Table 45.
Recommendations and Levels of Evidence for AF Defibrillation
| COR | LOE | GOR (MINDS) | LOE (MINDS) | |
|---|---|---|---|---|
| R‐wave triggered direct‐current defibrillation for drug‐refractory AF causing hemodynamic instability or AF causing sustained cardiac ischemia, symptomatic hypotension, worsening heart failure, or life threatening condition 2 , 21 , 530 | I | C | C1 | IVb |
| AF with ventricular pre‐excitation causing hemodynamically unstable tachycardia 2 , 21 , 530 | I | C | C1 | IVb |
| Interruption of drug‐refractory AF without anticoagulation therapy within 48 h of AF onset 2 , 530 | IIa | C | C1 | IVb |
| Case of AF in whom the possibility of 48 h continuation cannot be denied but the absence of intra‐atrial thrombus is confirmed by transesophageal echocardiography, or appropriate anticoagulation therapy has been continued more than 3 weeks at the time of defibrillation 2 , 21 , 530 | IIa | C | C1 | IVb |
| Direct‐current defibrillation under the use of antiarrhythmic agent for recurrent AF even after direct‐current defibrillation 2 , 21 , 530 | IIa | C | C1 | IVb |
| Case of sustained AF even after normalization of hyperthyroidism or postoperative state of cardiac surgery, in whom antiarrhythmic agent is ineffective or inapplicable 2 , 530 | IIa | C | C1 | IVb |
| Elective direct‐current defibrillation for asymptomatic AF with continuation <1 year and without obvious left atrial enlargement 2 , 21 , 530 | IIb | C | C1 | IVb |
| Elective direct‐current defibrillation for repetitive AF in relatively short period even after preventive antiarrhythmic drug therapy and repeated direct‐current defibrillation 2 , 21 , 530 | IIb | C | C1 | IVb |
| Direct‐current defibrillation for AF based on digitalis intoxication or hypokalemia 2 , 530 | III | C | C2 | IVb |
| Direct‐current defibrillation for AF complicated with obvious high‐degree AV block and/or sick sinus syndrome without backup pacing therapy 2 , 530 | III | C | C2 | IVb |
| Direct‐current defibrillation for hemodynamically stable persistent AF lasting longer than 48 h without taking standard antithrombotic strategy* 2 , 530 | III | C | C2 | IVb |
*Confirmation of absence of intra‐atrial thrombus with transesophageal echocardiography or continuous appropriate anticoagulation longer than 3 weeks.
AF, atrial fibrillation; AV, atrioventricular; COR, class of recommendation; GOR, grade of recommendation; LOE, level of evidence; MINDS, Medical Information Network Distribution Service.