Keys to a Safe and Effective Cardioversion

Cardioversion is a frequently performed procedure to terminate atrial arrhythmias; commonly atrial fibrillation and atrial flutter, to relieve symptoms and improve cardiac performance. In simple terms, it involves the delivery of high energy electrical shock to patient's chest wall to the heart to interrupt abnormal electrical currents to restore it to normal sinus rhythm. Prior to performing this procedure, there are several safety checks undertaken for a safe and successful outcome. There is a 48 hours safety window for cardioversion without appropriate anticoagulation and the need for continuation of appropriate anticoagulation for 4-6 weeks after cardioversion to reduce the risk of stroke. Advance practice providers (APPs) are emerging as an integral part of the cardiovascular team and they have been recognized as safe provider to perform cardioversions autonomously with appropriate clinical training using AHA Guidelines directed protocols. The AHA Guidelines for a safe and successful cardioversion will be discussed in this article.