Elective Cardioversion
Patient phenotype
AF/atrial flutter for rate/rhythm control. Patients have undergone AC therapy (3 wks) or TEE-guided. Often elderly, comorbidities, on beta-blockers or amiodarone.
Procedure
Short procedure (5-15 min). Pads applied, synchronized DC shock 50-200 J. May need multiple shocks. Off-floor (cath lab, ED, ICU) common.
Anesthetic plan
Brief deep sedation: propofol 1 mg/kg or etomidate 0.1 mg/kg. Mask ventilation only — no intubation. Recovery quickly.
Setup
- ·Standard monitors + defib
- ·PIV
- ·Mask + Ambu bag
- ·Suction
- ·Reversal/rescue: oxygen, ephedrine
- ·Anti-emetic
Biggest concerns by phase
Anticoagulation status
Stroke risk from cardioversion: thrombus dislodged. Either ≥ 3 wks therapeutic AC or TEE showing no thrombus. INR/DOAC level confirmed. Heparin if urgent + no AC.
Brief sedation to amnesia
Propofol 0.5-1 mg/kg titrated to loss of consciousness. Etomidate alternative in low-EF. Ketamine if hemodynamically borderline. Patient breathing spontaneously through mask.
Apnea + obstruction during sedation
Brief apnea common. Mask ventilate as needed. Awakening within 5-10 min.
Awake quickly, monitor for arrhythmia
Most awake within 10 min. Monitor for: returning AF, bradycardia (sick sinus unmasked), hypotension. Discharge after observation.
Mock-defense scenarios
Practice answering these out loud. The probes show what an examiner is listening for.
65-yo M, AF for 6 months, on apixaban × 4 wks, EF 50%, rate-controlled with metoprolol. To cardioversion lab. Plan?
What an examiner probes for
- ▹AC verification
- ▹Brief propofol sedation
- ▹Mask ventilation prep
- ▹Post-cardioversion monitoring
- ▹Bradycardia preparedness
Sources
- Miller's Ch 80
- ACC/AHA AF Guidelines 2019
Anatomy reference
Sourced reference images. 4 matches for "heart cardiac chambers".
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