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8.2.3. Pharmacological Cardioversion
COR LOE
Recommendations
2a C-LD 1. For patients with AF, pharmacological cardioversion is
reasonable as an alternative to electrical cardioversion for
those who are hemodynamically stable or in situations when
electrical cardioversion is preferred but cannot be performed.
2a A 2. For patients with AF, ibutilide is reasonable for
pharmacological cardioversion for patients without depressed
LV function (LVEF <40%).
2a A 3. For patients with AF, intravenous amiodarone is reasonable
for pharmacological cardioversion, although time to
conversion is generally longer than with other agents (8–12
hours).
2a A 4. For patients with recurrent AF occurring outside the setting
of a hospital, the "pill-in-the-pocket" (PITP) approach
with a single oral dose of flecainide or propafenone, with
a concomitant AV nodal blocking agent, is reasonable for
pharmacological cardioversion if previously tested in a
monitored setting.
2b B-R 5. For patients with AF, use of intravenous procainamide may
be considered for pharmacological cardioversion when other
intravenous agents are contraindicated or not preferred.
