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Cardioversion from a Patient's Perspective

Not too long ago, I underwent cardioversion. Almost a year had passed between the time the cardiologist diagnosed AFib (Atrial Fibrillation) and recommended cardioversion, to the time I finally broke down and had it done.

To put it quite simply, I was chicken ... scared out of my mind. I should add this fear was based on absolutely nothing. Just something about having electrodes attached to my chest and an electrical charge sent through my heart just didn't seem like something I wanted to do. I put it off and put it off looking for something, anything that would either correct the AFib or provide me with a good excuse for not doing it. Needless to say it was a miserable, anxiety…

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  Electrical Cardioversion: A Review

Little has changed the technique of cardioversion since Lown's article in the early 1960s. Progress has been made in reducing the already low associated complication rate and in understanding the factors responsible for success. Successful cardioversion or defibrillation occurs when a shock with sufficient current density reaches the myocardium.

 Cardioversion: Past, Present, and Future

Recent years have seen rapid proliferation of ablative and antiarrhythmic therapies for treating various ventricular and supraventricular arrhythmias. Yet cardioversion and defibrillation remain the main modalities to restore normal sinus rhythm. Their simplicity, reliability, safety, and, most important, their efficacy in promptly restoring normal sinus rhythm are unmatched in our current treatment armamentarium.

Articles of Interest

Electrical cardioversion

External electrical cardioversion was first performed in the 1950s. Urgent or elective cardioversions have specific advantages, such as termination of atrial and ventricular tachycardia and recovery of sinus rhythm. Electrical cardioversion is life-saving when applied in urgent circumstances. The succcess rate is increased by accurate tachycardia diagnosis, careful patient selection, adequate electrode (paddles) application, determination of the optimal energy and anesthesia levels, prevention of embolic events and arrythmia recurrence and airway conservation while minimizing possible complications.

What to Expect From Electrical Cardioversion

: First, to avoid having blood clots break free during this procedure, you may take anticoagulants (warfarin, Coumadin®, or one of the NOAC -non-VKA oral anticoagulants) for three to four weeks before the procedure to eliminate your risk of blood clots.

Becoming Familiar with Synchronized Cardioversion: A Comprehensive Guide

Unlike standard defibrillation, synchronized cardioversion delivers electrical energy at a specific moment during your heart's cycle—synchronized with the R wave on your electrocardiogram (ECG). This timing prevents the shock from occurring during the vulnerable T wave period, which could trigger dangerous ventricular fibrillation. The procedure serves as both an emergency intervention for hemodynamically unstable patients and a planned treatment for AFib when medications prove ineffective.

Cardioversion in ICU

failure (less successful on AF, with large atria, if chronic or precipitant still present)

Cardioversion vs. Defibrillation: Everything You Need to Know

Typically set at 100 joules, the first shock may be enough to restore a regular rhythm. If the first shock is unsuccessful, the clinician may ramp up the energy incrementally, delivering shocks until the abnormal rhythm ceases. The precise amount of energy delivered typically varies from 100 to 300 joules, with most arrhythmias stopping after an application of 120 joules.

Shocking AF — What’s the rush?

If I had just one thing to say to patients and doctors about the disease atrial fibrillation it would be this: Be as scared of AF treatment as you are of the disease.

Use of Transesophageal Echocardiography to Guide Cardioversion in Patients with Atrial Fibrillation

The conventional treatment strategy for patients with atrial fibrillation who are to undergo electrical cardioversion is to prescribe warfarin for anticoagulation for three weeks before cardioversion. It has been proposed that if transesophageal echocardiography reveals no atrial thrombus, cardioversion may be performed safely after only a short period of anticoagulant therapy.

What happens during electrical cardioversion?

If you're not already taking an anti-clotting medication, you'll probably need to take one for three to four weeks before the procedure. That usually allows any existing blood clots to stabilize or resolve. Another option is to receive a special ultrasound test called transesophageal echocardiography, which involves placing a thin, flexible tube down your esophagus (the tube connecting your throat and stomach) to get a closer view of the heart. If no blood clots are visible, an electrical cardioversion can be done without giving the anti-clotting pretreatment regimen for weeks ahead of time.

What is a cardioversion procedure?

Electrical cardioversion is generally a safe, painless procedure used to convert a rapid or irregular heartbeat (such as atrial fibrillation) back to a normal rhythm. You’ll be asleep during the treatment, which delivers brief, electrical shocks through pads placed on your chest. Here’s a rundown of what to expect during the procedure and how it may help.

Resources

RebelEM

Cardioversion archives...

Bupa

There are different types of arrhythmia that can be treated with cardioversion. These include atrial fibrillation, atrial flutter and ventricular tachycardia. Cardioversion isn’t suitable for everyone. Whether it’s right for you will depend on how long you’ve had arrhythmia, your symptoms and your medical history.

Cardiovascular Group

You might be wondering what exactly happens during electrical cardioversion. The procedure is typically performed in a hospital setting, where your safety and comfort are our top priorities. You’ll be given a short-acting sedative to ensure you’re relaxed and comfortable throughout the process. Once you’re sedated, our skilled heart doctors will deliver one or more carefully timed electrical shocks to your chest using special paddles or patches.

Cleveland Clinic

Cardioversion is a procedure in which an electrical shock is delivered to the heart to convert an irregular or fast heart rhythm (called an arrhythmia) to a normal heart rhythm. During cardioversion, your doctor uses a cardioverter machine to send electrical energy (or a ''shock'') to the heart muscle to restore the normal heart rhythm.

Dr. Smith's ECG Blog

Cardioversion archives...

MedlinePlus

Cardioversion is a method to restore a rapid heart beat back to normal. Cardioversion is used in persons who have heart rhythm problems (arrhythmias), which can cause the heart to beat too fast.

UpToDate

Cardioversion is used to treat different types of disruptions in the normal heart rhythm (also called cardiac arrhythmias). During cardioversion, an electrical shock is delivered to the heart to restore its rhythm to a normal pattern. The electrical energy can be delivered externally, with electrodes placed on the chest or directly to the heart by placing paddles on the heart during an open chest surgery.