CardioversionAF in afya

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''Onset < 48 hours''
 < 48 hours - heparinise
if risk factors for ischaemic stroke - lifelong oral anticoagulation. 
also need cardioversion
    electrical - 'DC cardioversion'
    pharmacology - amiodarone if structural heart disease, flecainide in those without structural heart disease
Note - if post electrical cardioversion SF confirmed as <48hrs - no need to anticoagulate

''Onset > 48 hours''
 > 48 hours - anticoagulation for > 3 weeks prior to cardioversion. 
Else transoesophageal echo (TOE) to exclude a left atrial appendage (LAA) thrombus. 
If excluded patients may be heparinised and cardioverted immediately.
If there is a high risk of cardioversion failure (e.g. Previous failure or AF recurrence) then it is recommend to have at least 4 weeks amiodarone or sotalol prior to electrical cardioversion
Following electrical cardioversion patients should be anticoagulated for at least 4 weeks. After this time decisions about anticoagulation should be taken on an individual basis depending on the risk of recurrence

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