written by: Cordie Kellerman
• edited by: Leigh A. Zaykoski
• updated: 5/21/2011
Some heart arrhythmias are not an immediate threat to a patient's life but could cause serious damage if allowed to continue long term. In these cases, the patient's cardiologist may recommend an elective (non-emergency) cardioversion.
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A cardioversion is a procedure that returns an irregularly beating heart (arrhythmia) to a normal (sinus) rhythm. To do this, a carefully controlled electrical impulse is delivered to the heart.
Heart arrhythmias are not unusual and many are not serious and require no treatment. However, some have the potential to cause substantial damage, and others can be fatal. Life-threatening arrhythmias are handled as emergencies, but others can be responded to with less urgency. Sometimes medication can be used to restore a sinus rhythm, but sometimes the best treatment is a cardioversion. When a cardioversion procedure is used in a non-emergency situation, it is called an elective cardioversion.
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Purpose of an Elective Cardioversion
This procedure is most often used when the patient's arrhythmia is either atrial fibrillation or atrial Flutter. These conditions involve the upper chambers (the atria) of the heart and usually are not immediately life threatening. Sometimes the patient has no symptoms or only mild ones, but symptoms can be quite distressing. They can include extreme shortness of breath, debilitating fatigue, and a very fast heart rate.
A normal, regular heartbeat is needed to properly circulate blood into and out of the heart. Inadequate circulation will deprive tissues and organs throughout the body of oxygen. In addition to oxygen deprivation, inadequate circulation increases the risk of blood clot formation. Blood clots can cause organ damage. If the damaged organ is the brain, it is called a stroke. If a very fast heartbeat is allowed to continue for a long time, the heart muscle itself can become weakened which can lead to heart failure.
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Preparation for an Elective Cardioversion
A cardiologist will do an initial assessment that will establish whether this procedure is the best treatment for the patient's condition. The assessment will include an EKG and blood tests. It may also include a search for blood clots in the heart with a special ultrasound test. The patient may be put on an anti-coagulation drug (such as Coumadin). This will help protect from clotting before and during the procedure.
The patient should have nothing to eat or drink for 6 or more hours before the procedure, although it may be permissible to take normal medications with a small sip of water. The doctor will instruct the patient on any medications (prescribed or over-the-counter) that must be discontinued. If the procedure is being done outpatient, the patient should make arrangements for someone to drive him home.
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What to Expect During the Procedure
The procedure is fairly short. It typically takes only 15 to 30 minutes.
A nurse will insert an intravenous line so that an anesthetic can be delivered during the procedure. Soft pads will be placed on the patients chest. Electrodes are embedded in the pads and are also attached to a nearby machine. The anesthetic will be delivered to the patient through the IV and the patient will sleep during the next step of the procedure.The patient will be comfortable and feel nothing.
The machine will be activated and an electrical impulse will be delivered to the patients heart through the electrodes in the pads. Usually a single impulse is enough to restore the heart to a normal rhythm but occasionally the process must be repeated several times. Often the additional impulses are slightly stronger than the first. The patient will be carefully monitored throughout the procedure.
After the last electrical impulse is delivered, the anesthetic will be stopped and the patient will awaken. The patient is generally asleep less than ten minutes.
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What to Expect After the Procedure
The patient will be monitored closely for 2 to 3 hours after the procedure. He will usually be able to eat and drink soon after he is fully awake. Frequently the patient has no after-effects from the procedure at all. Sometimes he will experience some soreness in his chest. Occasionally the area where the pads were paced becomes irritated. A topical medication will relieve the irritation.
Because of the general anesthetic, the patient will be somewhat drowsy for the rest of the day. For this reason he should not drive a car or operate any heavy machinery until the following day.
The cardiologist may want the patient to continue to take the anti-coagulation drug that was started before the procedure. She may also prescribe an anti-arrhythmic drug to prevent the abnormal heartbeat from returning. The patient may be instructed to take these medications for only a few weeks or months, or he may need to stay on them permanently.
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Risks of the Procedure
Sometimes the cardioversion is not successful and the abnormal rhythm cannot be stopped by this method. Occasionally it is successful, but not long lasting. In these cases, the patient may be given medication to try to control the arrhythmia. The procedure may be scheduled again. If the arrhythmia cannot be controlled, then a pacemaker or defibrillator may be implanted, usually under the patient's collarbone. Both of these medical devices use electrical impulses to regulate the rhythm of the heart and remain always ready to respond to an arrhythmia.
Rarely, serious complications may occur as a result of a cardioversion. These include permanent damage to the heart muscle or blood clots that can travel through the blood stream to cause organ damage, esp stroke.
Typically, an elective cardioversion is successful and the patient feels better since any symptoms caused by the arrhythmia are gone.