In general, electrical cardioversion is performed either electively or emergently. In the Emergency Department, the role of electrical cardioversion is usually limited to urgent or emergent situations or when medical therapy has failed.1,2 This includes symptomatic reentry tachycardias (e.g., supraventricular tachycardia, atrial fibrillation, atrial flutter, and Wolff–Parkinson–White syndrome) and hemodynamically stable ventricular tachycardia associated with acute myocardial infarctions, altered levels of consciousness, chest pain, congestive heart failure, dizziness, dyspnea, hypotension, presyncope, pulmonary edema, shock, or syncope.
In the Emergency Department, electrical cardioversion is often preferred to chemical cardioversion for many reasons. Electrical cardioversion is simple and quick to perform. It is effective—in most cases almost immediately. It may be more successful than chemical cardioversion. The complications are usually minimal. Potential allergic reactions and toxic effects are nonexistent with electrical cardioversion.