Q: In the unit where I work, we do many elective cardioversions. What is the most effective placement of the pads on the anterior and posterior chest?

A: Kayla Little, MSN, APRN, AGCNS-BC, PCCN, CHFN, and Deborah Klein, MSN, APRN, ACNS-BC, CCRN, reply:

Atrial fibrillation, the most common clinical arrhythmia, is characterized by irregular electrical impulses that result in ineffective atrial contractions.1-4  Rapid focal firing most often occurs in the pulmonary veins, initiating atrial fibrillation. The sinoatrial node, located in the right atrium, normally generates an electrical impulse in the heart. The impulse activates the atria, and then the electrical stimulus continues down the conduction pathway, activating the ventricles. In patients with atrial fibrillation, the electrical stimulus cannot follow the normal pattern because of an underlying disease state such as heart failure or myocardial infarction; additional risk factors for atrial fibrillation include hypertension, diabetes, hyperthyroidism, Wolff-Parkinson-White...

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