How safe is cardioversion?
Cardioversion has been considered safe within a 48-h time window after onset of atrial fibrillation without prior treatment with anticoagulants, but recent studies have set this practice into question based on e.g. erratic debut assessment of atrial fibrillation.
What is the success rate of electrical cardioversion?
What’s the Success Rate? Electrical cardioversion is more than 90% effective, though many have AFib again shortly after having it. Taking an antiarrhythmic drug before the procedure can prevent this. How well it works depends on the size of your left atrium as well as how long you’ve been in AFib.
What happens during a cardioversion?
Quick facts
- Arrhythmias may prevent blood from circulating properly to your heart and brain.
- Most often, doctors use cardioversion to treat a fast, irregular heart rhythm called atrial fibrillation.
- If you have electrical cardioversion, you’ll get medicine to put you to sleep so you don’t feel the shock.
What are the side effects of cardioversion?
You will likely:
- Wake up 5 to 10 minutes after the procedure
- Be closely watched for signs of complications for several hours
- Feel sleepy for several hours after the cardioversion. Arrange to have someone drive you home
- Go home the same day as the procedure
- Have some redness or soreness on your chest that lasts for a few days
Does cardioversion damage the heart?
It might make things worse: It's unlikely, but there's a small chance that cardioversion could damage your heart or lead to more arrhythmias. Irritated skin: This often happens where the paddles are applied. The doctor can give you a cream to treat it.
What is the mortality rate of cardioversion?
Results. Electrical cardioversion success rate was 90.4%. Within a year after cardioversion one patient (0.6%) suffered myocardial infarction, three patients (1.9%) had a stroke/transitory ischemic attack (TIA), three patients (1.6%) died and three patients (1.9%) had a bleeding event that required hospitalization.
How many times can you safely have cardioversion?
There is really no limit to the number of cardioversions that people can have but at some point of time, we figure out that either it is a futile strategy or patients tend to get frustrated. But when it is a necessity that our patients who've had 20, 25 cardioversions also.
How often is cardioversion successful?
The success rate of cardioversion with atrial fibrillation is generally better than 90 percent. Chances of success are lower when the atrial fibrillation has been present for more than several months or when the left atrium is very enlarged. In general, there are two ways that a cardioversion procedure for AF can fail.
How serious is a cardioversion?
Cardioversion can make blood clots move, causing life-threatening complications. Your provider will decide whether you need this test before cardioversion. If you have one or more blood clots in the heart, cardioversion is typically delayed for 3 to 4 weeks.
What are the dangers of cardioversion?
Heart damage (usually temporary and without symptoms) Heart failure. Skin damage. Dislodged blood clot, which can cause stroke, pulmonary embolism, or other problems.
Who is not a candidate for cardioversion?
You may not be a good candidate if: Your arrhythmia is due to drug toxicity or another known cause. You have a blood clot in your heart. You are not taking anticoagulant medicines and are not able to have a transesophageal echocardiogram (TEE).
What next if cardioversion does not work?
Repeat cardioversions can be performed. If the rhythm still doesn't stabilize, patients may be referred for catheter ablation, a procedure that destroys the heart tissue causing the irregularity.
Can atrial fibrillation go away?
It is possible to have an atrial fibrillation episode that resolves on its own. Or, the condition may be persistent and require treatment. Sometimes AFib is permanent, and medicines or other treatments can't restore a normal heart rhythm.
Is cardioversion a permanent fix for AFib?
While electrical cardioversion may be effective at converting the heart back into normal sinus rhythm, it has a low success rate in keeping it there, and thus may require multiple tries. It also doesn't cure afib.
How long should you rest after cardioversion?
For 24 hours, don't do anything that requires attention to detail. This includes going to work, making important decisions, or signing any legal documents. It takes time for the medicine's effects to completely wear off. For your safety, do not drive or operate any machinery that could be dangerous.
How long does it take to recover from cardioversion?
What is the recovery time? You'll most likely go home the same day as your cardioversion. However, you can't drive for 24 hours because you'll be sleepy from the anesthesia. You'll be able to eat and drink after your procedure.
What next if cardioversion does not work?
Repeat cardioversions can be performed. If the rhythm still doesn't stabilize, patients may be referred for catheter ablation, a procedure that destroys the heart tissue causing the irregularity.
Is cardioversion safe for elderly?
Electrical cardioversion can be performed safely in older patients, under sedation and continuous monitoring of blood pressure and oximetry. Available temporary pacing is mandatory to avoid unnecessary bradycardia episodes.
How long does it take to recover from cardioversion?
