Electrical Cardioversion Procedure Note (± Transcutaneous Pacing)

Procedure: [Synchronized electrical cardioversion / Synchronized electrical cardioversion with transcutaneous pacing] (Include "with transcutaneous pacing" only if pacing was performed.)

Date/Time: Start [Start date/time]; End [End date/time] (Start time required; end time recommended.)

Location: [Location / Unit / Bed]

Primary Operator: [Name, credentials]

Assistants/Team: [Nursing]; [Respiratory therapy]; [Anesthesia]; [Other] (List roles and names as documented.)

Monitoring: [Continuous ECG]; [Pulse oximetry]; [Noninvasive BP frequency]; [Capnography: yes / no] (Document all modalities in use.)

Equipment: [Defibrillator make/model]; [Waveform type: biphasic / monophasic]; [Pad type/size if relevant]

Procedure Summary

[Concise procedure synopsis] (Write 3–6 sentences. Include: indication and clinical context with urgency classification [elective / urgent / emergent]; confirmation that synchronized cardioversion was performed [and transcutaneous pacing if applicable]; sedation approach and provider; number of shocks and maximum energy delivered; final rhythm achieved; complications [or "None"]; and immediate post-procedure plan.)

Indication and Pre-Procedure Assessment

[Primary rhythm/diagnosis prompting procedure and clinical reasoning] (State the presenting rhythm and why cardioversion was indicated.)

• [Hemodynamic status and instability criteria] (Document hypotension, ischemic symptoms, pulmonary edema, altered mental status, or other signs if present.)
• [Urgency classification: elective / urgent / emergent] with rationale
• [Baseline vitals] (HR, BP, RR, SpO2, temperature if relevant.)
• [Baseline rhythm interpretation] (Reference 12-lead ECG if available with date/time and key findings.)
• [Relevant labs that influenced decision-making] (e.g., potassium, magnesium; include only if they affected management.)
• [Cardiac device status] (If pacemaker/ICD present, note device type, pad positioning away from generator, and post-procedure interrogation plan.)

(Scale depth to urgency: For emergent cases, focus on instability criteria and essential data.)

Anticoagulation Assessment

(Include this section only for atrial fibrillation, atrial flutter, or other atrial arrhythmias. Omit entirely for SVT or ventricular arrhythmias unless anticoagulation materially affected risk.)

• [Estimated arrhythmia duration: <48h / ≥48h / unknown] with source of estimate
• [Current anticoagulation status] (Drug, dose, adherence as stated by patient/records, last dose timing; INR if on warfarin.)
• [TEE or cardiac CT findings] (Date/time and result if performed to exclude thrombus.)
• [Peri- and post-cardioversion anticoagulation plan] (Agent, dose, minimum duration, and follow-up responsibility.)

(For emergent cardioversion where full assessment was not possible, document that instability required immediate action and anticoagulation steps taken afterward.)

Consent

• [Consent type: written / verbal / surrogate / implied emergency]
• [Who provided consent] (Patient with capacity assessment, or surrogate with relationship noted.)
• [If implied emergency: rationale] (Document why consent could not be obtained and why delay posed unacceptable risk.)

Time-Out

[Time-out status] (Document either completion of time-out OR reason not performed.)

• [Pre-procedure verification completed: correct patient, correct procedure (synchronized cardioversion)]
• [Defibrillator sync mode confirmed with sync markers visualized]
• [Team participation] (Names/roles if required by facility.)

(If not performed due to immediate life threat, document the specific circumstance instead of the above.)

Sedation

[Sedation summary] (If sedation not provided, briefly state why—e.g., patient intubated or unresponsive.)

• [Intended sedation level: minimal / moderate / deep / general anesthesia]
• [Sedation provider: proceduralist / anesthesia service]
• [Pre-sedation assessment] (Airway risk, allergies, NPO status if relevant.)
• [Medications administered] (List each with dose, route, and time.)
• [Monitoring during sedation] (ECG, SpO2, BP frequency, capnography if used.)
• [Airway interventions or reversal agents] (If required; omit if none.)
• [Recovery status] (Return to baseline mental status; meets criteria for unit/discharge.)

