Panic in Pregnancy: An Electrical Dilemma

Abstract 2343319, presented at Western Atrial Fibrillation Symposium 2026

In pregnant patients, electrical cardioversion (DCCV) has been recommended for symptomatic, stable patients with refractory atrial fibrillation (AF) or contraindications to pharmacological therapy. Evidence has primarily been via case reports and case series. The purpose of this review is to systematically evaluate and summarize the current safety and efficacy of electrical cardioversion (DCCV) for pregnant patients with AF.Two authors systematically searched through Pubmed database through January 2, 2026, using the search terms ‘cardioversion,’ atrial fibrillation,’ and ‘pregnancy.’ Case reports, case series, reviews, prior systematic reviews and meta-analyses were excluded. Reasons for electrical cardioversion, maternal outcomes, and fetal outcomes were noted.Three studies were identified with a total of 2,393 pregnant patients with AF were identified. Among those patients, 82 (3.4%) underwent electrical cardioversion. One study in the UK followed 12 AF pregnant patients with the mean gestation age at DCCV of 27 weeks and no complications with delivery. The second study found 16 pregnant AF patients in Canada with an average gestational age of 22 weeks and all patients delivered at term. The third study utilized the national readmission database and found 2,340 pregnant patients with AF. Of those, 2.6% underwent cardioversion. Overall, DCCV was found to not be associated with higher odds of stillbirth or preterm birth compared to those without cardioversion.Electrical cardioversion remains an option for pregnant AF patients with evidence for maternal and fetal safety. This review provides a summary of the most current evidence and additional studies on long-term outcomes of maternal and fetal morbidity and mortality are needed.