioversion'' is performed with drugs, such as [[amiodarone]], [[dronedarone]]<ref>{{cite journal |author=Singh BN, Connolly SJ, Crijns HJ, ''et al'' |title=Dronedarone for maintenance of sinus rhythm in atrial fibrillation or flutter |journal=N. Engl. J. Med. |volume=357 |issue=10 |pages=987–99 |year=2007 |pmid=17804843 |doi=10.1056/NEJMoa054686}}</ref>, [[procainamide]], [[ibutilide]], [[propafenone]] or [[flecainide]]. 
** [[Atrial fibrillation pharmacological cardioversion|Chemical cardioversion]] is performed with usage of [[medications]], such as [[amiodarone]], [[dronedarone]], [[procainamide]], [[ibutilide]], [[propafenone]] or [[flecainide]].  
 
*In [[patients]] with [[atrial fibrillation]] more than 48 hours or even in cases that onset of [[atrial fibrillation]] is unknown it is recommended to delay [[cardioversion]] [[treatment]] until at least 3 weeks after [[anticoagulation]] [[therapy]].<ref name="pmid34020968">{{cite journal| author=Perry M, Kemmis Betty S, Downes N, Andrews N, Mackenzie S, Guideline Committee| title=Atrial fibrillation: diagnosis and management-summary of NICE guidance. | journal=BMJ | year= 2021 | volume= 373 | issue=  | pages= n1150 | pmid=34020968 | doi=10.1136/bmj.n1150 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=34020968  }} </ref>
The main risk of cardioversion is systemic embolization of a [[thrombus]] (blood clot) from the previously fibrillating left atrium. Cardioversion should not be performed without adequate anticoagulation in patients with more than 48 hours of atrial fibrillation. Cardioversion may be performed in instances of AF lasting more than 48 hours if a [[transesophogeal echocardiogram]] (TEE) demonstrates no evidence of clot within the heart.<ref name="pmid16908781"/>
*The main risk of [[cardioversion]] is [[systemic embolization]] of a [[thrombus]] ([[Thrombus|blood clot]]) from the previously fibrillating [[left atrium]]. [[Cardioversion]] should not be performed without adequate [[anticoagulation]] in [[patients]] with more than 48 hours of [[atrial fibrillation]]. [[Cardioversion]] may be performed in instances of [[atrial fibrillation]] lasting more than 48 hours if a [[transesophogeal echocardiogram]] ([[transesophogeal echocardiogram|TEE]]) demonstrates no evidence of [[clot]] within the [[heart]].<ref name="pmid16908781"/>
 
Whichever method of cardioversion is used, approximately 50% of patient [[relapse]] within one year, although the continued daily use of oral antiarrhythmic drugs may extend this period. The key risk factor for relapse is duration of AF, although other risk factors that have been identified include the presence of structural heart disease, and increasing age.
 
==ACC / AHA Guidelines- Recommendations for Pharmacological Cardioversion of Atrial Fibrillation (DO NOT EDIT) <ref name="Fuster"> Fuster V, Ryden LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA, Halperin JL, Le Heuzey JY, Kay GN, Lowe JE, Olsson SB, Prystowsky EN, Tamargo JL, Wann S. ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation- Executive Summary: executive summary: 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 Guidlines for the Management of Patients With Atrial Fibrillation): Developed in Collaboration With the European Heart Rhythm Association and the Heart Rhythm Society. Circulation. 2006; 114: 700-752. PMID 16908781 </ref>==
{{cquote|
===Class I===
1. Administration of [[flecainide]], [[dofetilide]], [[propafenone]], or [[ibutilide]] is recommended for pharmacological [[cardioversion]] of [[AF]]. ''(Level of Evidence: A)''
 
===Class IIa===
1. Administration of [[amiodarone]] is a reasonable option for pharmacological [[cardioversion]] of [[AF]]. ''(Level of Evidence: A)''
 
2. A single oral bolus dose of [[propafenone]] or [[flecainide]] (“pill-in-the-pocket”) can be administered to terminate persistent [[AF]] outside the hospital once treatment has proved safe in hospital for selected patients without sinus or [[AV node]] dysfunction, [[bundle branch block]], [[QT-interval prolongation]], the [[Brugada syndrome]], or [[structural heart disease]]. Before [[antiarrhythmic medication]] is initiated, a [[beta blocker]] or non [[dihydropyridine]] [[calcium channel antagonist]] should be given to prevent rapid AV conduction in the event [[atrial flutter]] occurs. ''(Level of Evidence: C)''
 
3. Administration of [[amiodarone]] can be beneficial on an outpatient basis in patients with paroxysmal or persistent [[AF]] when rapid restoration of [[sinus rhythm]] is not deemed necessary. ''(Level of Evidence: C)''
 
===Class IIb===
1. Administration of [[quinidine]] or [[procainamide]] might be considered for pharmacological [[cardioversion]] of [[AF]], but the usefulness of these agents is not well established. ''(Level of Evidence: C)''
 
===Class III===
1. [[Digoxin]] and [[sotalol]] may be harmful when used for pharmacological [[cardioversion]] of [[AF]] and are not recommended. ''(Level of Evidence: A)''
 