(If a separate sedation record exists, reference it here and provide a concise summary.)

Cardioversion Procedure

• [Pad placement: anterior-lateral / anterior-posterior] (Note if changed between attempts.)
• [Waveform type: biphasic / monophasic]

(For each shock attempt, document rhythm at time of shock, sync confirmation, energy delivered, and immediate outcome. Use bullet format for multiple attempts; narrative acceptable for single attempt.)

• Attempt 1: [Rhythm]; sync confirmed [yes / no]; [Energy in J]; [Outcome: converted / transient response / unchanged]
• Attempt 2: [Rhythm]; sync confirmed [yes / no]; [Energy in J]; [Outcome]
• Attempt 3: [As above, if applicable]

• [Adjunctive steps if any] (Pad position change, antiarrhythmic given with drug/dose/time, electrolyte repletion.)
• [If unsynchronized shock delivered] (Document indication: polymorphic VT, VF, or inability to sync with reason.)

Transcutaneous Pacing

(Include this section only if pacing was performed.)

• [Indication] (Symptomatic bradycardia, high-degree AV block, medication failure, bridge to transvenous pacing.)
• [Pad placement: anterior-posterior / anterior-lateral]
• [Pacing mode and settings] (Demand vs fixed; rate in bpm; output in mA.)
• [Electrical capture on monitor: yes / no]
• [Mechanical capture confirmation method] (Palpable pulse at paced rate / arterial line waveform / pulse oximetry waveform / bedside ultrasound.)
• [Capture threshold in mA] and [Final output setting in mA]
• [Sedation/analgesia for pacing discomfort] (Medication, dose, route, time.)
• [Duration of pacing] and [Transition plan] (Transvenous pacing, medication infusion, or definitive therapy.)

(If pacing attempted but unsuccessful, document troubleshooting steps, maximum outputs tried, and reason for failure.)

Outcome

• [Post-procedure rhythm] (Confirmed by 12-lead ECG: yes / no; time if obtained.)
• [Post-procedure vitals compared to baseline] (BP, mental status, perfusion.)
• [Clinical response] (Symptom improvement, oxygenation, mentation.)
• [Sustained conversion vs immediate recurrence]

Complications

[Complication statement: "No immediate complications observed" or description of complications]

(If complications occurred, document specifics: arrhythmia deterioration [VF/VT/asystole/bradycardia requiring intervention], hemodynamic compromise, suspected thromboembolism [new neurologic deficits], sedation-related events [apnea, hypoxia, aspiration, airway intervention], or skin burns at pad sites.)

Post-Procedure Plan

• [Monitoring plan] (Telemetry duration, vitals frequency, repeat ECG timing.)
• [Medication plan] (Rate/rhythm control strategy; anticoagulation plan and duration for AF/flutter; electrolyte goals if relevant.)
• [Consults and follow-up] (Cardiology/EP involvement, outpatient timing.)
• [Disposition: ICU / stepdown / floor / ED discharge]
• [Return precautions if discharged] (Chest pain, dyspnea, syncope, neurologic symptoms, sedation recovery precautions.)

Attestation

[Operator attestation statement] (Example: "I was the primary operator and performed the entire procedure. The above documentation is accurate and complete.")

Referenced documents: [Pre-procedure ECG]; [Post-procedure ECG]; [Defibrillator event summary]; [Sedation record if separate]

(Meta-instructions: Do not leave required fields blank—use "Unknown" or "Unable to obtain due to [reason]" when information is unavailable. Do not infer anticoagulant adherence, arrhythmia duration, or mechanical capture—document only what is explicitly confirmed with source or method. Omit the Anticoagulation Assessment section entirely for non-atrial rhythms. Omit the Transcutaneous Pacing section entirely if pacing was not performed. Scale pre-procedure documentation to urgency—emergent cases should emphasize instability criteria over extensive history.)