What is cardioversion (electrical conversion of the heart)

From the Guidelines

Cardioversion is a medical procedure used to restore a normal heart rhythm in patients with certain types of abnormal heart rhythms, particularly atrial fibrillation or atrial flutter, and is recommended as a method to restore sinus rhythm in patients with AF or atrial flutter as part of a rhythm-control strategy 1.

Definition and Purpose

Cardioversion involves delivering a controlled electric shock to the heart through paddles or patches placed on the chest, momentarily stopping the heart's electrical activity and allowing the natural pacemaker to reset and resume a normal rhythm.

Indications

The procedure is indicated for patients with AF or atrial flutter who have not responded to pharmacological therapies and have ongoing myocardial ischemia, hypotension, or heart failure, as well as for those with pre-excitation and hemodynamic instability 1.

Procedure

Cardioversion can be performed as an elective procedure with sedation to minimize discomfort or as an emergency treatment when arrhythmias cause severe symptoms.

Precautions

Before elective cardioversion, patients often take blood thinners for several weeks to prevent blood clots and may need a transesophageal echocardiogram to check for existing clots.

Outcomes

The procedure is generally quick, taking only a few minutes, with patients typically able to go home the same day, and while cardioversion is often successful immediately, some patients may need medication or repeated procedures to maintain a normal rhythm long-term, especially if they have underlying heart conditions that predispose them to arrhythmias. Some key points to consider when performing cardioversion include:

• The use of antiarrhythmic medications to increase the success rate of the procedure
• The importance of anticoagulation therapy to prevent thromboembolism
• The need for careful patient selection and evaluation before the procedure
• The potential for repeated procedures or medication to maintain a normal rhythm long-term 1.

From the Research

Definition of Cardioversion

• Cardioversion is a medical procedure used to convert an abnormal heart rhythm (arrhythmia) back to a normal rhythm [(2,3)].
• It can be performed using electrical or pharmacological methods 2.
• Electrical cardioversion (EC) involves the use of electrical shocks to restore a normal heart rhythm, while pharmacological cardioversion (PC) uses medications to achieve the same goal 2.

Types of Cardioversion

• Electrical cardioversion: involves the use of electrical shocks to convert an abnormal heart rhythm back to a normal rhythm [(2,3)].
• Pharmacological cardioversion: uses medications to convert an abnormal heart rhythm back to a normal rhythm [(2,3)].

Indications for Cardioversion

• Atrial fibrillation (AF) [(2,3,4)].
• Ventricular tachycardia (VT) [(3,4)].
• Other supraventricular arrhythmias 2.

Considerations for Cardioversion

• Qualification criteria for cardioversion include assessment of hemodynamic status, estimation of arrhythmic episode duration, evaluation of anticoagulation regimen, exclusion of other supraventricular arrhythmias, and assessment of the chance of rhythm conversion and persistence of sinus rhythm 2.
• The choice of adequate antiarrhythmic drug (AAD) depends on the presence of structural heart disease (SHD) and local experience 2.
• Safety should always prevail over the possibility of rhythm conversion due to the risk of ventricular proarrhythmia of AAD 2.