- If the patient is low risk with CHA2DS2-VASc (men < 2, women < 3), cardioversion is safe up to 48 hours from onset.
- In higher risk patients, we should reserve cardioversion unless there is clear onset less than 12 hours or the patient has been anticoagulated for 3 weeks.
- Consider anticoagulation in every patient with atrial fibrillation whether they are cardioverted or referred.
- Electrical cardioversion (> 95%) is more likely to be successful than chemical cardioversion (~ 60%).
- Cardioversion recommendations exclude patients with recent strokes or valvular heart disease.
Read More
Atzema CL, Barrett TW. Managing atrial fibrillation. Ann Emerg Med 2015; 65(5): 532-9. PMID: 25701296
The SGEM: Shock Through the Heart (Ottawa Aggressive Atrial Fibrillation Protocol)
ALiEM: Atrial Fibrillation Rate Control in the ED: Calcium Channel Blockers or Beta Blockers.
ALiEM: Beta Blockers Vs. Calcium Channel Blockers for Atrial Fibrillation Rate Control: Thinking Beyond the ED.
MD Calc: CHA2DS2-VASc for Atrial Fibrillation Stroke Risk
References
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Atzema CL, Barrett TW. Managing atrial fibrillation. Ann Emerg Med 2015; 65(5): 532-9. PMID: 25701296
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Post Peer Reviewed By: Salim R. Rezaie, MD (Twitter/X: @srrezaie)
