What are the ESC guidelines for cardioversion in patients with holiday heart syndrome (HHS)?

Updated: May 30, 2018
  • Author: Lawrence Rosenthal, MD, PhD, FACC, FHRS; Chief Editor: Jose M Dizon, MD  more...
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Answer

In general, the European Society of Cardiology (ESC) recommendations for cardioversion concur with the AHA/ACC/HRS guidelines. Many of the differences between the guidelines involve the use of vernakalant, which was approved for use in European Union in 2010 but has not been approved by the US Food and Drug Administration. Additional and/or variant ESC recommendations include the following [31] :

  • In the absence of structural heart disease, IV flecainide, propafenone, ibutilide, or vernakalant
  • In patients with risk factors for stroke or AF recurrence, oral anticoagulant therapy should be continued lifelong, irrespective of the apparent maintenance of sinus rhythm following cardioversion
  • In patients with AF ≤7 days and moderate structural heart disease, IV vernakalant may be considered
  • Vernakalant should be used with caution in patients with NYHA class I–II heart failure

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