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Synchronized CardioversionAka: Synchronized Shock

Indications
1. Paroxysmal Supraventricular Tachycardia
2. Atrial Fibrillation
3. Atrial Flutter
4. Ventricular Tachycardia
Sedation prior to cardioversion
1. Midazolam and Fentanyl or
2. Propofol
  1. Considered superior agent if patient stable
    1. Short induction
    2. Rapid awakening and recuperation
    3. Minimal adverse effects
  2. Anesthesiologist supervision is recommended
  3. References
    1. Coll-Vinent (2003) Ann Emerg Med 42:767
    2. Basset (2003) Ann Emerg Med 42:773
Technique: Electrode (paddle) position
1. Anteroposterior electrodes most effective in Atrial Fib
  1. Anteroposterior placement conversion rate: 96%
  2. Anterolateral placement conversion rate: 78%
  3. Kirchhof (2002) Lancet 360:1275
Doses
1. Pediatric
  1. Initial: 0.5 Joule per kg
  2. Subsequent: 1 Joule per kg
2. Adult
  1. Supraventricular Tachycardia (PSVT) or Atrial Flutter
    1. Joule Progression: 50, 100, 200, 300, 360
  2. Ventricular Tachycardia or Atrial Fibrillation
    1. Joule Progression: 100, 200, 300, 360

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This page was written by Scott Moses, MD. This page was last revised before 5/10/08, prior to consistent tracking of revision date. This page was last published on 5/16/2008. Please send comments and questions to the editor. Contact information may be found on the page About the Family Practice Notebook. These pages are best viewed with Microsoft Internet Explorer 6.0.