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{{Atrial fibrillation}}
{{Atrial fibrillation}}
{{CMG}}
{{CMG}} {{AE}} {{Anahita}}


==Overview==
==Overview==
 
There are numbers of indications for electrical [[cardioversion]] [[treatment]] in [[atrial fibrillation]] [[patients]]. [[Arrhythmia]] longer than 48 hours, [[shock|hemodynamic instability]], decompensated [[heart failure]], and [[ischemia]] are some of the conditions the electrical [[cardioversion]] can be used.  
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]].


==Electrical Cardioversion==
==Electrical Cardioversion==
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*Consider proper [[amiodarone]] [[therapy]] from 4 weeks before the [[cardioversion|electrical cardioversion]] and up to 1 year after it to maintain the [[sinus rhythm]].<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>
*Consider proper [[amiodarone]] [[therapy]] from 4 weeks before the [[cardioversion|electrical cardioversion]] and up to 1 year after it to maintain the [[sinus rhythm]].<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 following scenarios warrant urgent DC [[cardioversion]]:
*The following scenarios warrant urgent DC [[cardioversion]]:
** The presence of [[cardiogenic shock]] or [[hypotension]].
** The presence of [[cardiogenic shock]] or [[hypotension]] (should be [[treatment|treated]] with [[Route of administration|parenteral agents]] as well).
** Decompensated [[heart failure]].
** Decompensated [[heart failure]].
** Refractory [[ischemia]] and [[ischemia|ischemic]] [[The electrocardiogram|EKG]] changes.
** Refractory [[ischemia]] and [[ischemia|ischemic]] [[The electrocardiogram|EKG]] changes.
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| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
|-
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' In pursuing a rhythm-control strategy, [[cardioversion]] is recommended for patients with [[AF]] or [[atrial flutter]] as a method to restore [[sinus rhythm]]. If [[cardioversion]] is unsuccessful, repeated direct-current [[cardioversion]] attempts may be made after adjusting the location of the electrodes, applying pressure over the electrodes, or following administration of an [[antiarrhythmic|antiarrhythmic medication]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' In pursuing a [[rhythm]]-control strategy, [[cardioversion]] is recommended for [[patients]] with [[AF]] or [[atrial flutter]] as a method to restore [[sinus rhythm]]. If [[cardioversion]] is unsuccessful, repeated direct-current [[cardioversion]] attempts may be made after adjusting the location of the electrodes, applying pressure over the electrodes, or following administration of an [[antiarrhythmic|antiarrhythmic medication]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki>
|-
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.''' [[Cardioversion]] is recommended when a rapid ventricular response to [[AF]] or [[atrial flutter]] does not respond promptly to pharmacological therapies and contributes to ongoing [[myocardial ischemia]], [[hypotension]], or [[HF]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.''' [[Cardioversion]] is recommended when a rapid [[vetricle|ventricular]] response to [[atrial fibrillation]] ([[AF]]) or [[atrial flutter]] does not respond promptly to [[pharmacology|pharmacological]] [[therapy|therapies]] and contributes to ongoing [[myocardial ischemia]], [[hypotension]], or [[heart failure]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|-
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''3.''' [[Cardioversion]] is recommended for patients with [[AF]] or [[atrial flutter]] and [[pre-excitation]] when [[tachycardia]] is associated with [[hemodynamic]] instability. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''3.''' [[Cardioversion]] is recommended for [[patients]] with [[atrial fibrillation]] ([[AF]]) or [[atrial flutter]] and [[pre-excitation]] when [[tachycardia]] is associated with [[hemodynamic]] instability. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|}
|}


