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.

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
Wayne avatar

I am a 78-year old male with persistent AFIB for about the last 20 years with only occasional instances of racing heart rate.  In 2010, I had open heart surgery to replace the aortic valve along with a triple by-pass and a cryo-maze procedure to correct the AFIB (the maze procedure only fixed the AFIB for about a month).  In my opinion, I have been doing very well and see my personal physician and cardiologist twice a year.  I keep a good record of my vitals on a weekly basis.  Every so often (2 to 3 times a year) I note that my heart rate (normally 68-70 BPM) while sleeping will dive to the 40's and 50's and stay at that lower rate for a week or two.  Neither of my doctors seem concerned about this.  During my discussion last week with my cardiologist, while discussing this issue, he stated that AFIB can result in low heart rates as well as high heart rates and talked about a pacemaker if and when the low heart rate situation warrants it.  I did not know that AFIB could cause low heart rates and would like to hear if others on this forum have expeienced low heart rates as a result of AFIB.  Thanks.

Trish avatar

Still sifting through the reams of info on ablation. Seems no real consensus on anything except that the centers that do the most have the best outcomes. Saw my lovely, warm dr yesterday for consult on ablation...when or if to do. He is outstanding and I was ready to pull the trigger on the procedure when he told me that since he is at a teaching hospital, his students(fellows) do the ablation with his oversight and correction when needed. I should have realized this but did not. So...the centers that do lots of ablations without student participation narrows the field considerably and let's out some of the major players. Please share any experiences. I am ready and will to travel but would prefer Miami/NYC area. Also, anyone out there have ablation at a teaching hospital?

Trish

Deb M avatar

I am going into the hospital next Wednesday for "tikosyn load". My doctor's office is not very forthcoming with information. Can anyone tell me what to expect? How is the load done and monitored? Is the load constant through IV or only at particular times? Do you have to actually lay in a bed for 3 days or can you get up and move around? Can you shower? What should you take to the hospital with you? Were you able to have visitors? How long before you can resume normal activies when you return home? Has being on this medication changed your life style?I would appreciate any advice anyone has. Thank you.

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