Your Health - Cardioversion

Cardioversion

Definition

Cardioversion is the delivery of an electric shock to the chest through electrodes or paddles. The shock is given to correct a dangerous heart rhythm or hearbeat.

Cardioversion can be done as an elective (scheduled) procedure, or may be done urgently if a abnormal heartbeat is immediately life threatening.

External Cardioversion

Reasons for Procedure

If the heart is not beating regularly, it may prevent the normal circulation of blood through the body. This may deprive various organs, including the brain and heart, of oxygen. Without oxygen the organs can not proper functionally and will eventually die.

Nonemergency cardioversion may be used to treat the following conditions:

Atrial fibrillation—very rapid, irregular twitching in the atrium, when the ventricular heart rate is not too fast
Atrial flutter—rapid but regular contractions in the atrium, when the ventricular heart rate is not too fast

Emergency cardioversion may be used to treat the following types of irregular heartbeats, which can lead to death if they are not immediately converted to a more normal rhythm:

Atrial tachycardia—rapid beating of the heart, originating in the atrium with rapid ventricular heart rate
Ventricular tachycardia—rapid beating of the heart, originating in the ventricle
Ventricular fibrillation—rapid movement of the ventricular muscle without effective pumping

Possible Complications

If you are planning to have cardioversion, your doctor will review a list of possible complications which may include:

Inability to stop the abnormal rhythm
Resumption of the abnormal rhythm after a normal rhythm was established
Development of a more dangerous dysrhythmia
Damage to the heart muscle
Blood clots introduced into your circulation, leading to such complications as stroke or damage to your organs
Burning or irritation to the skin of the chest where the paddles or electrodes are applied

What to Expect

Prior to Procedure

For elective cardioversion:

To diagnose the condition, you will have an electrocardiogram (ECG, EKG). An EKG can record the heart's electrical activity.
You may be given blood thinners for several weeks before the procedure.
You may undergo atransesophageal echocardiogram. This is an ultrasound test to look for blood clots in the heart.
Arrange for a ride to and from the procedure.
Arrange for help at home after the procedure.
The night before, eat a light meal. Do not eat or drink anything after midnight.
Check with your doctor to see if you should take your medicines normally on the morning of the procudure.

For urgent cardioversion, there is no time for to prepare for the procedure.

Anesthesia

You may have a short-acting general anesthesia or a brief, deep sedation so you will be unaware of the procedure happening.

Description of the Procedure

Electrodes or paddles will be applied to the chest. An electric charge will be delivered through these electrodes or paddles to the chest and into the heart. This will momentarily stops the electrical activity of the heart. This will allow the heart to reset itself into a normal rhythm. The process may need to be repeated several times. The electric charge may be increased with each attempt.

Immediately After Procedure

You will be monitored closely in a recovery room. You will need to be monitored for at least several hours after the procedure.

How Long Will It Take?

The procedure itself is usually less than 30 minutes.

How Much Will It Hurt?

Anesthesia prevents pain during the procedure. If you have an urgent cardioversion, you may be aware during the procudure. You may feel a jolt that some people liken to a kick in the chest.

Average Hospital Stay

If you had nonemergency cardioversion, you'll be sent home once you are in stable condition.

People who need emergency cardioversion may be admitted to the hospital. This may be done for further observation or because of the illness that caused the event.

Post-procedure Care

At Home

Be sure to follow your doctor's instructions. You may be put on blood thinners for a few weeks after the procedure. In this case, blood levels of these medications will need to be monitored via blood tests, usually weekly. You may also be put on a medication called an anti-arrhythmic. This type of drug will help prevent the abnormal heartbeat from happening again.

Call Your Doctor

After you leave the hospital, contact your doctor if any of the following occurs:

Blisters, redness, or open sores on your chest
Confusion, lightheadedness, or dizziness
Sensation of your heart fluttering (palpitations)
Sensation of a skipped or missed hearbeat, or an irregular pulse
Cough, difficulty breathing, shortness of breath
Severe nausea or vomiting
Chest pain or pain in your left arm or jaw
Pain in your abdomen, back, arms, or legs
Blood in your urine
Changes in vision or speech
Difficulty walking or using your limbs
Drooping facial muscles

In case of an emergency call 911.

RESOURCES:

American Heart Association
http://www.americanheart.org/

National Heart, Lung, and Blood Institute
http://www.nhlbi.nih.gov/index.htm/

CANADIAN RESOURCES:

Health Canada
http://www.hc-sc.gc.ca/index_e.html/

Heart and Stroke Foundation of Canada
http://ww2.heartandstroke.ca/

References:

Procedures for Primary Care Physicians . Mosby-Year Book, Inc; 1994.

Last reviewed October 2009 by Michael J. Fucci, DO and Brian P. Randall, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.