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| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
|-
|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' It is reasonable to perform repeated [[cardioversion]]s in patients with persistent [[AF]] provided that [[sinus rhythm]] can be maintained for a clinically meaningful period between [[cardioversion]] procedures. Severity of [[AF]] symptoms and patient preference should be considered when embarking on a strategy requiring serial [[cardioversion]] procedures. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' It is reasonable to perform repeated [[cardioversion]]s in [[patients]] with persistent [[atrial fibrillation]] ([[AF]]) provided that [[sinus rhythm]] can be maintained for a clinically meaningful period between [[cardioversion]] procedures. Severity of [[atrial fibrillation]] [[AF]] [[symptoms]] and [[patient]] preference should be considered when embarking on a strategy requiring serial [[cardioversion]] procedures. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|}
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Revision as of 04:53, 3 November 2021
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Atrial fibrillation electrical cardioversion On the Web

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Anahita Deylamsalehi, M.D.[2]

Overview

There are numbers of indications for electrical cardioversion treatment in atrial fibrillation patients. Arrhythmia longer than 48 hours, hemodynamic instability, decompensated heart failure, and ischemia are some of the conditions the electrical cardioversion can be used.

Electrical Cardioversion

2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation (DO NOT EDIT)[2]

Rhythm Control

Direct-Current Cardioversion: Recommendations

Class I
"1. In pursuing a rhythm-control strategy, cardioversion is recommended for patients with AF or atrial flutter as a method to restore sinus rhythm. If cardioversion is unsuccessful, repeated direct-current cardioversion attempts may be made after adjusting the location of the electrodes, applying pressure over the electrodes, or following administration of an antiarrhythmic medication. (Level of Evidence: B)"
"2. Cardioversion is recommended when a rapid ventricular response to atrial fibrillation (AF) or atrial flutter does not respond promptly to pharmacological therapies and contributes to ongoing myocardial ischemia, hypotension, or heart failure. (Level of Evidence: C)"
"3. Cardioversion is recommended for patients with atrial fibrillation (AF) or atrial flutter and pre-excitation when tachycardia is associated with hemodynamic instability. (Level of Evidence: C)"
Class IIa
"1. It is reasonable to perform repeated cardioversions in patients with persistent atrial fibrillation (AF) provided that sinus rhythm can be maintained for a clinically meaningful period between cardioversion procedures. Severity of atrial fibrillation AF symptoms and patient preference should be considered when embarking on a strategy requiring serial cardioversion procedures. (Level of Evidence: C)"

Sources

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 January, C. T.; Wann, L. S.; Alpert, J. S.; Calkins, H.; Cleveland, J. C.; Cigarroa, J. E.; Conti, J. B.; Ellinor, P. T.; Ezekowitz, M. D.; Field, M. E.; Murray, K. T.; Sacco, R. L.; Stevenson, W. G.; Tchou, P. J.; Tracy, C. M.; Yancy, C. W. (2014). "2014 AHA/ACC/HRS Guideline 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 Heart Rhythm Society". Circulation. doi:10.1161/CIR.0000000000000041. ISSN 0009-7322.
  3. ↑ 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
  4. ↑ Abraham NS, Hlatky MA, Antman EM, Bhatt DL, Bjorkman DJ, Clark CB; et al. (2010). "ACCF/ACG/AHA 2010 Expert Consensus Document on the concomitant use of proton pump inhibitors and thienopyridines: a focused update of the ACCF/ACG/AHA 2008 expert consensus document on reducing the gastrointestinal risks of antiplatelet therapy and NSAID use: a report of the American College of Cardiology Foundation Task Force on Expert Consensus Documents". Circulation. 122 (24): 2619–33. doi:10.1161/CIR.0b013e318202f701. PMID 21060077.
  5. ↑ Estes NA, Halperin JL, Calkins H, Ezekowitz MD, Gitman P, Go AS et al. (2008) ACC/AHA/Physician Consortium 2008 clinical performance measures for adults with nonvalvular 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 Clinical Performance Measures for Atrial Fibrillation): developed in collaboration with the Heart Rhythm Society. Circulation 117 (8):1101-20. DOI:10.1161/CIRCULATIONAHA.107.187192 PMID: 18283199
  6. ↑ 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


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