What Is Cardioversion?
Cardioversion is a procedure that returns an abnormal heart rhythm to normal. It's used when you have an arrhythmia, which means your heart is beating too fast or irregularly. Cardioversion can be life-saving, because irregular heartbeats can lead to heart attacks or strokes. It also helps prevent problems in the future.
When Do Doctors Use Cardioversion for AFib?
Cardioversion is a common treatment for atrial fibrillation (AFib). AFib is a condition when the upper chambers of the heart, called atria, beat in an abnormal way. This puts the upper chamber out of sync with the heart's lower chambers, called ventricles. Atrial fibrillation can increase the risk of having a stroke.
If you have AFib, you could feel very tired, dizzy, or short of breath. AFib can also give you heart palpitations. Some people have no symptoms.
Doctors are more likely to use cardioversion for AFib when it's your first time having AFib. If you have AFib on a regular basis, and it is also causing you to have symptoms, then your doctor might want you to have cardioversion.
Some patients may not be good candidates for cardioversion. Your doctor may not recommend cardioversion if you have only minor symptoms from AFib. If you are elderly, have other serious medical conditions, or you've had AFib for a long time, then your doctor may not want you to have cardioversion.
Types of Cardioversion
There are two types of cardioversion:
Chemical cardioversion
Your doctor may use medication to try to get your heart back to normal. This is called chemical or pharmacologic cardioversion. You typically get the medicine through an IV while doctors check your heart. But sometimes, people can take it as a pill.
Your doctor will decide the best medicine to use, depending on what type of abnormal rhythm you have. If you have other medical conditions, that could affect what type of cardioversion your doctor wants you to have. Different medicines are used for cardioversion, including:
- Amiodarone (Cordarone)
- Dofetilide (Tikosyn)
- Flecainide (Tambocor)
- Ibutilide (Corvert)
- Propafenone (Rhythmol)
Drugs alone may not correct your heartbeat. Electrical cardioversion gives shocks through electrode pads or paddles to regulate your heartbeat.
First, you'll get medicine to make you fall asleep. Then, your doctor will put the pads or 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.
You may only need one, or your doctor may use several shocks. Because you’re asleep, you probably won’t remember being shocked. You can usually go home the same day.
Your skin may be irritated where the patches or paddles touched it. Your doctor can suggest a lotion to ease pain or itching.
Electrical Cardioversion vs. Defibrillation
Cardioversion and defibrillation are not the same. Both procedures use shocks to make the heart's rhythm return to normal.
Defibrillation uses stronger shocks than cardioversion. It may be used in lifesaving situations to correct severe problems with heart rhythms.
The procedures deliver shocks at different stages of the cardiac cycle. The cardiac cycle happens during each heartbeat, as the heart muscle contracts and relaxes. Defibrillation sends energy to the heart at random times during the cardiac cycle. During cardioversion, shocks may be delivered at specific times.
Does Cardioversion Have Risks?
Cardioversion does have some risks.
Blood clots
Either kind of cardioversion could knock loose blood clots created from your abnormal heartbeat. Before the procedure, your doctor may do a type of ultrasound to look for blood clots in your heart. You’ll probably get medicine to take for three to four weeks before and after the procedure to help prevent blood clots.
If a clot travels to your brain, it can cause a stroke.
Irritated skin
This often happens where the paddles are applied. The doctor can give you a cream to treat it.
Cardioversion complications
It's unlikely, but there’s a small chance that cardioversion could damage your heart or lead to more arrhythmias.
Cardioversion Recovery
After cardioversion, you should wake up within five or 10 minutes. You'll stay in a recovery room for about an hour to be watched for complications. Most people go home the same day. You’ll be drowsy from the anesthesia, so someone will need to drive you home.
Your doctor will typically prescribe medicine to thin your blood. Take this medication as directed, and do not stop it without first discussing it with your doctor.
Cardioversion Success Rate
Electrical cardioversion often works, but it's not a cure for an abnormal heart rhythm. Your heart should return to a normal rhythm during the procedure, but it may not last. It's common for abnormal rhythms to happen again, so you may need to have more than one cardioversion.
Electrical cardioversion 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. 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.
Chemical cardioversion success rate
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. Chemical cardioversion may not work as well as electrical cardioversion. It has a success rate of about 50%.
Takeaways
Cardioversion can help treat AFib by taking the heart out of an abnormal rhythm and putting that rhythm back to normal. It can be done with medicine or while you’re under anesthesia using a machine called a cardioverter. The best option for you depends on what type of abnormal heartbeat you have, how long you've had it, and your overall health.
Cardioversion for AFib FAQs
How long does cardioversion take?
An electrical cardioversion only takes a few minutes, but you’ll be at the hospital for several hours for preparation and recovery. Chemical cardioversion can take a few minutes, hours, or days to work.
What should you not do after cardioversion?
You shouldn’t drive yourself home after cardioversion. You’ll be groggy from anesthesia. You should be able to do all of your normal activities once the anesthesia wears off.
What's next if cardioversion does not work?
If you’ve already had a chemical cardioversion, then your doctor may recommend having an electrical cardioversion. If electrical cardioversion doesn’t work, your doctor may want to repeat the procedure, or try something else, such as catheter ablation.
How many times can you have cardioversion?
Some patients have a dozen or more cardioversions. There’s no limit to how many you can have. But if it’s not working, you or your doctor may decide to stop repeating the procedure.
