Case-Based Modules > Case 22 > Stage 2

Sorry! We now have a more complete picture: this patient has a-fib with RVR, but he is hemodynamically stable. We don't actually need to cardiovert him now. (If he was having worsening of an acute HFpEF exacerbation, that could be a different story.) We need to be careful as we don't know the chronicity of his a-fib (at this point, it's unlikely to be completely new, so we have to assume he's had paroxysmal a-fib for more than 48 hours at least). There'd be a risk of throwing more emboli as his left atrium regains its kick with cardioversion. He's already had one embolic event.

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