What do I need to know about electrocardioversion? 

Using Electrical Cardioversion for AFib

“Electrical cardioversion” is a process that shocks the heart to convert it from an irregular pumping rhythm back into a normal sinus rhythm.

The EKG illustration shows what the heart rhythm looks like before and after cardioversion.

Using Electrical Cardioversion for AFib

When is Electrical Cardioversion Considered an Option?

Patients who have recently begun to have atrial fibrillation that isn’t stopping on its own (known as persistent atrial fibrillation) may be encouraged to try electrical cardioversion early in the process to stop the AFib and put the heart back into normal sinus rhythm.

For other AFib patients, electrical cardioversion may not be tried until later, when medication has stopped working.

While electrical cardioversion may be effective at converting the heart back into normal sinus rhythm, most people with persistent or recurring AFib will find that a cardioversion procedure is only a temporary solution for the sinus rhythm problem.

What to Expect From Electrical Cardioversion

Preparation for the Procedure

Clot Prevention: First, to avoid having blood clots break free during this procedure, you may take anticoagulants (warfarin, Coumadin®, or one of the NOAC -non-VKA oral anticoagulants) for three to four weeks before the procedure to eliminate your risk of blood clots.

Possible Visual Inspection: If you can't take anticoagulants, you may have a transesophogeal echocardiogram (TEE) in which you are sedated so a narrow tube containing an ultrasound imaging device can be inserted into your throat to ensure there are no existing blood clots in your heart. Sometimes the view taken from your esophagus provides the best look at the heart chambers.Mostly likely your doctor will tell you not to have anything by mouth after midnight the night before the procedure.

Sedation for The Procedure: You will have your electrical cardioversion in the electrophysiology (EP) lab or suite. Once you arrive, you will be fitted with an IV for receiving medications and fluids and connected to monitors so the doctor can see what is happening with you. When it's time for the procedure to begin, you'll be given a medication intravenously to put you to sleep.

Use of External Paddles: Once you're asleep, the doctor will use the defibrillator / cardioverter / pacemaker machine to give your heart a jolt of energy that will be delivered through paddles or EKG-type patches placed on the front and back of the chest. This electric shock should restore your normal heart rhythm, and may be repeated several times during a single procedure.

Internal Leads: If external cardioversion fails, then internal cardioversion may be done and involves delivering the jolt of energy through catheters inside the heart.

Recovery and Release or Discharge: Once you wake up following the electrical cardioversion, you can go home, but will need to have someone drive you. For a few days following the procedure, you may find that your chest is tender or your skin may have red patches.

After the electrical cardioversion, you may be on an antiarrhythmic drug, a rhythm control medication that should keep the heart in normal sinus rhythm. You will also remain on an anticoagulant, such as warfarin, Coumadin®, or the newer oral anticoagulants available to prevent blood clots.

Risks from Electrical Cardioversion

Electrical cardioversion risks include:

  • skin burns
  • fluid in the lungs
  • heart attack, stroke, or - as with most procedures - death

Success Rates for Electrical Cardioversion

Procedural Success: Various studies have reported that electrical cardioversion is over 90 percent effective in helping people return to a normal sinus rhythm during the procedure. However, many people revert back into AFib shortly thereafter. Success has been shown to be enhanced when patients are on an antiarrhythmic drug beforehand, which helps prevent reverting back to AFib.

Long-term Rhythm Maintenance Success: Continued success can depend on the size of the left atrium as well as how long the patient has been in AFib. Patients who have a very large left atrium (one greater than 5 cm) or those who have been in constant AFib for a year or two, may find that electrical cardioversion is not effective in either converting to or maintaining a normal sinus rhythm.

Although rhythm maintenance is not the only concern to be addressed for people with AFib, it is a significant one. It may also be important to note that getting back into a normal sinus rhythm may not affect your stroke risks.

Following a successful electrical cardioversion, only about 20–30 percent of patients who are not taking additional rhythm controlling medications will continue to maintain normal sinus rhythm throughout the first year. The overall likelihood of reverting back into atrial fibrillation is also quite high for those who are taking rhythm control drugs.

Outcomes for People with Sleep Apnea: We know that AFib patients with untreated sleep apnea are more likely to revert back into AFib after electrical cardioversion than AFb patients without sleep apnea. The possibility of sleep apnea might be something to investigate if you have had unsuccessful cardioversions.

What’s Next? When neither medication nor electrical cardioversion yields long-term success, then catheter ablation or surgical ablation may be next for consideration in an attempt to manage and cure your AFib.

Recent Discussions From The Providers Office Forum
Spencer avatar

OK.  Now, I didn't do it not to say that I didn't think it... but my cardiac doc broke his should.  Remember this doc - yelled at me when asking about other options, performed a cardioversion on me after I told him that I didn't approve one, and cooed about how intelligent and talented he was after my last ablation and then I had a heart attack 3 days later.  Well - he is out.  My ablation was moved from 4 Apr to 5 Apr and I have a new doc.  But, I will not be allowed to meet with this doc until I am on the OR table. I tried to get some info but since this is all military, there is zero records online.  The doc could have multiple malpractice claims against him, or have terrible success with ablations.  I don't know.  I only know that he is a doc and that is about it.  

So I will be operated on for cardiac surgery by someone that I don't know and won't meet until the moment before I am put under.  I have gotten worse from every single operation in this clinic and my symtpoms have gone from annoyance to debilitating and life threathening.  I can't back out as my VA benefits could be denied because I am not doing what is being perscribed.  So I's @@#$@ again.  Par for the course.


Waiting for my Sunrise

Blkat131 avatar

Hello all,

I was recently diagnosed with afib/rvr, and my doctor ordered a pocket ecg for one month. I am not taking any drugs for this condition, as I could not tolerate them, not because I didn't want to. Anyhow the cardiologist office just called and gave me an appointment on Tuesday due to an alert they received overnight from my monitor, but did not tell me what it was specifically. Does anyone here have experience with these monitors or know why an alert would be generated?  I had a short spike in hr up to about 130 which quickly resolved, and later woke in the middle of the night with my heart thumping like crazy, not high rate but very irregular. Now of course Im even more anxious than I was, waiting for a call back from a nurse. Thanks for any insights.


cowlady1 avatar

I am interested in knowing how many of you are seeing an EP rather than a cardiologist...I have been in SNR since my diagnosis in early November.  Cardiologist never put me on a monitor and I found him to be dismissive and distracted.  If episodes were caused by holiday heart syndrome (which are his thoughts) does this mean I will be on drugs forever? 

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