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Cardioversion of atrial fibrillation: how and when?

Ph. Ricard*, K. Yaïci, J.P. Rinaldi, M. Bergonzi and N. Saoudi

Division of Cardiology, Centre Hospitalier Princesse Grace, Monaco, USA

* Ph. Ricard, MD, Division of Cardiology, Centre Hospitalier Princesse Grace, avenue Pasteur, Monaco (Principauté) 98000

Abstract

Restoration of sinus rhythm in patients with persistent atrial fibrillation (AF) can be achieved either by pharmacological or electrical cardioversion. Pharmacological cardioversion is effective especially when the duration of AF is short (<7 days). In contrast for long duration episodes external cardioversion is the technique of choice. The success rate ranges from 64 to 96%. The development of new defibrillators delivering shocks with biphasic waveforms is associated with a higher success rate with lower energies. For some patient who had failed external cardioversion, internal cardioversion should be proposed. One major concern is the prevention of embolic complications. For this purpose, long term (> 3 weeks) anticoagulation with warfarin or short term anticoagulation with heparin when the presence of atrial thrombus has been ruled out by transoesophageal echocardiogram has been shown to be effective.

Key Words: Antiarrhythmic agents • Anticoagulant therapy • Atrial fibrillation • Biphasic waveform • Electrical cardioversion


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