Electrical Cardioversion in a Patient with Persistent Atrial Fibrillation- A Case Report and Literature Review

Atrial fibrillation is the most common sustained cardiac arrhythmia in adults with an estimated prevalence of between 2-4% of the general population with a significant effect on morbidity and mortality. It is an important contributor to stroke, myocardial infarction, thromboembolism, and heart failure. Management of atrial fibrillation involves rate control, rhythm control, and anticoagulation therapy. We present the case of a 30-year-old male who presented with complaints of persistent palpitations and intermittent lightheadedness for over 6 months. No risk factors were readily identifiable and the transthoracic echocardiogram was essentially normal. He was started on anticoagulation. Flecainide initiated after 4 weeks of anticoagulation and continued for 4 months with anticoagulants and the beta-blocker. There was an improvement in the heart rate but the sensation of palpitations continued. The patient underwent elective electrical cardioversion with 100J of direct current and his rhythm was successfully converted to a sinus rhythm, which was confirmed by a 12-lead ECG. Electrical cardioversion terminates AF in over 90% of cases.