Would you pursue imaging to clear the left atrial appendage or have a risk/benefit discussion with a patient prior to semi-urgent cardioversion if there was concern for delayed administration or a single missed dose of anticoagulation?

How would you proceed with cardioversion in a patient with concern for delayed administration or a single missed dose of anticoagulation?

• Proceed with imaging to clear the left atrial appendage before cardioversion
• Have a risk/benefit discussion with the patient and proceed with cardioversion without imaging if deemed appropriate
• Decide based on CHA2DS2-VASc score, with imaging for higher scores and potential to proceed without imaging for lower scores
• Other