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Electrical cardioversion is a procedure in which an
electric current is used to reset the heart's rhythm back to its regular
pattern (normal sinus rhythm). The low-voltage electric current
enters the body through metal paddles or patches applied to the chest wall.
Before cardioversion for atrial fibrillation, you will be
given medicine to control pain and cause relaxation.
For nonemergency cardioversion, the timing of when you have it depends on how long you have had atrial fibrillation and your risk of having a stroke.1
In some cases, such as an emergency, your doctor might do a transesophageal echocardiogram before a cardioversion to see if you have a clot in your heart that could cause a stroke. Then your doctor can decide when it is safe for you to have cardioversion.
For help deciding if you should have electrical cardioversion, see:
cardioversion, you will be monitored to make sure that you have a stable heart
You will take an anticoagulant, such as warfarin, for at least a few weeks after your cardioversion. This medicine lowers your risk of a stroke.
Additional medicines to help prevent the return of heart
rhythm problems (antiarrhythmics) also may be given before and after the
procedure. Your risk of having atrial fibrillation again is greater if
antiarrhythmics are not used after cardioversion.
Cardioversion is used:2
The success of electrical
cardioversion depends on how long you have had atrial fibrillation and what is
causing it. Cardioversion is less successful if you have had atrial
fibrillation for longer than 1 year.1
After this treatment, about 9 out of 10 people get back a normal heart rhythm right away.3 But for many people, atrial fibrillation returns. Normal rhythm may last less
than a day or for weeks or months. It depends on your other health
Staying in a normal rhythm is more likely when the
cause of your rhythm problem is not heart disease. But for most people, atrial
fibrillation is caused by heart disease and is very
likely to return.
If your atrial fibrillation returns, you may be able to have
cardioversion again. But you might not stay in a normal rhythm for very long. If atrial fibrillation comes back quickly (within a week or
so), having cardioversion a third time, or more, is less likely to help you. Your doctor might recommend a different treatment, such as medicine, to get your heart rhythm back to normal.
antiarrhythmic medicines too, they can help you stay
in a normal rhythm longer.
Cardioversion may be less
successful or may not be recommended if you:
Cardioversion is more likely to be successful if:
Risks of the procedure include the
Cardioversion can also be done with medicines. These medicines are called rhythm control medicines, or antiarrhythmics. These medicines can also help keep your heart in a normal rhythm after it has been reset.
You may get pills, or the medicine may be put into your arm through a tube called an IV.
If an IV is used, it will be done in the hospital. You may start pills in the hospital and continue taking them at home, or you may start the pills at home.
Complete the special treatment information form (PDF)special treatment information form (PDF)(What is a PDF document?) to help you understand this treatment.
Fuster V, et al. (2011). 2011 ACCF/AHA/HRS focused update incorporated into the ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation: A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation, 123(10): e269–e367.
Kerber RE (2011). Indications and techniques of electrical defibrillation and cardioversion. In V Fuster et al., eds., Hurst's The Heart, 13th ed., vol. 1, pp. 1088–1093. New York: McGraw-Hill.
Morady F, Zipes DP (2012). Atrial fibrillation: Clinical features, mechanisms, and management. In RO Bonow et al., eds., Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine, 9th ed., vol. 1, pp. 825–844. Philadelphia: Saunders.
December 14, 2012
Rakesh K. Pai, MD, FACC - Cardiology, Electrophysiology & John M. Miller, MD, FACC - Cardiology, Electrophysiology
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