Cardioversion

Cardioversion is a medical procedure that is performed with the aim of restoring a normal heart rhythm for individuals who have certain type of abnormal heartbeats (arrhythmias).

Cardioversion is most often done by sending electric shocks to your heart by using electrodes placed on your chest. Occasionally, your doctor may perform cardioversion using only medications to restore your heart's rhythm.

Cardioversion is mostly a scheduled procedure that is performed in a hospital, and you must be capable of going home the same day as your procedure. Cardioversion quickly restores a normal heart rhythm for most people.

The main reason for a cardioversion is to correct a heartbeat that is too fast (tachycardia) or irregular (fibrillation).

This procedure is usually applied in the treatment of individuals who have atrial fibrillation or atrial flutter. These are conditions in which the electrical signals that cause your heart to beat at a regular rate and rhythm do not properly travel through the upper chambers of your heart.

Cardioversion is performed when your heart is not beating effectively. It is not the same as defibrillation, an emergency procedure that is performed when your heart stops or quivers uselessly. Defibrillation delivers more potent shocks to the heart to correct its rhythm.

Cardioversion is usually scheduled in advance, but can be done in emergency situations.

Cardioversion is usually done with electric shocks, which are administered through electrodes attached to your chest while you are sedated. Electric cardioversions, generally faster to complete than cardioversion done solely with medications, and your doctor can immediately see if the procedure has restored a normal heartbeat.

If your doctor recommends cardioversion with medications in order to restore your heart's rhythm, you will not receive electric shocks to your heart.

The complications of cardioversion are quite rare, and doctors can take steps to reduce your risk.

Major risks of cardioversion may include the following:

• Dislodged blood clots: Some individuals with arrhythmias have blood clots in their hearts. Electric cardioversion can cause these blood clots to move to different parts of the body, thus, resulting in life-threatening complications, such as a stroke.

  Your doctor will check for blood clots in your heart prior to cardioversion. Before cardioversion, you may be given a blood-thinning medication for several weeks to significantly lower the risks of blood clots and stroke.

  Unless the episode of arterial fibrillation lasts less than 48 hours, you will need to take blood-thinning medication for at least a few weeks before and after the procedure to prevent a blood clot from forming even after your heart has returned to its normal rhythm.

• Abnormal heart rhythm: In rare circumstances, some individuals who undergo cardioversion end up with other heart rhythm problems during or after the procedure. If heart rhythm problems recur, you doctor can give you medications or additional shocks to correct the problem.
• Low blood pressure: Some people experience low blood pressure following the procedure, which generally improves on its own and does not require treatment.
• Skin burns: Rarely, some individuals have minor burns on their skin where their electrodes were placed.

Pregnant women can have cardioversion, but it is recommended that the baby's heartbeat be monitored during the process.

In preparing for your cardioversion, you must follow your doctor’s orders. 

Cardioversion is usually scheduled in advance, although if your symptoms are severe, you may need to have the procedure in an emergency setting.

You generally are not allowed to eat or drink for 12 hours before the procedure. Your doctor will tell you whether you should take any of your regular medications before the procedure. If you do take medications before the procedure, sip only enough water to help swallow your pills.

Before cardioversion, you may have a different procedure known as a transesophageal echocardiogram. This procedure is done to check for blood clots in your heart, which can be dislodged by cardioversion, causing life-threatening complications. Your cardiologist will make a decision if you need a transesophageal echocardiogram before the cardioversion.

In a transesophageal echocardiogram, your throat is numbed and a flexible tube known as a catheter with a transducer attached is guided down your throat and into your esophagus.

From there, the transducer can be able to obtain more-detailed images of your heart so that your doctor can check for blood clots. If your doctor finds blood clots, your cardioversion procedure will be delayed for a few weeks while you take blood-thinning medications to reduce your risks of forming blood clots or developing other complications.

Here’s what you can expect before, during, and after your cardioversion.

During the procedure

A nurse or technician will place large patches called electrodes on your chest and in some cases, your back. The electrodes will be connected to a cardioversion machine (defibrillator) using wires.

The defibrillator will then recorded your heart rhythm throughout the procedure and will also deliver shocks to your heart to restore a normal heart rhythm. This machine paces your heart as well if it beats too slowly after cardioversion.

Before the shocks are delivered, a nurse or technician will insert an intravenous (IV) line in your arm. The purpose of the IV line is to give you medications that will make you sleep during the procedure to prevent any sensation of pain from the shocks. Your doctor may also use the IV line to give you additional medications that can aid in restoring a normal heart rhythm.

Once you are sedated, electric cardioversion usually takes only a few minutes to complete.

After the procedure

Electric cardioversion is done on an outpatient basis, this means that you can go home the same day your procedure is performed. You will spend about an hour in a recovery room being closely monitored for complications.

Because you will be asleep during the procedure, your awareness of your surrounding may be impeded afterward. You will need someone to drive you home after the procedure, and your ability to make decisions may be affected for several hours following your procedure.

Even if no clots were discovered in your heart before your procedure, you will usually continue to take blood-thinning medications for several weeks after your procedure to prevent new clots from forming. Some people may also be prescribed medications to help prevent any future heart rhythm complications.

The results of a cardioversion will be given by your doctor.

For most individuals, cardioversion can quickly restore a regular heartbeat. For some, your irregular heart rhythm may return within a few minutes or days.

It's possible that you will need to have repeat procedures to keep a normal heart rhythm. You also may need to take medications to help maintain a normal heart rhythm.

To keep your heart healthy, you may need to make lifestyle changes that improve the overall health of your heart, especially to prevent or treat conditions that can cause arrhythmias, such as high blood pressure and heart disease.

Your doctor may suggest that you: 

• Eat heart-healthy foods and maintain a healthy weight.
• Use less salt (sodium), which can help lower blood pressure.
• Increase your physical activity
• Limit or avoid caffeine
• Quit smoking
• Avoid drinking or not more than one drink of alcohol a day for women of all ages and men older than age 65, or more than two drinks a day for men age 65 and younger if you choose to drink at all.
• Keep your cholesterol and blood pressure levels under control
• Reduce stress, as intense stress and anger, can cause heart rhythm problems
• Use over-the-counter medications with caution, as some cold and cough medications contain stimulants that may trigger a rapid heartbeat.