Can cardioversion (cardioversion procedure) cause chest pain?

Cardioversion Can Cause Chest Pain

Yes, cardioversion can cause chest pain in patients undergoing the procedure. According to guidelines, chest pain is a recognized side effect of electrical cardioversion, which may occur due to several mechanisms including muscle contractions, electrical stimulation, and potential myocardial injury 1.

Mechanisms of Chest Pain After Cardioversion

Chest pain following cardioversion can occur through several mechanisms:

1. Direct muscle stimulation:

   • The electrical current causes strong contractions of chest wall muscles
   • This can result in musculoskeletal chest pain that may persist for hours to days

2. Skin burns and electrode site pain:

   • Pain at the site of defibrillator pad placement is reported in approximately 6.6% of patients 2
   • Improper pad placement or excessive energy can increase this risk

3. Post-procedural discomfort:

   • Studies show that up to 53.8% of patients report some form of discomfort after cardioversion 3
   • Factors associated with greater discomfort include female gender and younger age

4. Rare but serious complications:

   • In rare cases, cardioversion can cause more serious complications that present with chest pain
   • There are documented cases of musculoskeletal injuries including compression fractures that can manifest as pain 4

Clinical Significance and Management

The European Heart Journal guidelines note that chest pain following cardioversion should be evaluated carefully to distinguish between benign musculoskeletal causes and potential cardiac complications 1:

• Benign causes (most common):

  • Musculoskeletal pain from muscle contractions
  • Electrode site discomfort
  • Transient post-procedural pain

• Serious causes (less common but important):

  • Myocardial injury
  • Pulmonary complications
  • Skeletal injuries

Risk Reduction Strategies

To minimize chest pain and discomfort during cardioversion:

1. Proper sedation and analgesia:

   • Propofol as a sole agent provides effective sedation with a low incidence of pain recall (only 0.4% of patients report severe pain) 2
   • Adequate sedation is essential as per anesthesia guidelines for cardioversion 5

2. Patient preparation:

   • Providing adequate information before the procedure decreases discomfort (OR = 0.16) and increases satisfaction (OR = 4.9) 3

3. Technical considerations:

   • Proper pad placement and appropriate energy selection
   • Biphasic shocks may cause less discomfort than monophasic shocks

When to Be Concerned

Chest pain after cardioversion warrants further evaluation when:

• Pain is severe, persistent, or worsening
• Pain is accompanied by dyspnea, hypotension, or ECG changes
• Pain is different from typical musculoskeletal discomfort

Conclusion

While cardioversion is generally considered a safe procedure, chest pain is a recognized side effect that occurs in a significant proportion of patients. Most cases represent benign musculoskeletal discomfort, but clinicians should remain vigilant for rare but serious complications that may present with chest pain. Proper patient preparation, adequate sedation, and appropriate technique can minimize this discomfort.