What is the recommended treatment for patients with atrial fibrillation and hemodynamic instability undergoing urgent cardioversion?
For patients with AF and hemodynamic instability undergoing urgent cardioversion (electrical or pharmacologic), we suggest that therapeutic-dose parenteral anticoagulation be started before cardioversion, if possible, but that initiation of anticoagulation must not delay any emergency intervention (Weak recommendation, low quality evidence). After successful cardioversion to sinus rhythm, therapeutic anticoagulation for at least 4 weeks is suggested rather than no anticoagulation, regardless of baseline stroke risk (Weak recommendation, low quality evidence).