Cardioversion is a procedure that realigns the heart’s electrical activity. This is achieved by passing a controlled electric shock through the chest, which is carried out using a short acting general anaesthetic so patients sleep throughout the procedure.
Why do I need a cardioversion?
Cardioversion is a treatment used to get the heart rhythm back to a normal pattern when it is beating irregularly – this is know as Atrial Fibrillation (AF) or Atrial Flutter.
Sometimes AF/Atrial Flutter can affect the pumping of heart and lead to fluid retention, breathlessness and tiredness. However not everyone experiences these symptoms and some people have no symptoms at all.
Will it work?
Restoring a normal rhythm is more likely to be successful if AF has been present for a short time and there is no enlargement of the heart chambers. Abstaining from alcohol and losing weight can improve the success rate. Whilst cardioversion is often successful on the day, AF can return, sometimes within a few days. The cardioversion can be repeated and some patients may require further medication.
What are the risks?
The risks are minimal. Cardioversions have been carried out routinely for many years and the procedure is generally very safe. Very rarely a blood clot, which can form within the heart chambers in AF, can dislodge causing a stroke. The risk of this is virtually eliminated by taking oral anticoagulation medication before and after the cardioversion. This may be warfarin, or a medication called a direct oral anticoagulant (DOAC) e.g. Edoxaban, Apixaban or Rivaroxaban.
Very rarely cardioversion can cause rhythm disturbance, so the procedure is carried out in the Cardiology Day Unit. Sometimes you may feel a slight discomfort on the surface of your chest following the procedure, this can be eased by using an aqueous cream and taking a standard pain killer such as paracetamol.
Anticoagulant therapy (blood thinner)
If you do not already take a tablet such as Warfarin or a DOAC this will need to be started and taken daily for a minimum of three to four weeks before cardioversion can be safely performed. The medication must be continued for a minimum of four weeks after cardioversion.
It is ESSENTIAL that you take the tablets every day and do not miss any doses. If doses are missed in the three weeks before the cardioversion, staff will have to postpone the procedure.
With Warfarin you will need to take your medication regularly as prescribed and have a blood test (INR) weekly to maintain the level between two and three. Warfarin prescribing and monitoring is carried out at a local health centre. The INR blood level needs to be above two every week for four weeks before cardioversion.
Digoxin medication
If you are on a tablet called Digoxin you should stop taking this 48 hours before your cardioversion. Please do not confuse this with an anticoagulant tablet as the names appear similar e.g. Edoxaban.
Preparing for the procedure
Advance blood test
At any point before your cardioversion you can call and speak with one of the nurses who perform the cardioversion procedure. They will be happy to answer any questions you may have regarding your treatment or the procedure.
A few days before your appointment for cardioversion you will be asked to attend the Cardiology Day Unit to have a blood test. This is a routine test to check your blood count, kidney and liver function and ensure the cardioversion is safe to proceed.
Please bring any medication you take and inform staff if you have diabetes.
You can ask staff for any details regarding what and when to take your daily tablets on the day of the cardioversion and check when you should last eat.
Day before and day of procedure
If there is any food in your stomach during your anaesthetic, it could come up into the back of your throat and then go into your lungs. This would cause choking or serious damage to your lungs.
To make sure your stomach is empty before your planned procedure, you must follow the rules about fasting:
- Eat meals as normal the night before your procedure.
- Eat a light breakfast ‘snack’ (a bowl of cereal or two slices of toast / biscuits or similar and a cup of tea, coffee or glass of milk).
- Breakfast must be completed six hours prior to your appointment. You are encouraged to drink clear fluids such as water, black tea or coffee throughout the morning until 11.30am. Thereafter sips of clear fluids are permissible until you attend your appointment.
- Take your medications as normal at the usual times unless otherwise informed.
- Do not chew gum or suck sweets before your procedure.
On the day of your cardioversion appointment, please go to the Cardiology Day Unit which is part of the Cardiology Unit on Level 1 of Forth Valley Royal Hospital.
You are advised to bring someone with you as you will be unable to drive home after your appointment which normally takes place around midday.
You will be seen by the healthcare staff who will perform the procedure (normally a nurse and an anaesthetist). It is necessary to have an ECG carried out and a small cannula is inserted into a vein for the anaesthetic drugs to be given. You will also be attached to a heart monitoring system and have your blood pressure and oxygen levels checked. This is routine and is for your safety during the anaesthetic and afterwards.
You will remain in a bed and be put to sleep for only a short time as the procedure is very quick.
After the procedure
You will remain in the Cardiology Day Unit for a few hours after the procedure and and given something to eat and drink when you are fully awake.
A member of the healthcare team will inform you if the cardioversion has been successful and arrange a follow up appointment for you to have an ECG after 4 weeks to assess if the heart stays in normal rhythm.
As you have had a general anaesthetic:
- You should not drive for 24 hours and so you need to arrange for someone to pick you up and take you home.
- Arrange to have someone with you at home the night after your procedure.
- You should not sign any legal documentation for 24 hours.
- You should not drink alcohol for 24 hours.
- You should have someone else in the house the night following
- your cardioversion so this should be arranged if you live alone.
- You should continue all medications unless informed otherwise.
Further information and contact details
If you have any questions about your appointment or are unable to attend for any reason please contact 01324 566964. If you have any questions about cardioversion and how you prepare for the procedure please contact the Cardiology Day Unit on 01324 567232.