This blog post begins where my previous post left off. It was Saturday morning, November 26th. I had been in atrial flutter for almost 72 hours straight. My resting heart rate had fluctuated between 110 – 145 beats per minute over that time. When I entered the ER it was at 130 bpm.
Jump Ahead To:
Heading to the ER
I tried flecainide a couple of times to convert my heart to normal sinus rhythm, but nothing worked so we were heading to the ER for an electrical cardioversion (aka ECV). This would be my fifth cardioversion since I was first diagnosed with atrial fibrillation in 2006. My last cardioversion was back in 2014.
There were two things I was mostly concerned about as my wife was driving me to the ER. First, how busy (and miserable) would the ER be? I had visions of dozens of sick people coughing all over the place and lying around while I waited for hours to be called into a room. I don’t know why, but my mind always goes to the worst places. I’ve always been a bit of a “negative Nellie.”
My second concern was the cardioversion itself. My cardioversion experiences have been a mixed bag. None of them ever hurt, but a couple of them left a lasting impression.
For two of the cardioversions, the anesthesia they used didn’t knock me out completely. It left me in this strange semi-conscious state. It was like I was half asleep and half awake. I felt the thunderous jolt of the 300 joules of electricity, but it didn’t hurt at all. It’s hard to explain but it was like falling from a tall building and feeling the thud of hitting the ground but not feeling anything.
I remembered what Shannon of Afibbers.org had told me during the call I had with him the previous day. He assured me the cardioversion wasn’t a big deal and I had nothing to worry about. He told me to just enjoy the “pleasant propofol nap.” We both laughed about it. I’m glad he mentioned Propofol, however, because it would ensure my cardioversion would be a good experience.
Checking In at the ER
We got to the ER shortly before 8:00 am. It was so quiet in the ER that you could hear a pin drop. There was only one person in the waiting room. I was so relieved. It completely put my mind at ease.
I also forgot how heart patients usually get special treatment when they go to the ER. You tend to get rushed to a room regardless of how busy (or dead) the waiting room might be. When you tell them you have a resting heart rate of 130 bpm, which is what my resting heart rate was when we got there, you get immediate attention.
Before I could even finish explaining to them what my situation was, as soon as they heard me say I was in tachycardia with a resting heart rate of 130 bpm, they had me in the triage room. I was immediately given an ECG and all my vitals were checked. Within five minutes they had me in a room.
Getting Prepped for the Cardioversion
As soon as I got in the room, I was asked to take my coat, shirt, and shoes off and lie in the bed. Within minutes, the ER doctor came in and various nurses started filtering in as well. Everyone immediately went to work prepping for the cardioversion. Everything went so much faster than the cardioversions I’ve had in the past.
For my previous cardioversions they would always monitor me first for an hour or more before proceeding to do the cardioversion. And for a couple of my cardioversions, they injected me with various drugs to try to chemically convert me. I never responded to those chemical conversions. My heart laughed at whatever drugs they threw at it!
For one cardioversion I was monitored for almost four hours and given two or three different drugs before they finally relented and gave me the electrical cardioversion.
For this cardioversion, there was none of that. The doctor and nurses were all business. There was no monitoring or waiting around, and there were no drug experiments. It was just go-time for an electrical cardioversion.
Atrial Flutter was the “Official” Diagnosis
As the nurses were prepping for the procedure, the doctor explained to me what was going on with my heart. He said it wasn’t conclusive, but he was certain I was in atrial flutter and not sinus tachycardia. The only way he could give an accurate diagnosis was to administer adenosine.
When your heart rate is so fast it is difficult to provide an accurate diagnosis because the waves on an ECG that would confirm atrial flutter get “buried.” That’s how he explained it anyway. He said adenosine slows the heart way down so those waves can clearly be seen.
He went on to explain that for most patients, however, adenosine isn’t a pleasurable experience. He said it only lasts for about 15 seconds, but for those 15 seconds it makes you feel a strong sense of dread because it feels like your heart is going to stop. He said it isn’t painful at all, but most patients report that it isn’t a good feeling. Then he asked me if I wanted to do the adenosine to get a confirmed diagnosis.
Gee, doc. When you describe it like that, sign me up…lol!
I thought about it for a minute and declined. I didn’t need a confirmed diagnosis. As long as he was fairly certain it was atrial flutter that was good enough for me. Besides, what did it matter if it was sinus tachycardia or atrial flutter? All I cared about was getting it stopped!
My EP would later confirm it was indeed atrial flutter. My decision to skip the “adenosine experiment” was a good one.
The ER doctor then went on to explain the cardioversion process. I asked him what anesthesia they were going to use. I don’t recall the name of it, but it wasn’t Propofol. I started to panic because all I could think about were those two awful cardioversions I had where I was partially awake during the procedures. There was no way I was going to go through that again!
I sheepishly asked the doctor, “is it possible I could be given Propofol instead?” I further made my case, “because I didn’t do so well on other anesthesia in some of my previous cardioversions. I do best with Propofol.” O.K. I admit, I sort of made that last part up because until Shannon mentioned Propofol, I had no clue what it was, or if I had ever been given it before. I was just saying whatever I felt I had to say to convince the doctor to give me Propofol instead.
