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©2013 UpToDate ® Print Email Synchronized cardioversion algorithm * Notes: 1. Effective regimens have included a sedative (eg, diazeparn, midazolam, barbiturates, etomidate, ketamine, methchexital) with or without an analgesic agent (eg, fentanyl, morphine, meperidine). Many experts recommend anesthesia if service is readily available. 2. Both monophasic and biphasic waveforms are acceptable if documented as clinically equivalent to reports of monophasic shock success. 3. Note possible need to resynchronize after each cardioversion. 4. If delays in synchronization occur and clinical condition is critical, go immediately to unsynchronized shocks. 5. Treat polymorphic ventricular tachycardia (irregular form and rate) like ventricular fibrillation. 6. Paroxysmal supraventricular tachycardia and atrial flutter often respond to lower energy levels (start with 50 J). Adapted from Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2000; 102:I-164.