Box 3Criteria for consulting EP

EP can be consulted for any question related to AF/AFL, but is especially useful when a rhythm control strategy is being considered. While EP consultation is not required to order DCCV, it is likely to be helpful prior to ordering DCCV if the patient has any of these criteria:

• The patient is followed by the EP Service at Michigan Medicine
• The patient has persistent AFL (an immediate ablation may be appropriate)
• The patient is having recurrent, brief paroxysms of AF (rapid or symptomatic, but not sustained)
• The patient has failed a DCCV attempt in the past (i.e., did not convert with DCCV attempt)
• The patient has had 2 or more DCCVs in the last 2 years
• The patient is already taking an antiarrhythmic medication for AF/AFL
• LA size known to be > 60 mm (DCCV is unlikely to be successful)
• The patient is a poor candidate for DCCV procedure (e.g., highly comorbid), such that an alternate management strategy is needed.