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AF-Cardioversion Strategy — EECC MCQ

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ModerateCardiologyAF-Cardioversion StrategyEECC

A 64-year-old with AF on warfarin (target INR 2-3) has INR 1.5 before cardioversion for AF duration 30 hours. Best approach?

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Correct answer: A — Proceed with TEE-guided cardioversion plus periprocedural anticoagulation

For AF >48 h or unknown duration-or when anticoagulation is subtherapeutic-TEE‑guided cardioversion with periprocedural anticoagulation is appropriate; then continue OAC ≥4 weeks. Proceeding without anticoagulation (B,E) risks embolism; delaying without OAC (C) is unsafe; aspirin (D) is inadequate.

Reference: ACC/AHA/ACCP/HRS Guideline (2023): Atrial Fibrillation