Cardioversion

Cardioversion is a medical procedure done to restore the normal rhythm of the heart in people suffering from some type of arrhythmia (abnormal heartbeats).

Cardioversion can either be done using certain medications or by sending electric shocks to the heart by placing electrodes on the chest. Cardioversion is a pre-planned procedure that is done at the hospital. It is an outpatient procedure, that is, the patient can go home on the same day as the procedure. It normally restores the normal heart rhythm in most cases.

Types: The two types of cardioversion procedures include:
1. Chemical or pharmacologic cardioversion:
If the heart arrhythmia is not a medical emergency, the doctor will use medications to get the heart back to normal.
The medication is normally given through an IV (intravenously), that is, injected directly into a vein.
Sometimes, medication can be given orally in the form of a pill.
The type of medication used depends on the type of abnormal heart rhythm you may have and any other medical problems you may be having.
The different types of medications that may be used include Amiodarone, Dofetilide, Ibutilide, Flecainide, Propafenone.

2. Electrical cardioversion:
Medications alone may not be able to correct the heartbeat.
In electrical cardioversion, shocks are given through paddles for regulating your heartbeat.
Mild electric shocks help in getting your heart rhythm back to normal.

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Cardioversion is needed to get the heart rate and heart rhythm back to normal and allow the heart to pump the way that it should. 
The cardioversion procedure is performed when the heart rhythms are abnormal and the following symptoms are seen:

  • Shortness of breath
  • Chest discomfort
  • Fluttering or pounding feeling in the chest
  • Dizziness
  • Extreme fatigue

The above symptoms may indicate that the heart is not pumping enough blood to the body. Even if the symptoms are mild, it is important to get treatment, as without treatment it could lead to serious complications like a heart attack or stroke (the blood supply to the brain is stopped).

 

  1. Physical examination: The doctor will assess you physically. Your medical history and family history are noted by the doctor.

  2. Blood tests: This is a lab test to check the various elements in your blood. It also helps in diagnosing underlying medical conditions like diabetes and thyroid disorders.

  3. X-rays: A chest x-ray may help in checking any abnormalities that may be present in the heart, lungs, bones, and blood vessels.

  4. Echocardiogram (echo): An ultrasound is used to create images within the heart. This is done by using high-frequency sound waves.

  5. Electrocardiogram (EKG or ECG): This test measures the electrical activity of the heart, and helps in diagnosing the various heart disorders.

  6. Transesophageal echocardiogram: This test helps in checking for the presence of any blood clots in the heart. The blood clots can break free during cardioversion leading to life-threatening complications. In case of the presence of blood clots, the cardioversion procedure is delayed for three to four weeks. The doctor will prescribe blood-thinning medications during this time to reduce the risk of complications.

  1. Medications will be given through an IV (intravenously) to help you fall asleep during the procedure so that you do not experience any pain from the shocks.

  2. Several large patches are known as electrodes are placed on your chest.

  3. The electrodes are connected to a cardioversion machine known as a defibrillator using wires.

  4. The machine helps in recording the rhythm of your heart and delivering shocks to your heart for restoring a normal heart rhythm.

  5. This machine also helps in correcting the heart’s rhythm if it beats too slowly after a cardioversion procedure.

  6. The procedure takes only a few minutes to complete.

 

The complications involved with the cardioversion procedure include:

  • Headaches

  • Dizziness

  • Low blood pressure

  • Discomfort in the chest area

  • Allergic reactions to the medicines used

  • Blood clots

  • Organ damage

  • Stroke

  • Pain, bruising, or burning sensation in the area where the electrodes were used

  • Worsening of the arrhythmia

  • The cardioversion procedure is performed on an outpatient basis, which means you can go home on the same day the procedure has been performed.
  • You will be spending approximately an hour in the recovery room, and be closely monitored for complications.
  • Someone will be needed to drive you home.
  • You will feel drowsy for a couple of hours due to the medications given during the procedure.
  • It is normal to have some redness or soreness in the chest that may last for a few days after the procedure.
  • The doctor may prescribe hydrocortisone (corticosteroid) cream to be applied to the chest region to relieve the tenderness over the chest.
  • Even if no blood clots were found before the procedure, the doctor may recommend taking blood-thinning medications for several weeks after the procedure to prevent the formation of new blood clots.
  • The doctor will call you in a few weeks for an electrocardiogram to check if your heartbeat is still regular.

