Therapy

DC cardioversion

Consider giving an initial shock of 360 J if AF duration > 48 hours ^a  

Why?

• Patients given an initial shock at 360 J are more likely to revert to sinus rhythm than if given 100 J or 200 J. ^a  
• Overall success rates are the same, but starting at 360 J reduces the number of shockls required and the amount of cumulative energy delivered. ^a  

An initial shock of 360 J is more successful than 100 J or 200 J for achieving cardioversion

Patient a	Treatment	Comparison	Outcome	CER	RRR (95% CI)	NNT (95% CI)
AF for > 48 hours undergoing elective DC cardioversion	initial shock at 360 J	initial shock at 100 J	sinus rhythm at minutes	14%	570% (130% to 1800%)	1 (1 to 2)
	initial shock at 360 J	initial shock at 200 J	sinus rhythm at minutes	39%	140% (44% to 310%)	2 (1 to 3)