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.