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Atrial Fibrillation - Cardioversion — EECC MCQ

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ModerateArrhythmia & ElectrophysiologyAtrial Fibrillation - CardioversionEECC

A 72-year-old man presents with atrial fibrillation of uncertain duration. He is haemodynamically stable with a ventricular rate of 95 bpm. He has been in AF for at most 20 hours based on symptom onset. He is not on anticoagulation. Per the 2024 ESC AF Guidelines, what is the maximum duration of AF below which cardioversion can be performed without prior anticoagulation for 3 weeks or more?

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Correct answer: E — 24 hours

A key change in the 2024 ESC AF Guidelines is the reduction of the AF duration threshold for early cardioversion from 48 hours to 24 hours. For AF with onset below 24 hours, cardioversion can proceed with peri-procedural anticoagulation. For AF 24 hours or above or uncertain duration, either 3 or more weeks of therapeutic anticoagulation or TOE to exclude LA thrombus is required before cardioversion.

Reference: ESC (2024): Guidelines for the Management of Atrial Fibrillation