Emergency cardioversion
If the patient is hemodynamically unstable (shock, ongoing chest pain, pulmonary edema, syncope), synchronized electrical cardioversion is indicated.
Elective cardioversion
- If AFL duration is >48 hours or unknown, use appropriate anticoagulation strategy and/or transesophageal echo (TEE) to reduce thromboembolism risk.
- Post‑cardioversion anticoagulation is typically continued for a period based on guideline frameworks and individual risk.
Risks
- Thromboembolism if not adequately anticoagulated / thrombus present.
- Transient bradycardia or pauses after conversion.
- Sedation/anesthesia risks are often the dominant procedural risk in stable elective cases.
Evidence
See the guideline and cohort references in References.