Cardioversion / TEE
Cardioversion / TEE
Patient with Afib / Aflutter, hemodynamically stable.
Would benefit from DC Cardioversion
Cannot be Cardioverted in ED (Onset > 48 hours if low CHADSVASC or > 24 hours if high CHADSVAC, Not on reliable anticoagulation)
Require TEE prior to cardioversion
Has been discussed with Cardiology
Not in acute heart failure, not hyperthyroid or other complication
Acute heart failure
Thyroid storm/thyroiditis/EtOH withdrawal or other secondary cause of Afib/Flutter
Severe Electrolyte Abnormality
Cardiac monitoring
NPO @ midnight prior to procedure
Start Anticoagulation per Cardiology Recommendations
Patient to go to Cardiac Procedure suite for TEE and Cardioversion
If patient is candidate for flecanide after discharge, may need stress/echo prior to discharge (cardiology will tell you this)
BMP / Mag and replete to normal.
Disposition
Successful Cardioversion by cardiology or spontaneously during period in CDU
Patient awake and alert recovered from anesthesia
DC Medications for Anticoagulation, Anti-arrthmyic per cardioloy
Recurrent Afib/Flutter at rapid rate
Patient cannot care for self / needs rehab
Unstable vital signs
Fib flutter discovered to be from a secondary cause that is not controlled.
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