Successful Direct Current Cardioversion (DCCV) in Pregnancy in a Non-Obstetric Emergency Department

Area of Science:

• Cardiology
• Obstetrics
• Emergency Medicine

Background:

• Atrial Fibrillation (AF) during pregnancy is rare but carries high mortality risks.
• Limited controlled studies exist for AF management in pregnancy.
• Current guidelines support Direct Current Cardioversion (DCCV) for hemodynamically compromised pregnant patients.

Observation:

• A 22-week pregnant patient presented with acute, symptomatic Atrial Fibrillation (AF) to an Emergency Department (ED).
• A multidisciplinary team (emergency medicine, cardiology, maternal-fetal medicine) was consulted.
• Rhythm control via DCCV was chosen for immediate management.

Findings:

• A single 200-joule synchronized DCCV successfully restored sinus rhythm.
• The procedure was performed safely using established sedation protocols.
• No adverse maternal or fetal events were recorded during the procedure or inpatient stay.

Implications:

• This case supports the safety of DCCV for pregnant patients with AF.
• Standard analgesia and sedation medications used in cardioversion appear safe during pregnancy.
• A collaborative, multidisciplinary team approach is crucial for managing acute AF in pregnant patients, especially in non-obstetric settings.