Electrical cardioversion for AF in acute heart failure
AF could induce heart failure due to the loss of atrial systole, and
irregular and/or rapid ventricular
conduction.58Therefore, electrical cardioversion to
restore sinus rhythm might improve heart failure. However, in COVID-19
patients, acute heart failure is highly attributed to cytokine storm,
instead of AF induced hemodynamic changes. AF and heart failure are
bothharmful consequence of cytoine storm. Electrical cardioversion might
contribute to a minor role, and instead, immunological treatment might
be associated with recovery of left ventricular systolic
function.59The procedure of electrical cardioversion
might increase the risk to healthcare workers. For examples, the
delivery of aerosol generating procedures is needed to a patient
infected during general anesthesia.60 The potential
complications from electrical cardioversion including ventricular
fibrillation due to unsynchronized shock, heart block, bradycardia,
transient myocardial dysfunction, and hypotension would lead to
unavoidable urgent resuscitation.60All of these
increase infection risk for caregivers. AF recurrence after successful
cardioversion is not uncommon in the patients with heart
failure.58Therefore, we suggested medical treatment
should be maximized including adequate rate control, anticoagulation, or
diuresis or inotropic support. Prompt electrical cardioversion should be
avoided.