A Unified Three-Step Mirror-Image Protocol for ECG, Echocardiography, and Cardioversion in Dextrocardia: A Case Report.

Dextrocardia with situs inversus totalis presents challenges in routine cardiovascular procedures. Although individual adaptations for electrocardiography, echocardiography, or cardioversion have been described, integrated guidance across these procedures remains limited. We report a man in his 50s with dextrocardia and situs inversus totalis who presented with atrial fibrillation and underwent electrical cardioversion. Electrocardiography, transthoracic echocardiography, and cardioversion pad placement were all performed using a mirror-image configuration. Sinus rhythm was restored without complications. This case highlights that a unified mirror-image approach across multiple procedures enables safe, reproducible management and provides a simple and reproducible framework for clinicians in emergency and primary care settings.