A picture of me right after the cardioversion was completed.As someone that has battled a-fib since 2006, I’ve had my fair share of experiences with cardioversions. At the time of this writing, I’ve had five cardioversions. My most recent cardioversion was just a couple weeks ago!
Prior to my most recent cardioversion, it had been over eight years since I last had one. As a result, I was a bit rusty preparing for it. For my own sake, and for the sake of others who face a cardioversion, I thought I would put together some tips on how to prepare for a cardioversion.
If you want to skip right to the tips, click on the “8 Tips on How to Prepare for a Cardioversion” in the table of contents below. Otherwise, I’d like to provide some information about cardioversions in general before getting to the tips. I’d like to discuss:
What are cardioversions? What are the different types of cardioversions? Why would you have one, and how do you go about getting one? Is there a limit to the number of cardioversions you can have? I’ll dive into all of these questions and then finish with some useful tips on how to prepare for a cardioversion.
Jump Ahead To:
What are Cardioversions?
Cardioversions are an attempt to convert your heart from an abnormal heart rhythm (i.e. atrial fibrillation or atrial flutter) to a normal heart rhythm (NSR, or normal sinus rhythm).
It’s critical to understand that cardioversions are a short-term fix at best for atrial fibrillation or atrial flutter. Granted, temporary may mean a year or more, but for some it might only be for a few hours. I have heard from numerous people over the years who have had a cardioversion to stop their a-fib, only to have a-fib return just a few hours later. And for some people a cardioversion doesn’t even work.
What are the Different Types of Cardioversions?
There are two different types of cardioversions. There is an electrical cardioversion, also known as ECV, and a chemical cardioversion. An electrical cardioversion is done with electricity and a chemical cardioversion is done with drugs. The goal is to have the electrical current, or drug, convert your heart to normal sinus rhythm.
Electrical Cardioversion
An electrical cardioversion is done with an electrical shock to the heart. And no, it isn’t done the way you see them done on TV or in movies. This is NOT how electrical cardioversions are done:
This is NOT how they do an electrical cardioversion for a-fib or atrial flutter!Electrical cardioversions aren’t nearly as dramatic as that! Instead, the first thing they do is put small oxygen tubes in your nostrils. Then large thin pads are placed on your left chest and then another one on your left upper back. These pads are like thick large stickers that stick to your skin. Here is a close up of the one they placed on my chest:
This was taken after my cardioversion.You can see where the large pad was placed on my chest.
These two pads create a sandwich, if you will, with your chest in the middle as the “meat” of the sandwich. The electrical current passes from one pad to the other. When the electrical current passes through your chest, the idea is the jolt of electricity will literally shock your heart back to normal sinus rhythm.
They will usually use 150-200 joules first and then if that doesn’t work, they’ll shock you again with 300 joules. They usually don’t do more than two shocks, and I don’t think they ever go more than 300 joules.
You don’t feel any of this because you are given anesthesia. Propofol is my anesthesia of choice but there are others they use as well. What I like about propofol is that you are out completely during the cardioversion. One minute you’re awake and the next minute you are sound to sleep. Within minutes you are slowly waking up having no clue what just happened.
Other anesthesia will leave you partially awake. These make cardioversions way more traumatic than they need to be because you are awake and partially conscious. You just don’t feel any pain. I’m only slightly exaggerating but it’s sort of like falling off a skyscraper and being fully awake as you plunge to the ground. You see yourself hit the ground and you even feel the “thud” as you hit the ground, but there isn’t any pain. Sounds like fun, right?
When the cardioversion is about to take place, there is the doctor running the show and a team of nurses in the room. It’s a bit strange having an audience. During my five cardioversions, the number of people in the room has varied, but it’s been anywhere from 5-8 people.
I don’t think they all play a role during the cardioversion. I think most of them are there “just in case” something goes wrong. I imagine if you went into cardiac arrest or something they would all jump in and it would be an “all hands on deck” situation, but I honestly don’t know. All I know is that there is a team of people in the room during the cardioversion.
