“You want to do what?” she asked.  

“Because you have Atrial Fibrillation, I’d like to schedule you for an electrical cardioversion,” I said.

A middle-aged woman with Atrial Fibrillation was in my office.  She was suffering with symptoms of fatigue and breathlessness.  Her heart was racing at times and it was difficult to get controlled.  I felt should would best be served by getting her heart back into the normal rhythm. 

One way to do this is by giving a very mild electrical shock to the patient while they are under anesthesia.  Electrical Cardioversion is the name given to this procedure.

Many patients wonder, “Is this Dangerous?

It is a frequent question that concerns many patients.  Most people have watched movies or heard horrifying stories of people who have been electrocuted.  So it is understandable that that you might have a question if your cardiologist brings up the idea of scheduling you for this procedure.

First of all you should know that Electrical Cardioversion is very safe. 

Although medical studies have shown a minimal release of muscle enzymes from the heart with electrical cardioversion and rare need of temporary pacing, serious complications are unusual.  In my own experience of doing this procedure for over 20 years, I have never had a serious complication.

Perhaps the biggest worry is the release of blood clots from a pouch in the heart called the Left Atrial Appendage.  If a person has been in Atrial Fibrillation for more than 48 hours it is necessary that they be placed on warfarin (Coumadin®) prior to the cardioversion. 

The current recommendation from the American College of Cardiology is to anticoagulate patients with chronic AF for three to four weeks prior and for at least four weeks following cardioversion.  A different approach is to perform a TEE (Transesophageal Echocardiogram) to view the Left Atrial Appendage to make sure no clots are present before performing the procedure.

OK, I hope I’ve alleviated your fears about a cardioversion.

Why would my doctor want to do this procedure? 

The next issue that you might want to know is why is your heart doctor would want to perform this procedure?  Why would it be indicated?

You should know that cardiologists consider 2 different treatment strategies when approaching patients with atrial fibrillation. 

Rate Control vs Rhythm Control

Atrial Fibrillation is a heart condition where the heart rhythm is abnormal.  Rather than being controlled by the heart’s typical pacemaker cells- called the “Sinus Node” the rhythm is chaotic.  The electrical pattern is very marked irregular. 

Rhythm Control:  One approach in treating Atrial Fibrillation is controlling the rhythm, trying to get the heart back in the normal regular rhythm.  Cardiologists call this rhythm control.

Controlling the symptoms caused by AF is the reason most cardiologists recommend Rhythm Control. Returning a person’s heart to a normal rhythm will reduce symptoms for the vast majority of people.