Cardioversion

Cardioversion is a conservative method to treat patients with an abnormal heart rhythm, also known as an arrhythmia. There are two types of cardioversion: pharmacologic (chemical) cardioversion and electrical cardioversion. Chemical cardioversion involves using one or more medications to restore normal heart rhythm. Electrical cardioversion involves administering an electrical shock to the heart to restore regular heart rhythms.

Indications

Cardioversion is usually recommended when your heart is beating too fast, or with an irregular rhythm – This is known as an arrhythmia. Atrial fibrillation, or AFib, is the most common kind of irregular heartbeat. Arrhythmias can cause issues such as fainting, stroke, heart attack, and even sudden cardiac death. Cardioversion can also treat other types of abnormal heartbeats, such as atrial tachycardia, atrial flutter, and ventricular tachycardia.

Preparation

In general, preparation for cardioversion may involve the following:

• A review of your medical history and a physical examination
• An imaging test called a transesophageal echocardiogram to look for blood clots in the heart
• Abstaining from food or drink for about 8 hours prior to cardioversion
• Informing your doctor about any medications, herbs, or supplements you are taking
• Avoiding the use of body lotion, deodorant, or powder on the back or chest
• Arranging for someone to take you home after the treatment
• Signing an informed consent form

Procedure

For a chemical cardioversion, you will be in the hospital for a day or two, so that your healthcare provider can closely monitor your heart function during treatment. You will be given drugs commonly used to treat heart rhythm problems, either orally or intravenously.  The medication can work in minutes, hours or even days. If your heart does not regain a normal rhythm from this treatment, your physician may recommend an electrical cardioversion.

An electrical cardioversion is an outpatient procedure and generally involves the following:

• Your nurse or physician will place an intravenous (IV) line in your arm and administer a sedative medicine to keep you asleep and pain-free during the procedure.
• Soft electrode pads are then placed on your chest and sometimes your back. These electrodes are connected to a cardioversion machine that records your heartbeat and sends a brief electric current to your heart.
• Using the cardioversion machine, your physician delivers a programmed high-energy shock to your heart through the electrode pads. This should convert your heart back to a normal rhythm.
• The whole procedure takes about 30 to 45 minutes

Post-procedure care

As electrical cardioversion is performed on an outpatient basis, you can go home the same day as the procedure. You may have some redness or soreness on your chest that lasts for a few days. You will be monitored by your nurse or doctor for several hours in the observation room for any signs of complications. If you feel any discomfort, inform the medical staff immediately. Upon release, you may still feel sleepy for a few hours following the procedure, due to the effects of the sedative. You are advised not to drive or operate any machinery during this period. Your physician may also provide you with medications for pain relief and to prevent abnormal rhythms and/or blood clots.

Risks and Complications

Cardioversion is usually a safe procedure, but in certain cases, you may experience some side effects, such as:

• Skin damage
• Abnormal heart rhythm
• Blood clots
• Stroke
• Temporary low blood pressure
• Allergic reaction

Summary

Cardioversion is a nonsurgical treatment to bring your heart back into a normal rhythm utilizing an electric device or medication. Usually, cardioversion quickly restores a typical heart rhythm. Healthcare providers often employ cardioversion to treat atrial fibrillation and atrial flutter, but it also assists with other arrhythmias, including abnormally fast heart rhythms.