🔶 DEFIBRILLATION VS. CARDIOVERSION 🔷

⚡ Defibrillation (DC Shock) is an unsynchronized shock used in emergencies for life-threatening arrhythmias like VF and pulseless VT, delivered immediately without regard to the heart’s cycle, and usually without sedation.

❤️ Cardioversion is a synchronized shock delivered at the QRS complex to avoid induction of dangerous rhythms, used for AF, atrial flutter and SVT.

🚨 Defibrillation is always emergency, while cardioversion can be planned or urgent.

💔 Defibrillation for a non- pumping heart, cardioversion is for an abnormal rhythm with a pulse.

💤 Sedation is common in cardioversion but not in defibrillation.

🩺 DR. ANWER ALZURFI, MD, FHRS

🩺 Clinical Case

‼️AF Ablation For Non-AF Patient‼️

A 41-year-old woman, she underwent AF ablation based on her resting ECG using general anaesthesia. Following the procedure, she continued to experience the same symptoms. What do you think? ⚠️

📊 ECG Interpretation
This ECG shows artifacts that obscure the P wave with frequent ectopic beat followed by a compensatory pause resulting in irregular R–R intervals → led to incorrect diagnosis of AF ❌

💡 Key Point
Always examine all leads carefully:
In this case, limb lead II clearly shows P wave before the QRS, plus an ectopic beat — confirming it is not AF.

✅ Final diagnosis: Sinus rhythm with frequent ectopic beat ✔️

🩺 DR. ANWER ALZURFI, MD, FHRS

🔍 PVC Morphology & Origin Identification

Premature Ventricular Contractions (PVCs) showing:
• 📉 LBBB-like morphology, QRS transition ( R>s) in V4, V5 or V6.
• 📈 Positive QRS complexes in the inferior leads (II, III, aVF)

💡 These electrocardiographic features are highly suggestive of a Right Ventricular Outflow Tract (RVOT) origin.

🩺 ANWER ALZURFI, MD, FHRS.

✅ Case Summary

A 53-year-old man presented with a high burden of premature ventricular contractions (PVCs).

📉 First ECG demonstrated bigeminal PVCs. Post-procedure ECG following successful catheter ablation showed normal sinus rhythm with no PVCs detected.

✔️ The fluoroscopic image shows successful ablation site in RVOT.

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🧠 Tips & Tricks
Treatment Recommendation – ESC 2022 Guidelines
• Catheter ablation is recommended for high burden right ventricular outflow tract (RVOT) PVCs, even in asymptomatic patients.
• This strategy helps prevent PVC-induced cardiomyopathy.


🩺 DR. ANWER ALZURFI, MD, FHRS