Definition

Cardioversion refers to the process of restoring the heart's normal rhythm by applying a controlled electric shock to the exterior of the chest.

  Purpose

When the heart beats too fast, blood no longer circulates effectively in the body. Cardioversion is used to stop this abnormal beating so that the heart can begin normal rhythm and pump more efficiently.

  Precautions

Not all unusual heart rhythms (called arrhythmias) are dangerous or fatal. Atrial fibrillation and atrial flutter often revert to normal rhythms without the need for cardioversion. Healthcare providers may also try to correct the heart rhythm with medication or recommend a lifestyle change before trying cardioversion. However, ventricular tachycardia lasting more than 30 seconds and ventricular fibrillation require immediate cardioversion.

  Description

Elective cardioversion is usually scheduled ahead of time. After arriving at the hospital, an intravenous (IV) catheter will be placed in the arm and oxygen will be given through a face mask. A short-acting general anesthetic will be administered through the vein. During the two or three minutes of anesthesia, the doctor will apply two paddles to the exterior of the chest and administer the electric shock. It may be necessary to give the shock two or three times to obtain normal rhythm.

  Preparation

Medication to thin the blood is usually given for at least three weeks before elective cardioversion. Food intake should be stopped eight hours before the procedure.

  Aftercare

Medical personnel will monitor the heart rhythm for a few hours, after which the patient is usually sent home. It is advisable to arrange for transportation home, because drowsiness may last several hours. The doctor may prescribe anti-arrhythmic medication to prevent the abnormal rhythm from returning.

  Risks

Cardioverters have been in use for many years and the risks are few. Those unlikely risks that remain include those instances when the device delivers greater or lesser power than expected or when power setting and control knobs are not set correctly. Unfortunately, in a number of cases, the heart prefers its abnormal rhythm and reverts to it despite cardioversion.

Normal results

Most cardioversions are successful and, at least for a time, restore the normal heart rhythm.

   Key Terms:

Atrial fibrillation A condition in which the upper chamber of the heart quivers instead of pumping in an organized way. Atrial flutter A rapid pulsation of the upper chamber of the heart that interferes with normal function. Ventricular fibrillation A condition in which the lower chamber of the heart quivers instead of pumping in an organized way. Ventricular tachycardia A rapid heart beat, usually over 100 beats per minute.

   Resources:

Books

• McGoon, Michael D., ed. Mayo Clinic Heart Book: The Ultimate Guide to Heart Health. New York: William Morrow and Co., Inc., 1993.

Organizations

• American Heart Association. 7320 Greenville Ave. Dallas, TX 75231. (214) 373-6300. http://www.americanheart.org