Electrical Cardioversion in Atrial Fibrillation

Refers to the delivery of electrical current causing a momentary depolarization of most cardiac cells allowing the sinus node to resume normal pacemaker activity.

Two electrode pads are used, each comprising a metallic plate which is faced with a saline based conductive gel that are placed on the chest of the patient, or one is placed on the chest.

A synchronizing function allows the cardioverter to deliver a reversion shock of electric current over a predefined number of milliseconds at the optimal moment in the cardiac cycle which corresponds to the R wave of the QRS complex on the ECG.

Timing the shock to the R wave prevents the delivery of the shock during the vulnerable period of the cardiac cycle, which could induce ventricular fibrillation.

Synchronized electrical cardioversion is used to treat hemodynamically significant supraventricular tachycardias, including atrial fibrillation and atrial flutter.

Associated with increased risk of strokes.

Success rate of cardioversion is enhanced by ibutilide from 72-100%.

Conventional anticoagulation in patients with atrial fibrillation of prolonged duration (longer than two days) calls for three weeks of empirical anticoagulant treatment before cardioversion, followed by four weeks of warfarin after cardioversion.

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