How many joules do you use for cardioversion?

As a medical professional with expertise in cardiology, I can provide you with information on the energy levels typically used for cardioversion. Cardioversion is a procedure used to restore the normal rhythm of the heart in patients with certain types of arrhythmias, such as atrial fibrillation or atrial flutter. The energy required for successful cardioversion can vary significantly depending on the type of arrhythmia and the patient's specific characteristics. For external cardioversion, the initial energy levels are often set as follows: - For atrial arrhythmias like atrial fibrillation or atrial flutter, the initial energy level is typically 100 to 200 joules for the first shock. - For ventricular arrhythmias, such as ventricular tachycardia, the initial energy level is usually 100 to 200 joules as well. However, for internal cardioversion, which is less common and typically used for atrial arrhythmias that do not respond to external cardioversion, the energy levels can be much higher, ranging from 200 to 360 joules. It's important to note that the energy levels may need to be adjusted based on the patient's response to the initial shock. In some cases, a lower energy level may be effective, while in others, higher energy levels may be necessary. Please remember that this information is a general guideline, and the actual energy levels used should be determined by a healthcare professional based on the patient's specific medical condition and the results of diagnostic tests.

The initial energy may be lower for cardioversion of atrial flutter (25). In a review including 985 cardioversions in 840 patients with atrial flutter, the median energy level for successful cardioversion was 50 joules with a biphasic defibrillator and 200 joules with a monophasic defibrillator (26).