Question 25#

A patient is admitted for a DC cardioversion for their persistent atrial fibrillation.
Which one of the following statements is true?

A) Monophasic waveforms are more effective than biphasic waveforms at cardioverting patients
B) IV flecainide pre-procedure does not increase the chances of electrical cardioversion
C) The initial success rate is around 50%
D) Patients do not require anticoagulation prior to cardioversion if their CHADS2 score is ≤1
E) Increased left atrial size is associated with an increased risk of AF recurrence

Correct Answer is E


Biphasic waveforms are more effective than monophasic ones, requiring less energy and fewer shocks to cardiovert patients. Pretreatment with IV ibutilide, flecainide, or sotalol has been shown to decrease the energy requirement for DC cardioversion and increase the success rate. The initial success rate for persistent AF cardioversion is around 80%. All patients should be anticoagulated prior to cardioversion for persistent AF regardless of CHADS2 score. Increased left atrial size, duration of AF prior to cardioversion, previous recurrences, reduced LA function, and underlying cardiac disease are all known to increase AF recurrence risk.