What is the recommended Joules for synchronized cardioversion in patients with a-fib and ventricular tachycardia?

For synchronized cardioversion in patients with atrial fibrillation and ventricular tachycardia, the recommended starting energy is typically 100 Joules. This level of energy is considered effective for morphologically narrow and wide QRS complexes, which includes certain presentations of atrial fibrillation and ventricular tachycardia.

Using 100 Joules provides a balance between efficacy and safety, as lower doses may not successfully reset the rhythm, while higher doses increase the risk of complications. For patients with ventricular tachycardia, especially those who are stable but symptomatic, starting with 100 Joules is often the first line of treatment. In practice, adjustments may be made based on the patient's response and clinical situation, but beginning at 100 Joules is well-supported by guidelines.

This understanding is important as it highlights the necessity of synchronized cardioversion in managing these arrhythmias effectively.