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Management
8.2.2. Electrical Cardioversion
COR LOE
Recommendations
1 C-LD 1. In patients with hemodynamic instability attributable to AF,
immediate electrical cardioversion should be performed to
restore sinus rhythm.
1 B-R 2. In patients with AF who are hemodynamically stable,
electrical cardioversion can be performed as initial rhythm-
control strateg y or following failed pharmacological
cardioversion.
1 C-LD 3. In patients with AF undergoing electrical cardioversion,
energ y delivery should be confirmed to be synchronized to
the QRS to reduce the risk of inducing ventricular fibrillation
(VF).
2a B-R 4. For patients with AF undergoing elective electrical
cardioversion, the use of biphasic energ y of at least 200 J as
initial energ y can be beneficial to improve success of initial
electrical shock.
2a B-NR 5. In patients with AF undergoing elective cardioversion, with
longer duration of AF or failed initial shock, optimization of
electrode vector, use of higher energ y, and pretreatment with
AADs can facilitate success of electrical cardioversion.
2b C-LD 6. In patients with obesity and AF, use of manual pressure
augmentation and/or further escalation of electrical
energ y may be beneficial to improve success of electrical
cardioversion.
