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October 21, 2025 Circulation. 2025;152(suppl 2):S538–S577. DOI: 10.1161/CIR.0000000000001376 S568

Wigginton et al Advanced Life Support: 2025 AHA Guidelines for CPR and ECC

synchronization).2,3 Clinical factors influencing cardioversion outcome include body habitus, cardiac status (ventricular function, atrial size), rhythm duration, and concomitant medication use. Any of these, alone or together, can affect outcome as much or more than the energy setting itself.4,5 Apart from energy, electrical cardioversion requires regard for the details of how the procedure itself is conducted and the characteristics of the patient in whom it is performed.6 These recommendations are supported by the “2023 ACC/AHA/ACCP/HRS Guideline for the Management of Atrial Fibrillation” and a 2025 evidence update.

Recommendation-Specific Supportive Text 1 and 2.	Uncontrolled tachycardia may impair ventricular filling, cardiac output, and coronary perfusion while increasing myocardial oxygen demand.

Figure 7. Electrical Cardioversion Algorithm. IV indicates intravenous; and VT, ventricular tachycardia.

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