SAQ 75 – Cardiology – atrial fibrillation cardioversion

Question 8. atrial fibrillation cardioversion.

a. Factors favouring rhythm control. (6 marks)

• Clear onset within 48 hours in lone AF.
• AF secondary to a treated or corrected precipitant.
• Haemodynamic instability.
• Associated cardiac failure.
• Already therapeutically anticoagulated.
• Marked symptoms or unacceptable arrhythmia-related symptoms.
• Younger patient, for example under 65 years.
• Relevant comorbidities.
• Patient preference.
• Unlikely spontaneous reversion or previous failure requiring eventual DC reversion.

b. Initial defibrillator settings. (3 marks)

• 100 to 150 J.
• DC shock.
• Synchronised mode.

c. Information before cardioversion. (4 marks)

• Explain the procedure, including sedation drugs and risks such as aspiration or allergy.
• Explain the shock and its risks, including failure and rare deterioration into a malignant rhythm.
• Warn about early or late recurrence.
• Discuss alternatives, including spontaneous reversion, chemical cardioversion, elective outpatient cardioversion, or rate control.
• Explain expected recovery, observation period, discharge plan, antiplatelet/anticoagulant decision-making, and cardiology follow-up including echo.