The Living Guidelines: Direct-current cardioversion of atrial fibrillation and atrial flutter: Suggest Revisions to the CLASS III Guidelines

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Class III Guidelines

 * 1) Frequent repetition of direct-current cardioversion is not recommended for patients who have relatively short periods of sinus rhythm between relapses of AF after multiple cardioversion procedures despite prophylactic antiarrhythmic drug therapy. (Level of Evidence: C)
 * 2) Electrical cardioversion is contraindicated in patients with digitalis toxicity or hypokalemia. (Level of Evidence: C)