Monday, June 18, 2018

Unsuccessful cardioversion in AF

Q: Cardioversion from atrial fibrillation (AF) to normal sinus rhythm (NSR) has low likelihood in the presence of all of the following except?

A) AF continuously present for more than 3 months
B) Markedly enlarged atriums
C) Pneumonia
D) Thyrotoxicosis
E) Mitral valve disease

Answer:  A

If underlying diseases are not treated (choices C, D and E), chances of successful cardioversion from AF to NSR remains low. Markedly enlarged atriums with left atrium having dimension >6.0 cm or right atrium having dimension >37 mm may also be a hindrance in this process (choice B). 3

Time period described to make successful cardioversion from AF to NSR is to be present continuously for about one year.



1. Elhendy A, Gentile F, Khandheria BK, et al. Predictors of unsuccessful electrical cardioversion in atrial fibrillation. Am J Cardiol 2002; 89:83. 

2. Dittrich HC, Erickson JS, Schneiderman T, et al. Echocardiographic and clinical predictors for outcome of elective cardioversion of atrial fibrillation. Am J Cardiol 1989; 63:193. 

3. Henry WL, Morganroth J, Pearlman AS, et al. Relation between echocardiographically determined left atrial size and atrial fibrillation. Circulation 1976; 53:273. 

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