Electrical-first cardioversion protocol

The 'Electrical-first' protocol is a sequential treatment strategy for acute atrial fibrillation developed and studied by the University of British Columbia (specifically in the RAFF trial). This intervention arm prioritizes synchronized electrical cardioversion over pharmacological rhythm control. The procedure begins with patient sedation, typically using propofol (0.5 - 1.0 mg/kg), followed by up to three synchronized electrical shocks (100 J, 200 J, 200 J). If the patient remains in atrial fibrillation after the third shock, the protocol proceeds to chemical cardioversion using intravenous procainamide (17 mg/kg administered over 30 minutes). This approach is designed to optimize the speed of rhythm conversion and reduce emergency department length-of-stay compared to strategies that lead with antiarrhythmic medications.

Other names

Electrical-firstElectrical-chemical sequenceElectrical-first-University of British Columbia-atrial fibrillation