Cardiology  |  Atrial Fibrillation Pathway - Criteria For Delayed Cardioversion


Atrial Fibrillation Pathway - Criteria For Delayed Cardioversion

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:

  • Failure to obtain adequate heart rate control with medication
  • Lack of clear precipitant for AF - such as infection, surgery, thyrotoxicosis
  • Persistent first episode of AF - especially if severe symptoms or in the younger patient

Note:  Anti-arrhythmic medication - any specific rhythm controlling agent should only be prescribed with specialist approval.

Medications include:

  • Amiodarone - has significant potential extra-cardiac side effects including thyroid dysfunction, lung fibrosis, liver dysfunction, photosensitivity
  • Flecainide and Sotalol - may be pro-arrhythmic in the elderly and in those with structural heart disease

Last updated : Thursday, September 10, 2015
Next review date : Friday, September 09,2016

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