Cardioversion

Learning About Cardioversion

What is cardioversion?

Cardioversion is used to reset your heart's rhythm to its normal pattern. It can be used to treat heart rhythm problems like atrial fibrillation or supraventricular tachycardia.

Cardioversion is also used in emergency situations to correct a fast heart rhythm that is causing low blood pressure, chest pain, or heart failure.

There are two types of cardioversion:

Electrical cardioversion uses electric current to reset your heart’s rhythm. The electric current enters your body through metal paddles or patches on your chest and back.
Chemical cardioversion uses antiarrhythmic medicines to reset your heart. The medicine is usually put into your arm through a tube called an IV. Talk to your doctor about these medicines.

How is cardioversion done?

Your doctor may ask you to take certain medicines for a period of time before you have either type of cardioversion. The medicines can help keep blood clots from forming.

In both types of cardioversion, you will be watched closely to make sure there are no problems.

Electrical cardioversion

Electrical cardioversion is done in a hospital. It can be painful, so you are given medicine to help you relax and to control pain. Your doctor then places paddles or patches on your chest and back. The patches or paddles send an electric current to your heart. This resets your heart rhythm.

Electrical cardioversion itself only takes about 5 minutes, but the whole procedure, including recovery, will probably take 30 to 45 minutes.

Chemical cardioversion

Chemical cardioversion is usually done in a hospital. The medicine usually is put into your arm through a tube called an IV. But you may be given medicines to take by mouth.

When you get the medicine, you may feel a quick sting or pinch when the IV is started. The procedure usually takes about 4 to 8 hours.

What can you expect after cardioversion?

You can usually go home the same day. You may need someone to drive you home.
Your doctor may have you take medicines daily to help your heart beat normally and to prevent blood clots.
After electrical cardioversion, you may have redness, like a sunburn, where the paddles were.
Abnormal heart rhythms sometimes return after cardioversion.

Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor if you are having problems. It's also a good idea to know your test results and keep a list of the medicines you take.

Electrical Cardioversion: Before Your Procedure

What is electrical cardioversion?

Electrical cardioversion is a treatment for an abnormal heartbeat (heart rhythm), such as atrial fibrillation. It uses a brief electrical shock to reset your heart's rhythm.

Before the treatment, a doctor or nurse will give you medicine to make you sleepy. You should not feel any pain.

Your doctor will put paddles or patches on your chest, or on your chest and back. These carry a brief electric current to your heart. In most cases, this restores the heart's normal rhythm right away.

Cardioversion itself only takes about 5 minutes, but the whole procedure, including recovery, will probably take about 30 to 45 minutes.

Abnormal heart rhythms sometimes return after cardioversion. You may need to take medicines to help your heart keep its normal rhythm.

What happens before the procedure?

Having a procedure can be stressful. This information will help you understand what you can expect and how to safely prepare for your procedure.

Preparing for the procedure

Bring a list of questions to ask your doctors. It is important that you understand exactly what procedure is planned, the risks, benefits, and other options before your procedure.
Tell your doctors ALL the medicines, vitamins, supplements, and herbal remedies you take. Some of these can increase the risk of bleeding or interact with anesthesia. Your doctor will tell you which medicines to take or stop before your procedure.
If you take blood thinners, such as warfarin (Coumadin), clopidogrel (Plavix), or aspirin, be sure to talk to your doctor. He or she will tell you if you should stop taking these medicines before your procedure. Make sure that you understand exactly what your doctor wants you to do.
You may need to stop taking certain medicines a week or more before your procedure, so talk to your doctor as soon as you can.

Taking care of yourself before the procedure

Build healthy habits into your life. Changes are best made several weeks before the procedure, since your body may react to sudden changes in your habits.

Stay as active as you can.
Eat a healthy diet.
Cut back or quit alcohol and tobacco.

If you have an advance directive—which may include a living will and a durable power of attorney for health care—let your doctor know. If you do not have one, you may want to prepare one so your doctor and loved ones know your health care wishes. Doctors recommend that everyone prepare these papers before a procedure, regardless of the type of procedure or condition.

What happens on the day of the procedure?

Follow the instructions exactly about when to stop eating and drinking, or your procedure may be canceled. If your doctor has instructed you to take your medicines on the day of the procedure, please do so using only a sip of water.
Take a bath or shower before you come in for your procedure. Do not apply lotions, perfumes, deodorants, or nail polish.
Remove all jewelry, piercings, and contact lenses.
Leave your valuables at home.

At the hospital or surgery center

Bring a picture ID.
A small tube (IV) may be placed in a vein, to give you fluids and medicine to help you relax.
You will lie down on a table. The doctor or nurse may place small electrode patches on your skin. You will also have a cuff around your arm that will regularly squeeze your arm and check your blood pressure.
You will get medicine to make you sleepy. You should not feel any pain.
As you wake up in the recovery room, the nurse will check to be sure you are stable and comfortable. It is important for you to tell your doctor and nurse how you feel and ask questions about any concerns you may have.

Going home

You will probably be able to go home after the medicine to relax you wears off. This is usually about 30 minutes after the procedure, but it may be longer.
You will need someone to drive you home.
If your doctor has prescribed medicines to prevent blood clots (blood thinners), you may need to take them for several months or longer.
You will be given more specific instructions about recovering from your procedure, including activity and when you may return to work.

When should you call your doctor?

You have questions or concerns.
You don’t understand how to prepare for your procedure.
You become ill before the procedure (such as fever, flu, or a cold).

