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By Lila Havens, HealthAtoZ Writer
In atrial fibrillation, the heart's upper chambers (atria) quiver instead of beating in the orderly way needed to pump blood efficiently. This can allow blood to pool in the heart and form clots, which increases the risk of stroke.
If you have recently been diagnosed with atrial fibrillation, your doctor may suggest cardioversion to reset your heart rhythm to normal. Returning the heart to a normal rhythm can lower your risk of stroke. It can also reduce unpleasant symptoms.
How is it done?
There are two types of cardioversion:
- Electrical cardioversion uses an electric shock to jolt your heart into a normal rhythm. A doctor gives the shock using wires or paddles applied to your chest or a wire threaded into your heart. You will be given a sedative to make you sleep for the few minutes it takes to do the procedure.
- Pharmacologic cardioversion uses rhythm-control medicines (anti-arrhythmics) to get your heart rhythm back to normal. These may be swallowed or put directly into a vein using an IV line. You can be awake during this procedure.
Most people take a blood-thinning medicine (anticoagulant) such as Coumadin for at least a month after cardioversion. This helps prevent clots and reduce the risk of stroke.
Some people may take rhythm-control medicines after cardioversion to help maintain a normal heart rhythm.
How well does it work?
Cardioversion usually restores the heart to a normal rhythm. In general, the less time you've had atrial fibrillation, the more likely it is that cardioversion will work.
Even when cardioversion works, the effects may not be long-lasting. Over time, the heart is likely to return to an abnormal rhythm. If this happens, you may be able to try cardioversion again. Or, you might take anticoagulants and rate-control medicines. Anticoagulants reduce the risk of stroke. Rate-control medicines keep your heart from beating dangerously fast.
What are the risks?
Stroke is the greatest risk. If you have a clot in your heart, there's a chance that cardioversion could dislodge it. The clot could travel through your bloodstream and block a blood vessel leading to the brain, causing a stroke. The risk of stroke is greatest if you've had atrial fibrillation for more than 48 hours.
To reduce the risk of stroke from cardioversion:
- You might take an anticoagulant medicine for a few weeks before the procedure.
- The doctor may do an echocardiogram before the procedure to check for the presence of clots.
In some cases, cardioversion doesn't work. It's less likely to work if:
- You've had several episodes of atrial fibrillation
- You've had atrial fibrillation for a long time
- You have long-term heart disease or a structural problem with your heart, such as mitral valve disease
There's a chance that cardioversion could make the irregular heartbeat worse, but this risk is generally low.
Your doctor can help you weigh the risks and benefits of cardioversion so you can decide if it's right for you.
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External Sources
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Fuster V, Ryden LE, Cannom DS, et al. ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation - executive summary. Circulation. 2006;114(7):700-752. Accessed November 28, 2007.
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McNamara RL, Tamariz LJ, Segal JB, Bass EB. Management of atrial fibrillation: Review of the evidence for the role of pharmacologic therapy, electrical cardioversion and echocardiography. Annals of Internal Medicine. 2003;139(12):1018-1033. Accessed November 29, 2007.
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Snow V, Weiss KB, LeFevre M, et al. Management of newly detected atrial fibrillation: A clinical practice guideline from the American Academy of Family Physicians and the American College of Physicians. Annals of Internal Medicine. 2003;139(12):1009-1017. Accessed November 28, 2007.
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