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Electrical cardioversion of atrial fibrillation
Jose A Joglar1, Robert C Kowal
1Department of Internal Medicine, Division of Cardiology, The University of Texas Southwestern Medical Center at Dallas, 5323 Harry Hines Boulevard, Dallas, TX 75390-8837, USA. jose.joglar@utsouthwestern.edu
Cardiology Clinics
|March 5, 2004
Summary
External direct current cardioversion is effective for persistent atrial fibrillation (AF). Biphasic defibrillators offer higher success rates, while anticoagulation prevents thromboembolism, a key complication.
Area of Science:
- Cardiology
- Electrophysiology
Background:
- Persistent atrial fibrillation (AF) affects many patients.
- Restoring normal sinus rhythm is crucial for managing AF.
- External direct current cardioversion is a primary treatment.
Purpose of the Study:
- To outline current recommendations for external direct current cardioversion in persistent AF.
- To discuss strategies for optimizing cardioversion success and preventing complications.
Main Methods:
- Review of established protocols for biphasic and monophasic defibrillators.
- Consideration of adjunctive therapies like antiarrhythmic drugs.
- Strategies for thromboembolism prophylaxis.
Main Results:
- Biphasic defibrillators achieve higher success rates for AF cardioversion.
- Specific energy levels and electrode positions are recommended.
- Antiarrhythmic drugs can improve cardioversion outcomes.
- Anticoagulation or TEE is vital to prevent cardioembolic events.
Conclusions:
- External direct current cardioversion is the standard for persistent AF.
- Optimized energy delivery and prophylactic anticoagulation are key to successful and safe cardioversion.
- Alternative strategies exist for refractory cases.