Medication and Electrical CV
All patients were on antiarrhythmic drugs at baseline (Amiodarone 200 mg once daily, Sotalol 80-120 mg twice daily, Flecainide 100 mg twice daily, or Propafenone150-225 mg three times daily). After light sedation with Midazolam (up to a maximum of 5 mg, based on the patient weight), all patients underwent ECV with 200 Joules using a biphasic defibrillator patches. If sinus rhythm was not achieved and upon discretion of the treating physician, antiarrhythmic drugs were given for several 4-12 hours (Amiodarone 900-1200 mg, Flecainide 400 mg, Propafenone 450 mg). After several hours (12 hours for Amiodarone, 4 hours for Flecainide and Propafenone) an ECG was performed. If the patient converted to SR, then the time of the CV was updated (based on the Holter results), and the patient was monitored for two hours post CV (conventional monitoring), thereafter discharged with Holter monitoring. If the patient was still in AF, ECV shock was re-delivered using the same sedation and shock protocol as described above. After achieving SR, patients were monitored for 2 hours (conventional monitoring) and thereafter discharged home with Holter monitoring (eFigure A in the online supplementary). Patients were seen in office for clinical follow-up at 1-3 months following CV.