What is cardioversion?
Cardioversion is a medical procedure used to restore a normal heart rhythm in individuals with abnormal heartbeats (arrhythmias), such as atrial fibrillation (AFib or AF).
There are two types of cardioversion:
- Electrical cardioversion: this involves delivering a controlled electrical shock to the heart through paddles or patches placed on the chest. The shock helps reset the heart's rhythm to normal and is usually performed under sedation to ensure the patient does not feel pain.
- Pharmacological (chemical) cardioversion: medications known as antiarrhythmics are administered orally or intravenously to help restore a normal heart rhythm. This method is typically used when electrical cardioversion is not necessary.
When is cardioversion needed?
Cardioversion is recommended for individuals with arrhythmias such as:
- Atrial fibrillation (AFib): the most common reason for cardioversion.
- Atrial flutter: a rhythm disorder similar to AFib.
Cardioversion is generally a scheduled procedure, but can also be performed in an emergency if the arrhythmia is causing severe symptoms. It is different from defibrillation, which is used in life-threatening cardiac arrest situations.
What are the benefits of cardioversion:
Cardioversion is a medical procedure used to restore a normal heart rhythm in people with certain types of abnormal heartbeats (arrhythmias), most commonly atrial fibrillation (AFib). The main benefits of cardioversion include:
- Converts an abnormal heart rhythm (like AFib or atrial flutter) back to a normal sinus rhythm.
- Helps the heart pump blood more effectively.
Reduces or eliminates symptoms such as:
- Palpitations
- Shortness of breath
- Dizziness or fatigue
- Chest discomfort
Many patients experience significant improvements in energy levels and exercise capacity after successful cardioversion.
Long-standing arrhythmias may weaken the heart over time. Restoring normal rhythm may reduce the risk of cardiomyopathy or heart failure.
Although cardioversion itself doesn't eliminate stroke risk, maintaining sinus rhythm alongside proper anticoagulation or implantation of a LAAC can lower the long-term risk of stroke compared to persistent AFib.
What are the risks of cardioversion:
There are some risks associated with having a cardioversion including:
AFib can cause blood clots in the heart, which may be dislodged during cardioversion and travel to the brain, leading to a stroke. To reduce this risk, patients may need to take blood thinners (anticoagulants) like warfarin, apixaban, or rivaroxaban before and after the procedure.
In rare cases, cardioversion can cause a dangerous arrhythmia. This is why the procedure is done in a controlled hospital setting with emergency equipment nearby.
The electrical shock can cause minor skin burns or irritation where the patches were placed.
Rarely, cardioversion can lead to low blood pressure or worsen existing heart failure symptoms.
What happens before the procedure?
Patients may be asked not to eat or drink for 6–8 hours before electrical cardioversion.
If a person has had AFib for more than 48 hours, they will likely need to take blood thinners for at least 3 weeks before and 4 weeks after to reduce stroke risk.
Doctors may order an echocardiogram (ultrasound of the heart) to check for blood clots.
What happens after the procedure?
- Patients usually wake up within minutes if sedated for electrical cardioversion.
- Heart rhythm is monitored for a short time before going home.
- Some people may feel tired or sore for a day or two.
- Blood thinners and medications to maintain a normal rhythm (like beta-blockers or antiarrhythmics) may be prescribed.
Effectiveness and outcomes following cardioversion
In most cases, cardioversion quickly restores a regular heart rhythm. But some people may need more treatments to keep the regular rhythm.
Your care team may also ask you to make lifestyle changes to improve your heart health, lower high blood pressure and reduce any other potential causes that may cause irregular heartbeats.
Try these heart-healthy tips:
- Do not smoke or use tobacco.
- Eat a healthy diet.
- Get regular exercise
- Keep a healthy weight.
- Get 7 to 8 hours of sleep daily.
- Reduce emotional stress.
More questions about cardioversion?
Learn more about cardioversion in the management of atrial fibrillation.
