Atrial fibrillation direct current cardioversion

FIGURE 6-2. Algorithm for the treatment of acute (top portion) paroxysmal supraventricular tachycardia and chronic prevention of recurrences (bottom portion). Note For empiric bridge therapy prior to radiofrequency ablation procedures, calcium channel blockers (or other atrioventricular [AV] nodal blockers) should not be used if the patient has AV reentry with an accessory pathway. (AAD, antiarrhythmic drugs AF, atrial fibrillation AP, accessory pathway AVN, atrioventricular nodal AVNRT, atrioventricular nodal reentrant tachycardia AVRT, atrioventricular reentrant tachycardia DCC, direct-current cardioversion ECG, electrocardiographic monitoring EPS, electrophysiologic studies PRN, as needed VT, ventricular tachycardia.)... 

NPV = negative predictive value PPV = positive predictive value ACS = acute coronary syndrome PTCA = percutaneous transluminal coronary angioplasty PCI = percutaneous coronary intervention DCCV = direct-current cardioversion A fib = atrial fibrillation NA = not applicable. 

Roy D, Quiles J, Sinha M, et al. Effect of direct-current cardioversion on ischemia modified albumin levels in patients with atrial fibrillation. Am J Cardiol 2004 93 366-368. 

Arnold AZ, et al. Role of prophylactic anticoagulation for direct current cardioversion in patients with atrial fibrillation or atrial flutter. J Am Coll Cardiol 1992 19(4) 851-855. 

Therapeutic uses Quinidine is used in the treatment of a wide variety of arrhythmias, including atrial, AV junctional, and ventricular tachyarrhythmias. Quinidine is used to maintain sinus rhythm after direct current cardioversion of atrial flutter or fibrillation and to prevent frequent ventricular tachycardia. 

FIGURE 6-1. Algorithm for the treatment of atrial fibrillation (AF) and atrial flutter. °lf AF <48 hours, anticoagulation prior to cardioversion is unnecessary may consider transesophageal echocardiogram (TEE) if patient has risk factors for stroke. Ablation may be considered for patients who fail or do not tolerate one antiarrhythmic drug (AAD). Chronic antithrombotic therapy should be considered in all patients with AF and risk factors for stroke regardless of whether or not they remain in sinus rhythm. (BB, 8-blocker CCB, calcium channel blocker p.e., verapamil or diltiazem] DCC, direct-current cardioversion.)... 

FIGURE 17-6. Algorithm for the treatment of atrial fibrillation and atrial flutter. Sx = symptoms AVN = AV node DCC = direct-current cardioversion CCB = calcium channel antagonist (verapamil or diltiazem) BB = jS-blocker ASA = aspirin OHD = organic heart disease AADs = antiarrhythmic drugs INR = international normalized ratio MVD = mitral valve disease CHF = congestive heart failure HTN = hypertension DM = diabetes mellitus. 

Murdock DK, Schumock GT, Kaliebe J, et al. Clinical and case comparison of ibutilide and direct-current cardioversion for atrial fibrillation and flutter. Am J Cardiol 2000 85 503-506. 

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