 

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Cardioversion

Cardioversion is a medical procedure done to restore the normal rhythm of the heart in people suffering from some type of arrhythmia (abnormal heartbeats).

Cardioversion can either be done using certain medications or by sending electric shocks to the heart by placing electrodes on the chest. Cardioversion is a pre-planned procedure that is done at the hospital. It is an outpatient procedure, that is, the patient can go home on the same day as the procedure. It normally restores the normal heart rhythm in most cases.

Types: The two types of cardioversion procedures include:
1. Chemical or pharmacologic cardioversion:
If the heart arrhythmia is not a medical emergency, the doctor will use medications to get the heart back to normal.
The medication is normally given through an IV (intravenously), that is, injected directly into a vein.
Sometimes, medication can be given orally in the form of a pill.
The type of medication used depends on the type of abnormal heart rhythm you may have and any other medical problems you may be having.
The different types of medications that may be used include Amiodarone, Dofetilide, Ibutilide, Flecainide, Propafenone.

2. Electrical cardioversion:
Medications alone may not be able to correct the heartbeat.
In electrical cardioversion, shocks are given through paddles for regulating your heartbeat.
Mild electric shocks help in getting your heart rhythm back to normal.

Symptoms

Cardioversion is needed to get the heart rate and heart rhythm back to normal and allow the heart to pump the way that it should. 
The cardioversion procedure is performed when the heart rhythms are abnormal and the following symptoms are seen:

  • Shortness of breath
  • Chest discomfort
  • Fluttering or pounding feeling in the chest
  • Dizziness
  • Extreme fatigue

The above symptoms may indicate that the heart is not pumping enough blood to the body. Even if the symptoms are mild, it is important to get treatment, as without treatment it could lead to serious complications like a heart attack or stroke (the blood supply to the brain is stopped).

 

Diagnosis

  1. Physical examination: The doctor will assess you physically. Your medical history and family history are noted by the doctor.

  2. Blood tests: This is a lab test to check the various elements in your blood. It also helps in diagnosing underlying medical conditions like diabetes and thyroid disorders.

  3. X-rays: A chest x-ray may help in checking any abnormalities that may be present in the heart, lungs, bones, and blood vessels.

  4. Echocardiogram (echo): An ultrasound is used to create images within the heart. This is done by using high-frequency sound waves.

  5. Electrocardiogram (EKG or ECG): This test measures the electrical activity of the heart, and helps in diagnosing the various heart disorders.

  6. Transesophageal echocardiogram: This test helps in checking for the presence of any blood clots in the heart. The blood clots can break free during cardioversion leading to life-threatening complications. In case of the presence of blood clots, the cardioversion procedure is delayed for three to four weeks. The doctor will prescribe blood-thinning medications during this time to reduce the risk of complications.

Treatment

  1. Medications will be given through an IV (intravenously) to help you fall asleep during the procedure so that you do not experience any pain from the shocks.

  2. Several large patches are known as electrodes are placed on your chest.

  3. The electrodes are connected to a cardioversion machine known as a defibrillator using wires.

  4. The machine helps in recording the rhythm of your heart and delivering shocks to your heart for restoring a normal heart rhythm.

