Why should A-Fib/A-Flutter not be cardioverted?

Atrial fibrillation (A-Fib) and atrial flutter (A-Flutter) are both types of irregular heartbeats that can increase the risk of blood clots forming in the heart. When these clots dislodge, they can travel to the brain, causing an embolic stroke. Therefore, performing cardioversion on a patient with A-Fib or A-Flutter without proper anticoagulation management can dislodge existing clots and significantly elevate the risk of stroke.

In clinical practice, when patients present with A-Fib/A-Flutter, it is critical to assess the duration of the arrhythmia and the patient's anticoagulation status before considering cardioversion. This is particularly important when the arrhythmia has been present for more than 48 hours, as there is a heightened concern for thrombus formation within the heart chambers.

Making sure patients are appropriately anticoagulated and evaluating their risk factors can lead to safer management strategies, highlighting the importance of understanding the risks associated with cardioversion in these conditions.