The doctor chuckled at my request but was glad to accommodate it. I believe his exact words were (as he chuckled a bit), “You want propofol? I don’t normally use it, but I have no problem using it if that’s what you want.”
I would love to talk to an anesthesiologist, or an ER doctor, to learn what the differences are among these anesthetic drugs, and why some ER’s use one type of drug while other ER’s use another type of drug. Regardless of what an ER uses, I will always request propofol moving forward because it’s a wonder drug!
Having My Chest Shaved
The doctor then stepped out of the room while a nurse prepped me for the procedure. One of the things he had to do was put two large thin pads on my chest and back. Getting a cardioversion isn’t anything like you see on TV. They don’t rub two paddles together and then put them on your chest and shock you. I imagine those kinds of cardioversions are reserved for emergencies.
These pads are more like thick stickers. One goes on your left chest and the other one goes on your left upper back. The pads sort of create a sandwich with your left chest in the middle. The electrical shock goes from one pad through to the other.
If you have a hairy chest like I do, they have to shave it in order for the pad to stick. I wasn’t embarrassed about being shaved because I knew the drill, but the nurse, who was a “guy’s guy,” felt bad and apologized that he had to shave me. He said, “Oh man, I hate to do this to you, but I have to shave you. I know it sucks but that’s the only way this pad is going to stick.” I assured him it was no big deal. Shave away!
For my previous cardioversions I always shaved my chest myself at home before going to the ER. It had been so many years since I had my last cardioversion that I totally forgot about it, so the poor nurse had to shave it for me.
How Many Joules Necessary to Convert?
With my chest shaved and the pads in place, it was almost time for the procedure. The doctor came back into the room with a few more nurses in tow. I asked the doctor how many joules he was going to hit me with.
He said they always start with 150 joules and if that doesn’t work, they go to 300 joules. I jokingly told him not to bother with 150 because that is never enough. I told him it always takes the full 300 joules. He chuckled again and thanked me for the tip.
I said it jokingly, but it was the truth. It always took 300 joules to convert my heart to normal sinus rhythm in my previous cardioversions. My heart scoffs at 150 joules.
Shortly after that exchange, all the prepping was completed. The doctor and nurses were in place and ready to go. When you have a cardioversion there is always a team of people in the room. I never keep track but it’s around 8-10 people. While some of them probably have things to do during the cardioversion, I imagine most of them are there just in case something goes wrong.
Let the Cardioversion Begin!
The doctor then asked the team if everyone was ready and then he proceeded to tell the anesthesiologist she could start the propofol. I jokingly said to her, “Please be generous with that. I don’t want to feel or remember anything!” Everyone in the room laughed.
I didn’t see her inject it, but I knew it was being administered and I’d be asleep any minute because the doctor suddenly started to have this random conversation with me. He asked me what I did for a living, if I had kids, what were their ages, where they went to school, etc.
I was all too familiar with this technique as every ER doctor has done this during my previous cardioversions. Presumably they do this so they know when the anesthesia has fully kicked in because you’ll stop talking and fall asleep.
It’s Over Already?
The next thing I knew I was slowly waking up. The room, that just moments ago was bustling with people and activity, was now completely silent. The only people left in the room now were my wife and one of the nurses who was typing notes into the computer. It was such a surreal experience.
I don’t remember this, but my wife told me that as I was coming to, I joked with the nurse, asking him how high my body jumped off the table during the cardioversion. He apparently got a kick out of it and joked back that I got some “good air,” and that, “I easily jumped a solid six inches or more.”
The cardioversion was a success. I was in normal sinus rhythm again with a resting heart rate of 72.
After an hour of resting in the room, a nurse came in and asked me how I was doing. I told her I felt great. She confirmed I looked well, and that all my vitals were great too. She said she would get the discharge papers and be back shortly so we could leave.
When she left, the ER doctor came in to tell me that everything went as smooth as could be. As I suspected, he said the first shock of 150 joules didn’t work. He had to shock me a second time with 300 joules to get my heart to convert. He asked me if I had any questions and then wished me well. He told me to be sure to follow up with my cardiologist.
Discharged from the ER
A few minutes later the nurse came back with my discharge papers, and said we were free to leave. I got dressed and just before we left the room my wife took this picture of me.
Of the five cardioversions I’ve had so far, this was by far the most pleasurable. We were in and out of the ER in just under two hours. I’ve never had a cardioversion go that fast. I was so glad I wasn’t in the hospital all day long as I feared might happen.
The other thing I was so happy about was I didn’t remember anything during the procedure. The propofol knocked me out cold. I had zero pain, zero feeling of anything, and didn’t experience any “mental trauma” of being awake during it. And there were no lingering side effects either. I felt totally normal within an hour of being injected with it. That’s why I call propofol a wonder drug!
I was starving since I couldn’t have anything to eat after midnight prior to the procedure. When we got home, I had some breakfast. As I reflected on the morning it was so strange. Just a couple of hours prior, my heart was beating out of my chest, and I was in the ER to have my heart shocked. Now I was sitting at the kitchen table eating breakfast like nothing happened. It was like a wild dream.
Share Your Cardioversion Experience
Have you had a cardioversion? If so, what was your experience like? Was it good or bad? Was it successful? Please share your cardioversion experience in the comments below.