The whole process from beginning to end only takes about 20-30 minutes. Then there is about an hour of recovery time where they have you rest in your hospital bed while they observe you. After your brief recovery time, you’re discharged.
Chemical Cardioversion
I’ve only had a couple chemical cardioversion attempts. I say “attempts” because they never worked for me. Apparently, my heart only responds to massive amounts of electricity…lol.
Chemical cardioversions aren’t as complicating as electrical cardioversions. They don’t have to put pads on you because electricity isn’t involved, and you aren’t given any anesthesia. There also isn’t a team of people in the room. The doctor simply pumps you with a drug via your IV line and observes to see if your heart converts to normal sinus rhythm.
My experience and knowledge of chemical cardioversions is very limited so I can’t even tell you the names of the drugs they use, but these are obviously potent drugs and are administered at very high doses directly into your blood stream. The result is you experience a sudden rush of “something.”
I can’t really describe the feeling other than to say you definitely feel “something.” For example, for one of my chemical cardioversions the drug they used made me feel like I lifted a one-ton weight. It was a sudden intense feeling of exertion followed by an intense feeling of exhaustion. It lasted mere seconds. That’s how quickly the drug coursed through my body. Unfortunately, my heart didn’t respond. I remained in a-fib. They ended up doing an electrical cardioversion shortly after.
Why Would You Have a Cardioversion?
When your heart goes into atrial fibrillation or atrial flutter, the goal is always to get out of it and into normal sinus rhythm ASAP. It is never a good idea to stay in a-fib or atrial flutter.
If you stay in a-fib or atrial flutter for more than a couple days, your risk of stroke dramatically increases. And if you stay in a-fib or atrial flutter for months on end, you could end up with heart failure.
When your heart goes into a-fib or atrial flutter, one of two things is going to happen. Your heart is going to eventually convert to normal sinus rhythm on its own, or you’re going to have to intervene to convert it.
There are two ways you can intervene. One method is the “pill-in-the-pocket.” This is when you take a large dose of an antiarrhythmic drug such as flecainide when the a-fib episode begins. If you’re lucky, within hours the drug will slowly convert your heart to normal sinus.
If your heart doesn’t respond to the pill-in-the-pocket, then a cardioversion is your next best intervention method.
As I stated at the beginning of this blog post, even if a cardioversion is successful, it is a short-term fix. There may be a rare example of someone having a cardioversion and then never experiencing a-fib again, but that is the exception to the rule and not the norm!
A cardioversion is simply a quick fix while you work on a long-term fix for your atrial fibrillation. The long-term fix might be daily drugs, an ablation, lifestyle changes, or any combination of these. The point is, cardioversions are not a long-term fix.
Think of this analogy. Your house suddenly catches fire due to an electrical issue. The firemen come out to put out the fire so your house doesn’t burn down, but they don’t fix the root cause of the fire. They don’t fix the faulty electrical issue. For that, you need to have an electrician fix it.
The fire is the a-fib episode. The firemen putting out the fire is the cardioversion. The electrician fixing the electrical problem so a fire doesn’t occur in the first place is the long term fix – drugs, ablation, or lifestyle changes.
How Do You Go About Getting a Cardioversion?
The best way is to have one scheduled with your cardiologist. When you go into a-fib or atrial flutter you can call your cardiologist and tell him or her that you’d like to schedule a cardioversion ASAP. My cardiologist told me that they can usually get one scheduled within a day or two.
The other way to get a cardioversion, and the way I did it for all five of my cardioversions, is to go to the ER. When you check in you just tell them you’re in a-fib or atrial flutter and that you need a cardioversion. They will usually accommodate you quickly as they don’t mess around with heart issues.
For my latest cardioversion, I was given a room within minutes of checking into the ER and had the cardioversion done within an hour.
