“Wait and See” Approach to the Emergency Department Cardioversion of Acute Atrial Fibrillation

Table 1

Emergency Department protocol for cardioversion of atrial fibrillation.

(i) Ensure patient has stable acute atrial fibrillation
(ii) Exclusion criteria: unstable or severe symptoms, patient requires hospitalization, >48-hour duration of AF by next day cardioversion, poor candidate for ED procedural sedation, age <18, or pregnancy
(iii) Patients may get rate control and other medications at the discretion of treating doctor
(iv) Discharge patient to return to ED the following day at 08:00 for DC cardioversion. Advise patient to fast after midnight.
(v) Obtain ECG on day 2
(vi) If patient still in AF, confirm inclusion & exclusion criteria and proceed with DC cardioversion