What is a Cardioversion?

Patient Expert

We've all seen the dramatic scene, which is almost required for any heart patient on House, Grey's Anatomy, and even General Hospital ...shocking an unconscious patient back to life with "the paddles."

"Clear" shouts the doctor. Paddles applied. Patient jumps. Everyone looks worriedly at the monitor. Flat line. "Clear!" shouts the doctor again. Usually, after the third or fourth try, some kind of heart rhythm is restored and all breathe easier, especially the patient.

This kind of drama is exciting, but it has little to do with a standard medical procedure used often to help convert patients from irregular to normal heart rhythms, called an Electrocardioversion, or Cardioversion.

For one thing, a cardioversion doesn't use paddles. Rather, electrodes are placed on the patient's chest. And a cardioversion is not usually an emergency procedure. It is scheduled in advance, you go to the hospital to have it done, and you can probably leave the same day (actually, within an hour or two) for home.

For most people, a cardioversion quickly restores a normal heart rhythm. (Whether or not it stays that way is another topic.)    It is most frequently used for a heartbeat that's too fast ( tachycardia) or irregular ( fibrillation.)   Most frequenty, cardioversion is used to treat people with atrial fibrillation or flutter.

These kinds of irregular beats cause our hearts to beat ineffectively.   In the case of atrial fibrillation, for example, you can certainly live with the irregular beat. Many thousands, perhaps millions, of people do and most take medication to slow the heartbeat. (There is a debate about rate versus rhythm in Atrial Fibrillation, which is gist for another blog.)

Since I have had Atrial Fibrillation, and I have also been through a Cardioversion, I'd like to share my experience with this procedure so you won't worry about it unnecessarily if you or someone you love has to have one.

Once I was diagnosed with Atrial Fibrillation, it was only a matter of time until my cardiologist would try a Cardioversion. I say "a matter of time" because there are specific criteria that must be met before you can have a cardioversion (unless it is a true emergency.)

The biggest concern is that the shock to the heart may dislodge a blood clot and cause serious health risks. How to avoid this? If you are able to pinpoint exactly when your heart changed from a normal sinus rhythm to Atrial Fibrillation, and get to your doctor immediately, he or she can cardiovert right away without the use of blood thinning drugs.

However, if you are surprised that you are in Atrial Fib, as I was (I had felt breathless when going for my walks, and a strange tightness in my chest, but I attributed these new symptoms to stress) you must first take Coumadin (warfarin) and go through at least 3-4 weeks of being in INR ratio (your blood must be thinned between a 2-3 on the scale consistently before your doctor will do a cardioversion. For some, this can be a challenge, as blood thinning can be tricky and the body does not always adjust to it right away.

Because I changed cardiologists after my diagnosis, I had to begin all over again.   In my case I lived with Atrial Fib and coumadin for three months before my doctor attempted the cardioversion.

(Next time, all about my cardioversion experience. How did it feel?  Did it work? What did it mean?)