 After in depth explanation of the procedure with him that there would be more definitive resumption of normal sinus rhythm by using electrocardioversion with less long-term side effects, past the acute procedure, alternatives being continued atrial flutter with potential for electrophysiologic consultation for ablation and/or heart rate control with anticoagulation, which the patient was not interested nor was I primarily recommending as the next step, and risks including, but not limited to and the patient was aware and this was all done in the presence of his wife that this is not an all-inclusive list, but the risks include but not limited to oversedation from conscious sedation, risk of aspiration pneumonia from regurgitation of stomach contents, which would be less likely as I did confirm with the patient that he had been n.p.o. 
After in depth explanation of the procedure with him that there would be more definitive resumption of normal sinus rhythm by using electrocardioversion with less long - term side effects , past the acute procedure , alternatives being continued atrial flutter with potential for electrophysiologic consultation for ablation and/or heart rate control with anticoagulation , which the patient was not interested nor was I primarily recommending as the next step , and risks including , but not limited to and the patient was aware and this was all done in the presence of his wife that this is not an all - inclusive list , but the risks include but not limited to oversedation from conscious sedation , risk of aspiration pneumonia from regurgitation of stomach contents , which would be less likely as I did confirm with the patient that he had been n.p.o .