Cardioversion

Medical procedure to restore normal heart rhythm

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Diagram of electrical cardioversion

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Cardioversion is a medical procedure used to restore a normal heart rhythm in patients experiencing certain types of abnormal heartbeats, known as arrhythmias. The procedure can be performed using either electrical shocks or medications.

Types of Cardioversion

Electrical Cardioversion

Electrical cardioversion being performed.

Electrical cardioversion involves delivering a controlled electric shock to the heart through electrodes placed on the chest. This shock momentarily stops the heart's electrical activity, allowing the heart's natural pacemaker to restore a normal rhythm. The procedure is typically performed under sedation to ensure patient comfort.

Electrical cardioversion is often used to treat atrial fibrillation, atrial flutter, and other supraventricular tachycardias. The synchronization of the shock with the QRS complex on the electrocardiogram (ECG) is crucial to avoid inducing ventricular fibrillation.

LIFEPAK 20e Defibrillator and Monitor displaying synchronization with QRS complexes.

Pharmacological Cardioversion

Pharmacological cardioversion, also known as chemical cardioversion, involves the use of antiarrhythmic medications to restore normal heart rhythm. Commonly used drugs include amiodarone, flecainide, and propafenone. This method is often used when electrical cardioversion is not feasible or as a first-line treatment in certain cases.

Indications

Cardioversion is indicated for patients with symptomatic arrhythmias that do not resolve spontaneously and are not controlled by medications. It is particularly useful in cases of atrial fibrillation and atrial flutter, where restoring sinus rhythm can alleviate symptoms and reduce the risk of stroke.

Risks and Complications

While cardioversion is generally safe, it carries some risks, including:

• Thromboembolism: Patients with atrial fibrillation are at risk of forming blood clots, which can dislodge during cardioversion and cause a stroke. Anticoagulation therapy is often recommended before and after the procedure.
• Skin burns: The electrical shock can cause minor burns on the skin where the electrodes are placed.
• Arrhythmias: In rare cases, cardioversion can induce other arrhythmias, including ventricular fibrillation.

Preparation and Procedure

Before cardioversion, patients are typically evaluated with an ECG and may undergo transesophageal echocardiography to check for blood clots in the heart. Anticoagulation therapy is often initiated to reduce the risk of stroke.

During the procedure, the patient is sedated, and electrodes are placed on the chest. The defibrillator is set to deliver a synchronized shock, and the patient's heart rhythm is monitored throughout the process.

Aftercare

Following cardioversion, patients are monitored for any complications, and their heart rhythm is assessed to ensure the procedure was successful. Long-term management may include medications to maintain sinus rhythm and prevent recurrence of arrhythmias.

Also see

• Atrial fibrillation
• Defibrillation
• Electrocardiogram
• Antiarrhythmic agent

Cardiovascular disease A-Z

Most common cardiac diseases

• Cardiac arrhythmia‎
• Cardiogenetic disorders‎
• Cardiomegaly‎
• Cardiomyopathy‎
• Cardiopulmonary resuscitation‎
• Chronic rheumatic heart diseases‎
• Congenital heart defects‎
• Heart neoplasia‎
• Ischemic heart diseases‎
• Pericardial disorders
• Syndromes affecting the heart‎
• Valvular heart disease‎

A | B | C | D | E | F | G | H | I | J | K | L | M | N | O | P | Q | R | S | T | U | V | W | X | Y | Z

A

• Accelerated idioventricular rhythm
• Acute decompensated heart failure
• Arteriosclerotic heart disease
• Athletic heart syndrome
• Atrial flutter
• Atrioventricular fistula
• Cardiovascular disease in Australia
• Autoimmune heart disease

B

• Brown atrophy of the heart

C

• Ebb Cade
• Cardiac allograft vasculopathy
• Cardiac amyloidosis
• Cardiac asthma
• Cardiac tamponade
• Cardiogenic shock
• Cardiogeriatrics
• Cardiorenal syndrome
• Cardiotoxicity
• Carditis
• Coronary artery aneurysm
• Coronary artery anomaly
• Coronary artery disease
• Spontaneous coronary artery dissection
• Coronary artery ectasia
• Coronary occlusion
• Coronary steal
• Coronary thrombosis
• Coronary vasospasm
• Cœur en sabot
• Coxsackievirus-induced cardiomyopathy

D

• Duke Treadmill Score
• Duroziez's disease

E

• Eisenmenger's syndrome
• Embryocardia
• Endocardial fibroelastosis
• Eosinophilic myocarditis

H

• Heart attack
• Heart failure
• Heart failure with preserved ejection fraction
• Heart to Heart (1949 film)
• High-output heart failure
• Hyperdynamic precordium

A | B | C | D | E | F | G | H | I | J | K | L | M | N | O | P | Q | R | S | T | U | V | W | X | Y | Z

I

• Idiopathic giant-cell myocarditis
• Interventricular dyssynchrony
• Intraventricular dyssynchrony
• Isolated atrial amyloidosis

K

• Keshan disease

L

• Loeffler endocarditis

M

• Mydicar
• Myocardial bridge
• Myocardial disarray
• Myocardial rupture
• Myocardial scarring
• Myocardial stunning
• Myocarditis

N

• Nonbacterial thrombotic endocarditis

O

• OLR1
• Ostial disease

P

• Papillary fibroelastoma
• Pathophysiology of heart failure
• Postpericardiotomy syndrome
• Pulmonary vein stenosis

R

• Right axis deviation
• Roemheld syndrome

S

• Saturated fat and cardiovascular disease
• SCAR-Fc
• Shone's syndrome
• Strain pattern
• Subacute bacterial endocarditis
• Sudden cardiac death of athletes

A | B | C | D | E | F | G | H | I | J | K | L | M | N | O | P | Q | R | S | T | U | V | W | X | Y | Z

T

• Traumatic cardiac arrest

V

• Ventricular aneurysm
• Vibroacoustic disease
• Viral cardiomyopathy

W

• Waon therapy