Cardioversion: After Your Visit

Your Care Instructions

Cardioversion is a treatment for an abnormal heartbeat, such as atrial fibrillation. In cardioversion, a brief electric shock is given to the heart to reset its rhythm. The shock comes through metal paddles or patches placed on the outside of your chest. Cardioversion usually restores the heartbeat to normal.

After the procedure, you may have redness, like a sunburn, where the paddles were. Do not drive until the day after a cardioversion. You can eat and drink when you feel ready to. Your doctor may have you take medicines daily to help the heart beat normally and to prevent blood clots. Your doctor may prescribe medicine before and after cardioversion to help keep your heart in a normal rhythm after the procedure.

Instead of electric cardioversion, your doctor may try to convert your heart to a normal rhythm using medicine given through a vein. This is usually done in a clinic or hospital.

Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor if you are having problems. It’s also a good idea to know your test results and keep a list of the medicines you take.

How can you care for yourself at home?

Medicines

Take your medicines exactly as prescribed. Call your doctor if you think you are having a problem with your medicine. You may take some of the following medicines:

Beta-blockers such as propranolol (Inderal), metoprolol (Lopressor), or carvedilol (Coreg).
Calcium channel blockers such as diltiazem (Cardizem) or verapamil (Calan).
Digoxin (Lanoxin).
Antiarrhythmic medicines such as amiodarone (Cordarone), procainamide, or flecainide (Tambocor).

You will get more details on the specific medicines your doctor prescribes.

If your doctor has given you blood thinners such as warfarin (Coumadin) to prevent blood clots, be sure to:

Take your medicine at the same time each day.
Talk with your doctor before you make any major changes to your diet or start a weight loss plan. The foods that you eat can affect how well blood thinners work for you.
Tell your dentist, pharmacist, and other health professionals that you take blood thinners.
Watch for unusual bruising or bleeding, such as blood in urine, maroon or black stools, or bleeding from the nose or gums.
Get regular blood tests to check how fast your blood clots.
Wear medical alert jewelry that says you take blood thinners. You can buy this at most drugstores.

Do not take any vitamins, over-the-counter medicines, or herbal products without talking to your doctor first.

Lifestyle changes

Do not smoke. Smoking increases your risk of stroke and heart attack. If you need help quitting, talk to your doctor about stop-smoking programs and medicines. These can increase your chances of quitting for good.
Limit alcohol to 2 drinks a day for men and 1 drink a day for women. Alcohol may interfere with blood thinners. It also increases your risk of falls, which can cause bruising and bleeding.
Limit or avoid caffeine (coffee, tea, and cola drinks) and other stimulants (decongestants, over-the-counter cold and flu medicines, and illegal substances) if your doctor says to. They can trigger heart problems.
If you are taking blood thinners, avoid sports or activities that could lead to injury. Make your home safe and take other measures to reduce your risk of falling. Always wear a seat belt while in a car.

Activity

If your doctor recommends it, get more exercise. Walking is a good choice. Bit by bit, increase the amount you walk every day. Try for 30 minutes on most days of the week. You also may want to swim, bike, or do other activities.
When you exercise, watch for signs that your heart is working too hard. You are pushing too hard if you cannot talk while you are exercising. If you become short of breath or dizzy or have chest pain, sit down and rest immediately.
If your doctor has not set you up with a cardiac rehabilitation program, talk to him or her about whether that is right for you. Cardiac rehab includes supervised exercise, help with diet and lifestyle changes, and emotional support. It may reduce your risk of future heart problems.
Check your pulse regularly. Place two fingers on the artery at the palm side of your wrist in line with your thumb. If your heartbeat seems uneven or fast, talk to your doctor.

When should you call for help?

Call 911 anytime you think you may need emergency care. For example, call if:

You have severe trouble breathing.
You cough up pink, foamy mucus and you have trouble breathing.
You have symptoms of a heart attack. These may include:

Chest pain or pressure, or a strange feeling in the chest.
Sweating.
Shortness of breath.
Nausea or vomiting.
Pain, pressure, or a strange feeling in the back, neck, jaw, or upper belly or in one or both shoulders or arms.
Lightheadedness or sudden weakness.
A fast or irregular heartbeat.

After you call 911, the operator may tell you to chew 1 adult-strength or 2 to 4 low-dose aspirin. Wait for an ambulance. Do not try to drive yourself.

You have signs of a stroke. These may include:

Sudden numbness, paralysis, or weakness in your face, arm, or leg, especially on only one side of your body.
New problems with walking or balance.
Sudden vision changes.
Drooling or slurred speech.
New problems speaking or understanding simple statements, or feeling confused.
A sudden, severe headache that is different from past headaches.

You cough up blood.
You vomit blood or what looks like coffee grounds.
You pass maroon or very bloody stools.
You passed out (lost consciousness).

Call your doctor now or seek immediate medical care if:

You have new or increased shortness of breath.
You are dizzy or lightheaded, or you feel like you may faint.
You have sudden weight gain, such as 3 pounds or more in 2 to 3 days.
You have increased swelling in your legs, ankles, or feet.
You have new bruises or blood spots under your skin.
You have a nosebleed.
Your gums bleed when you brush your teeth.
You have blood in your urine.
Your stools are black and tarlike or have streaks of blood.
You have vaginal bleeding when you are not having your period, or heavy period bleeding.

Watch closely for changes in your health, and be sure to contact your doctor if you have any problems.