Intermittent interatrial block after electrical cardioversion for atrial fibrillation.

A 67-year-old woman with persistent atrial fibrillation presented for elective electrical cardioversion. The patient was cardioverted to normal sinus rhythm with a synchronized 150 joules (J) biphasic shock. Varying P-wave morphology suggesting intermittent interatrial block (IAB) was noted after the cardioversion on the rhythm strip. Three minutes later the patient developed early recurrence of atrial fibrillation and a second successful 150 J biphasic shock was delivered; IAB was still evident on a single lead II monitoring. However, the patient remained in sinus rhythm. The patient was discharged in normal sinus rhythm with electrocardiographic evidence of intermittent interatrial block. This case report examines the occurrence of IAB postcardioversion for atrial fibrillation and speculates on its prognostic significance.