2. [[Quinidine]], [[procainamide]], [[disopyramide]], and [[dofetilide]] should not be started out of hospital for conversion of [[AF]] to [[sinus rhythm]]. ''(Level of Evidence: B)''}}


==ACC / AHA Guidelines- Direct-Current Cardioversion of Atrial Fibrillation and Flutter (DO NOT EDIT) <ref name="Fuster"> Fuster V, Ryden LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA, Halperin JL, Le Heuzey JY, Kay GN, Lowe JE, Olsson SB, Prystowsky EN, Tamargo JL, Wann S. ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation- Executive Summary: executive summary: 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 Guidlines for the Management of Patients With Atrial Fibrillation): Developed in Collaboration With the European Heart Rhythm Association and the Heart Rhythm Society. Circulation. 2006; 114: 700-752. PMID 16908781 </ref>==
*Whichever method of [[cardioversion]] is used, approximately 50% of [[patients]] [[relapse]] within one year, although the continued daily use of [[mouth|oral]] [[antiarrhythmic drugs]] may extend this period.  
{{cquote|
*The key [[risk factor]] for relapse is duration of [[atrial fibrillation]]. Other [[risk factors]] that have been identified include the presence of [[structural heart disease]], and [[old age]].
===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 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)''
 
===Class III===
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)''}}
 
==Sources==
* The ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation <ref name="Fuster"> Fuster V, Ryden LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA, Halperin JL, Le Heuzey JY, Kay GN, Lowe JE, Olsson SB, Prystowsky EN, Tamargo JL, Wann S. ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation- Executive Summary: executive summary: 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 Guidlines for the Management of Patients With Atrial Fibrillation): Developed in Collaboration With the European Heart Rhythm Association and the Heart Rhythm Society. Circulation. 2006; 114: 700-752. PMID 16908781 </ref>


==References==
==References==
{{reflist|2}}
{{reflist|2}}


==Further Readings==
{{WikiDoc Help Menu}}
{{refbegin|2}}
{{WikiDoc Sources}}
* Fuster V, Rydén LE, Cannom DS, 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.
[[CME Category::Cardiology]]
* Estes NAM 3rd, Halperin JL, Calkins H, Ezekowitz MD, Gitman P, Go AS, McNamara RL, Messer JV, Ritchie JL, Romeo SJW, Waldo AL, Wyse DG. ACC/AHA/Physician Consortium 2008 clinical performance measures for adults with non valvular atrial fibrillation or atrial flutter: a report of the American College of Cardiology/American Heart Association Task Force on Performance Measures and the Physician Consortium for Performance Improvement (Writing Committee to Develop Performance Measures for Atrial Fibrillation). Circulation 2008; 117:1101–1120
* Braunwald's Heart Disease, Libby P, 8th ed., 2007, ISBN 978-1-41-604105-4
* Hurst's the Heart, Fuster V, 12th ed. 2008, ISBN 978-0-07-149928-6
* Willerson JT, Cardiovascular Medicine, 3rd ed., 2007, ISBN 978-1-84628-188-4
{{refend}}
 
{{Electrocardiography}}
{{Circulatory system pathology}}
{{SIB}}


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[[Category:Electrophysiology]]
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[[de:Vorhofflimmern]]
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[[it:Fibrillazione atriale]]
[[nl:Boezemfibrilleren]]
[[ja:心房細動]]
[[no:Atrieflimmer]]
[[pl:Migotanie przedsionków]]
[[ro:Fibrilaţia Atrială]]
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Latest revision as of 21:11, 27 October 2021
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]; Varun Kumar, M.B.B.S. Anahita Deylamsalehi, M.D.[3]

Overview

Cardioversion is a medical procedure by which an abnormally fast heart rate (tachycardia) or cardiac arrhythmia is converted to a normal rhythm. When rate control is not successful enough or when it is not able to improve the symptoms of patients rhythm control (either pharmacological or electrical) should be considered. Electrical cardioversion involves the restoration of normal heart rhythm through the application of a defibrillator. The pharmalogical method is performed with usage of medications, such as amiodarone, dronedarone, procainamide, ibutilide, propafenone or flecainide. Whichever method of cardioversion is used, approximately 50% of patients relapse within one year, although the continued daily use of oral antiarrhythmic drugs may extend this period.

Cardioversion

References

  1. ↑ 1.0 1.1 Perry M, Kemmis Betty S, Downes N, Andrews N, Mackenzie S, Guideline Committee (2021). "Atrial fibrillation: diagnosis and management-summary of NICE guidance". BMJ. 373: n1150. doi:10.1136/bmj.n1150. PMID 34020968 Check |pmid= value (help).
  2. ↑ 2.0 2.1 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
  3. ↑ Shea, Julie B. (2002). "Cardioversion". Circulation. 106 (22): e176–8. doi:10.1161/01.CIR.0000040586.24302.B9. PMID 12451016. Unknown parameter |coauthors= ignored (help)
  4. ↑ Singh BN, Connolly SJ, Crijns HJ; et al. (2007). "Dronedarone for maintenance of sinus rhythm in atrial fibrillation or flutter". N. Engl. J. Med. 357 (10): 987–99. doi:10.1056/NEJMoa054686. PMID 17804843.


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