What is the recovery time? You'll most likely go home the same day as your cardioversion. However, you can't drive for 24 hours because you'll be sleepy from the anesthesia. You'll be able to eat and drink after your procedure.
How often does AFib return after cardioversion?
Many people who have had successful cardioversion develop atrial fibrillation again. According to studies, this happens within a year in up to 80 out of 100 people. The success rate can be improved somewhat by taking anti-arrhythmic medication over the longer term.
History
Contemporary cardiology has been significantly affected by the ready availability of this simple method for terminating atrial and ventricular tachyarrhythmias. However, fascination with electricity and its use in biological systems is hardly contemporary.
Present
Little has changed in 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.
Future Directions
It is hard to imagine the changes that the future may bring to a technique that has changed so little over the last several decades. Progress usually occurs when light is shed on the unknown. Clearly, as we more fully understand all the intricacies of fibrillation and defibrillation, advances in this field will be made.
Epilogue
As we reviewed the beginnings and subsequent development of defibrillation and cardioversion for this article, we were surprised to learn how much seminal work had been done behind the Iron Curtain that was almost completely unknown in the West.
Footnotes
Correspondence to Ivan Cakulev, MD, Division of Cardiology, MS LKS 5038, University Hospitals of Cleveland Case Medical Center, 11100 Euclid Ave, Cleveland, OH 44106-5038. E-mail [email protected]
How is cardioversion done?
Cardioversion is usually done by sending electric shocks to your heart through electrodes placed on your chest. It's also possible to do cardioversion with medications. Cardioversion is usually a scheduled procedure that's performed in a hospital. You should be able to go home the same day as your procedure.
What is cardioversion in medical terms?
Cardioversion is a medical procedure that restores a normal heart rhythm in people with certain types of abnormal heartbeats (arrhythmias). Cardioversion is usually done by sending electric shocks to your heart ...
How long does it take for blood clots to break free?
If your doctor finds blood clots, your cardioversion procedure will be delayed for three to four weeks.
What is the name of the machine that records your heart rhythm?
A nurse or technician places several large patches called electrodes on your chest. The electrodes connect to a cardioversion machine (defibrillator) using wires. The machine records your heart rhythm and delivers shocks to your heart to restore a normal heart rhythm. This machine can also correct your heart's rhythm if it beats too slowly after cardioversion.
How long before cardioversion can you eat?
However, if your symptoms are severe, you may need to have cardioversion in an emergency setting. You typically can't eat or drink anything for about eight hours before your procedure.
What to do before cardioversion?
If necessary, your doctor may prescribe blood-thinning medications before the procedure or will check for blood clots in your heart before cardioversion.
How long does it take to do electric cardioversion?
Once you're sedated, electric cardioversion usually takes only a few minutes to complete.
What is Synchronized Cardioversion?
Synchronized cardioversion is a life-saving procedure performed to treat certain arrhythmias when medication is unable to convert those rhythms to a normal rhythm. This method involves a low-energy shock to the front of the body. While similar to defibrillation, this shock synchronizes to administer the shock at a precise moment–when the QRS complex peaks. This high point is called the R wave.
What Patients Do Not Benefit from Cardioversion?
Cardioversion is not called for when a patient is known to have an incessant arrhythmia. Even though cardioversion may “fix it”. It will come right back.
Why Are Irregular Rhythms Corrected?
First of all, you cannot correct all abnormal rhythms. If the cause continues, so will the condition. However, medication can keep some Incessant (chronic) arrhythmias in check. And, if needed, synchronized cardioversion to correct these rhythms, although a corrected rhythm may return to arrhythmia after a period.
What is cardioversion used for?
Cardioversion also treats other kinds of abnormal heartbeats, including atrial flutter, atrial tachycardia and ventricular tachycardia. Cardioversion or defibrillation is also used in emergency situations for people who suffer sudden life threatening arrhythmias.
Why do people have cardioversion?
People have non-emergency or elective cardioversion to treat arrhythmias. The electrical signals that control your heartbeat start in the upper right chamber of your heart (atrium). In atrial fibrillation, very fast, irregular electrical signals move through both of the upper chambers of your heart. This can make your heartbeat fast and irregular. Some people who have atrial fibrillation don’t notice any changes in the way they feel. But others feel:
What are the risks of cardioversion?
If you have atrial fibrillation, blood clots can form in your heart’s left atrium. Cardioversion may knock loose a blood clot in your left atrium. If the clot (embolus) travels to your brain, it can cause a stroke. To avoid this, your doctor may give you medicine (such as warfarin) to make your blood less likely to form blood clots. If your doctor gives you the medicine, you’ll need to take it for 2 to 3 weeks before the procedure. Transesophageal echocardiography (TEE) is often used to check for the presence of blood clots before this procedure.
