Synchronized cardioversion is the preferred treatment for unstable patients with a tachycardia such as Atrial Fibrillation, V-Tach with a pulse, or Supraventricular Tachycardia (SVT). The shock is timed by the monitor to be delivered in coordination with the QRS complex of the heart. If the patient is conscious, consider sedation prior to cardioversion; however, synchronized cardioversion should not be delayed while waiting for sedation in severely symptomatic patients.
With a biphasic monitor, dosage and steps are device-dependent; if optimal doses are unknown, begin at 100 J and step up from there.
(With a monophasic monitor, the initial shock is delivered at 100 J; if the rhythm does not terminate, deliver additional shocks in stepwise fashion (200J, 300J, and 360J for subsequent shocks).