  5. This machine also helps in correcting the heart’s rhythm if it beats too slowly after a cardioversion procedure.

  6. The procedure takes only a few minutes to complete.

 

Risks

The complications involved with the cardioversion procedure include:

  • Headaches

  • Dizziness

  • Low blood pressure

  • Discomfort in the chest area

  • Allergic reactions to the medicines used

  • Blood clots

  • Organ damage

  • Stroke

  • Pain, bruising, or burning sensation in the area where the electrodes were used

  • Worsening of the arrhythmia

After Procedure

  • The cardioversion procedure is performed on an outpatient basis, which means you can go home on the same day the procedure has been performed.
  • You will be spending approximately an hour in the recovery room, and be closely monitored for complications.
  • Someone will be needed to drive you home.
  • You will feel drowsy for a couple of hours due to the medications given during the procedure.
  • It is normal to have some redness or soreness in the chest that may last for a few days after the procedure.
  • The doctor may prescribe hydrocortisone (corticosteroid) cream to be applied to the chest region to relieve the tenderness over the chest.
  • Even if no blood clots were found before the procedure, the doctor may recommend taking blood-thinning medications for several weeks after the procedure to prevent the formation of new blood clots.
  • The doctor will call you in a few weeks for an electrocardiogram to check if your heartbeat is still regular.

 

FAQ Section

1) What is Cardioversion?

Cardioversion is the procedure done to correct cardiac arrhythmias, i.e. to bring abnormal heartbeat to normal rhythm. This is a condition where the heart is beating either very fast or irregularly. In electrical cardioversion procedure, high energy shock is sent to the heart, to reset the normal cardiac rhythm. In chemical cardioversion, medicines are used to restore the normal cardiac rhythm. 

 

2) What are the symptoms that require Cardioversion procedure?

The symptoms of Cardiac arrhythmias like- fainting, stroke, heart attack, cardiac death- require the procedure of Cardioversion.

 

3) When does a patient need electrical cardioversion?

The various abnormal heart rhythm conditions like- Atrial fibrillation, Atrial flutter, Supraventricular tachycardia ( VT ), Ventricular tachycardias, that cause the heart to beat too fast and pump less blood to the body, need electrical cardioversion. 

 

4) What are the other methods done to correct heart rhythm, before Cardioversion procedure is done?

The doctor tries to bring back the heart to normal rhythm by other methods, before opting for the electrical cardioversion method. These include- Valsalva maneuver and medicines. 

5) What are the risks of the electrical cardioversion?

The various risks of cardioversion procedure are- dangerous abnormal cardiac rhythm, low blood pressures, heart muscle damage, heart failure, skin damage, blood clot ( that may cause stroke, pulmonary embolism, etc ).

 

6) How is cardioversion procedure done ?

In this procedure, electric shocks are sent to the heart via the electrodes placed on the chest. The electrical currents reset the heart beat and correct the cardiac arrhythmias. Cardioversion is also done by using medicines. 

7) How long does a cardioversion procedure take?

The actual procedure takes only 5 minutes, however the entire process including the anesthesia, procedure and recovery takes around 30- 45 minutes.

 

8) What is the cost of Cardioversion in India?

The cost of Cardioversion in India varies across different cities and hospitals. 

Cost of Cardioversion in India
CITY COST
Cost of Cardioversion in Mumbai      INR 100000- INR 130000
Cost of Cardioversion in Bangalore INR 98000- INR 125000
Cost of Cardioversion in Delhi INR 98000- INR 125000
Cost of Cardioversion in Chennai INR 95000- INR 120000

 

9) Is cardioversion an invasive procedure?

Cardioversion is a non-invasive procedure where no cuts, no small punctures are given. The electrical shock is sent to the heart via electrodes placed on the chest, that changes the abnormal heart rhythm to normal heart beats.

 

10) What is the 48 hours rule for the cardioversion procedure?

The 48 hour rule for the cardioversion procedure means that there is a limit of 48 hours after the onset of atrial fibrillation (AF), to perform the cardioversion procedure without using the anticoagulant medications. 

 

11) What is the success rate of Cardioversion?

The success rate of Cardioversion with atrial fibrillation is about 90 percent and above. The success rate becomes less, if the atrial fibrillation lasts for more than several months or when the atrium is enlarged.