How does an IV shock work?
You won’t feel pain during the procedure. Your doctor will deliver an electrical shock through two paddles. One is placed on your chest and the other on your back.
What is the term for the process of restoring rhythms?
This is called pharmacologic (chemical) cardio version. Doctors also restore regular rhythms by sending an electrical shock to the heart. This is called electrical cardioversion.
What is abnormal heart rhythm called?
Abnormal heart rhythms are called arrhythmias. Watch an animation of arrhythmias. There are two kinds of cardioversion. Your doctor may give you one or more medicines to bring back your regular heartbeat. This is called pharmacologic (chemical) cardioversion.
What Is Recovery From Cardioversion Like?
Once your heart is back in a normal rhythm, your doctor will give you medicine to make sure it stays that way.
How does electrical cardioversion work?
Electrical cardioversion gives shocks through paddles to regulate your heartbeat. First, you'll get medicine to make you fall asleep. Then, your doctor will put the paddles on your chest, and sometimes your back. These will give you a mild electrical shock to get your heart's rhythm back to normal.
How long does it take for AFIB to work?
Chemical cardioversion: You should know quickly if it works. It usually takes effect within hours, but sometimes it takes days. If it doesn’t work for you, the doctor might suggest electrical cardioversion.
What is the treatment for AFIB?
Cardioversion for AFib. If you have an irregular heartbeat (you might hear it called arrhythmia, atrial fibrillation, or AFib), your doctor will probably suggest a treatment called cardioversion to help you get a normal rhythm back. If your heart beats too fast or unevenly, it can be dangerous. It may not be pumping enough blood to meet your body's ...
Does cardioversion work?
It might not work: Cardioversion doesn't always fix a fast or irregular heartbeat. You may need medicine or a pacemaker to control things.
Can you get AFIB again after a cardioversion?
Electrical cardioversion is more than 90% effective, though many have AFib again shortly after having it. Taking an antiarrhythmic drug before the procedure can prevent this. How well it works depends on the size of your left atrium as well as how long you’ve been in AFib. If you have a large left atrium or you’ve been in constant AFib for a year or two, it may not work as well. Taking antiarrhythmic drugs can also prevent AFib after a successful electrical cardioversion.
What is the conversion of a cardiac (heart) arrhythmia into an alternative cardiac rhythm?
Cardioversion is the conversion of a cardiac (heart) arrhythmia into an alternative cardiac rhythm. Cardioversion refers to a variety of medical procedures. The most common involve either medications (pharmacological cardioversion ) or electricity (electrical cardioversion or defibrillation). 1 Which method is used depends on the patient's condition and overall stability.
Why is cardioversion used for pharmacological solutions?
Use of the term cardioversion for pharmacological solutions is less common, probably because there is a variety of uses for medications that might cause an immediate change in the heart rhythm —traditionally known as cardioversion—but can also be used chronically to control heart rate or rhythm .
How does electrical cardioversion work?
Process. Electrical cardioversion uses electrodes that are several inches across to conduct electricity through the heart muscle. The electrodes can be placed externally on the chest wall or internally directly on the heart muscle. There are different types of electrical cardioversion, but they all use the same device known as a defibrillator.
Why is sedation used after cardioversion?
In the event the patient is not stable enough to wait for sedation before cardioversion, sedation is often used after the fact to help the patient manage discomfort post-shock. Patients often report a retrograde amnesia effect from the use of sedation after cardioversion and cannot remember the actual procedure.
What are the two most common types of cardioversion?
The types of cardioversion that might be performed by either a medical professional or a lay rescuer depend mainly on the medical condition experienced by the patient and on the severity of the patient's condition. Electrical and pharmacological are the two most common types of cardioversion.
What is the same as a defibrillator?
There are different types of electrical cardioversion, but they all use the same device known as a defibrillator. Defibrillators come in manual and automated versions. Some of them are capable of being used in either mode. Defibrillators are used when a patient is in certain cardiac rhythms such as ventricular fibrillation or unstable ventricular ...
What are the side effects of electrical cardioversion?
Some side effects of electrical cardioversion include pain and irritation at the site of the electrodes, soreness in the chest, and anxiety. As noted above, the best management for after electrical cardioversion is to provide the patient with sedation. Pain medication may also be administered if the patient's pain is significant.
What Is A Cardioversion?
