creation date: 2026-06-12 00:32
tags: Interventions Incomplete
Cardioversion
Background
Cardioversion is the conversion of non-sinus rhythms to sinus rhythm.
Indications include:
- New onset atrial fibrillation or atrial flutter
- CHADS65 <2
- Onset <12 hours with no stroke/TIA in prior 6 months OR anticoagulated for prior 3 weeks
- Symptomatic or hemodynamically unstable
- Supraventricular tachycardias
- Ventricular tachycardia
Contraindications are:
- Unable to be anticoagulated (unless onset <12h or hemodynamically unstable)
- Comorbidities cause risk of cardioversion to be greater than risk of arrythmia
- Significant risk due to comorbidities AND cardioversion unlikely to last (eg. left atrial dilation, significant hyperthyroidism)
- Known left atrial thrombus
- Failed previous cardioversion
Additional relative contraindication are:
- Sustained afib for preceding year
- Afib recurrence while on appropriate anti-arrhythmic (without adherence problems); suggests likely revert to afib after conversion
Electrical Cardioversion
Preparation
Establish:
- Monitoring (SpO2, BP cuff, telemetry)
- IV access for procedural sedation
- Supplemental O2 and end tidal CO2 monitoring
Access to suction, intubation equipment, code cart, and ACLS medications should be prepared.
Place leads in anterior-lateral or anterior-posterior position. It should be noted there are conflicting evidence for whether AP is superior or not. In any case, failure to cardiovert should prompt relocation of electrodes.