Cardioversion and rhythm control - reverting AF back to sinus rhythm and maintaining in sinus rhythm with medication.
Adequate anti-coagulation and rate control medication to be in place for at least four weeks prior to delayed cardioversion attempt.
Warfarin may be preferable prior to DC cardioversion because the effect is easily measurable, unlike dabigatran. Dabigatran can be considered in this situation, but patient compliance must be guaranteed. The patient would need to be fully aware of this if dabigatran is chosen- and a specific consent form that specifies strict patient adherence to doses should be considered.
Anticoagulation should be continued until post-cardioversion review in clinic, as full mechanical atrial activity tends to take longer than return of atrial electrical activity.
Patients may be considered for delayed cardioversion if they are stable but symptomatic - includes the following patients with:
Note: Anti-arrhythmic medication - any specific rhythm controlling agent should only be prescribed with specialist approval.
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