First of all, what is a cardioversion? A cardioversion is an electrical shock to your heart to try to reset your heart, to get you out of atrial fibrillation, and back to normal sinus rhythm. You may have seen on TV, or in a movie when someone's heart stops, and they take the electrical paddles and give them the electrical shock to bring them back to life. Meanwhile, your favorite actor will usually yell-“Everyone Clear!”
How long does cardioversion take?
A cardioversion procedure typically only takes a few minutes to do. More time is spent prepping a patient and monitoring a patient after the procedure then the time of the actual cardioversion. In most cases patients go home within 2 hours of arrival to the procedure area.
What Is The Success Rate of Cardioversion?
What is the main benefit of doing a cardioversion? The main benefit is to get someone out of Atrial Fibrillation. But how well does a cardioversion actually work? Does it actually get someone out of atrial fibrillation? I usually tell my patients that the cardioversion itself usually works very well. In my experience, the actual shock treatment works probably about 90% of the time to actually get a patient out of atrial fibrillation. Now, that doesn't mean the atrial fibrillation can't come back. There's an inherent short circuit problem or a problem with a patient’s heart which is triggering episodes of atrial fibrillation, so, the AFib may come back an hour later, a week later, or a year later, there is no good method to predict if or when the AFib will come back. Usually, changes in medication or lifestyle modifications are required after the cardioversion in order to help keep you in a normal rhythm and improve the success rate.
Who Is A Candidate For A Cardioversion?
A cardioversion is only beneficial for people who are in what's called Persistent At rial Fibrillation which means you are in Atrial Fibrillation all the time. If your AFib episodes come and go, meaning they usually stop on their own, then a cardioversion is not the right treatment for you. But if you're in AFib consistently, it may be a beneficial treatment option for you. However, I will say when it comes to the success rate of a cardioversion, the longer somebody is in Atrial Fibrillation, the less likely the cardioversion will be successful.
How Much Energy (Also Known As Joules) Is Typically Needed During A Cardioversion?
In addition, the longer someone is in atrial fibrillation, the more energy is required to be successful to cardiovert someone. Someone who has been in persistent atrial fibrillation for a few weeks will typically require less energy then someone that has been in persistent atrial fibrillation for over one year. I use 200 Joules most of the time during a cardioversion for atrial fibrillation.
Does your chest hurt after cardioversion?
There are a few patients that experience chest pain after a cardioversion, but it is not chest pain from your heart. It is usually pain on your skin where the shock was delivered. The more energy that was needed to perform a cardioversion, the more likely there will be some pain after the procedure. Some patients also get a rash or redness on their skin from where the cardioversion pads where placed. However, most of these symptoms are very mild and resolve within a few days.
When Do I Recommend A Cardioversion?
I can offer them cardioversion on the same day or the next day to help get them out of AFib and improve their symptoms. Long term, other options such as an ablation may work better, but in the short term, a cardioversion can be a very useful treatment option.
What is cardioversion in heart?
Cardioversion is a procedure that can be used to correct many types of fast or irregular heart rhythms. The most common of these are atrial fibrillation and atrial flutter. Cardioversion is also used to correct ventricular tachycardia, which is a very fast, life-threatening heart rhythm that starts in the lower chambers of the heart (ventricles).
Where is cardioversion done?
The cardioversion will likely be done in the electrophysiology (EP) lab.
How does a defibrillator work?
The shock interrupts the abnormal electrical rhythm and restores a normal heart rhythm. It may take several shocks to get the rhythm back to normal.
What is EKG in medical terms?
ECG/EKG: Keeps track of your heart’s electrical activity. Several sticky patches (electrodes) are attached to your chest, and wires carry the information to a machine that creates a graph.
What is the tool that measures oxygen in blood?
Oximeter : A small clip on your finger measures the amount of oxygen in your blood.
Can you take Coumadin on cardioversion?
Please ask your doctor how you should take your blood thinners/anticoagulants, such as Coumadin (warfarin), and your diabetes medications or insulin on the day of your cardioversion. Unless your doctor or nurse tells you otherwise, take all other regular medications as scheduled.
Is cardioversion part of a plan of care?
Cardioversion is only one part of your plan of care. It is also important for you to take your medications, a heart-healthy lifestyle and keep your follow-up appointments. Please talk to your doctor if you have any questions or concerns.
Overview
A procedure to restore normal heart rhythm.
Treatment for: Arrhythmia · Atrial Flutter · Wolff-Parkinson-White Syndrome · Ventricular Tachycardia · Congenital Heart Disease and more
Type of procedure: Noninvasive
Recovery time: About one day
Duration: Few minutes
Hospital stay: Typically a few hours
Why It's Done
Risks
How You Prepare
What You Can Expect
- Little has changed in 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....
Results
Clinical Trials