Keep in mind, going to the ER isn’t always the most convenient option. For me, heading to the best ER in my area requires a 25-minute drive into a seedy area of a large urban city. There is also no guarantee that they will get you in immediately. You may have to sit around the waiting room for a while. Who likes to sit around an ER waiting room with a bunch of sick and injured people? Nobody!
When you schedule a cardioversion, the process is so much more convenient and pleasant than going to the ER. You bypass the ER completely. You simply show up to the hospital shortly before your scheduled cardioversion and they check you into your room. Then they give you the cardioversion and you leave.
If it’s possible, always try to schedule a cardioversion, but if you can’t, then the ER is your only option.
Is There a Limit to the Number of Cardioversions You Can Have?
The short answer is no. The body is an amazing thing, isn’t it? You would think your heart would have a limit to the number of times it could be zapped with 150-300 joules of electricity but that apparently isn’t the case.
I know someone personally that has had 15 cardioversions without any ill effects. I’ve had five myself. One elderly woman sent me an email telling me she had “a couple dozen” cardioversions over the years! I don’t know if she was exaggerating, but the point is it is not uncommon for people with atrial fibrillation to have multiple cardioversions over their lifetime.
Even though there might not be a limit, it just doesn’t seem like it would be a good idea to have your heart shocked over and over again. This is another reason why you shouldn’t look to cardioversions as a long-term treatment. Do you really want to go to the hospital on a regular basis to have your heart shocked?
8 Tips on How to Prepare for an Electrical Cardioversion
The more you prepare, the more pleasant your cardioversion will be, if you can call any aspect of having a cardioversion, “pleasant.” No matter how you slice it, cardioversions just aren’t fun, but they don’t have to be a total pain in the butt if you are properly prepared.
1. Schedule Your Cardioversion
As I already mentioned, scheduling a cardioversion is far more convenient and pleasant than heading to the local ER. I’ve never had the pleasure of scheduling a cardioversion but now that I know my cardiologist can have one scheduled within a day or two, I will skip the ER moving forward if I can. When you go into a-fib or atrial flutter and you don’t convert to normal sinus rhythm on your own within 24 hours, call your cardiologist and get a cardioversion scheduled ASAP.
2. Have a Blood Thinner on Hand
This tip is crucial, but only applicable if you are not already on a daily blood thinner. You have a 48-hour window from the time you go into a-fib or atrial flutter before a cardioversion can be done without a blood thinner in your system. As soon as you are outside that window, they will not do a cardioversion without first running a tube down your throat to make sure your blood isn’t pooling in your heart, or without giving you a blood thinner and making you wait 24 hours or more until it takes effect. Neither option sounds fun, right?
To avoid all that hassle, have a blood thinner on hand. I always have a prescription of Eliquis handy. As soon as I go into a-fib or atrial flutter, I pop 5mg of Eliquis and then I stay on it until a week or more after my cardioversion. By doing this, it doesn’t matter if I have my cardioversion on day three or day five. I’ll be good to go to have a cardioversion anytime because I’ll have a blood thinner in my system.
3. No Eating or Drinking 6 Hours Before Your Cardioversion
They don’t want any food or liquid in your system when you have a cardioversion so the first thing they’ll ask you when you arrive is when you last ate or drank anything. If you tell them you just finished a pizza and a can of pop, you’ll be waiting for a while before they can give you a cardioversion.
I had my last cardioversion at around 9am so I stopped eating and drinking after midnight to make sure there would be no delays.
4. Shave Your Chest
If you’re a guy with a hairy chest like I have, they will have to shave your left chest so the pad will stick to your skin. It’s kind of awkward having a total stranger shave your chest. It’s especially awkward if another man is shaving your chest like I had…lol. You also have other stickers put on your chest. When they yank those off you get a free “wax job.”
To avoid all this, shave your chest in the comfort of your own home before heading to the hospital for your cardioversion! Here is a picture of my half shaven chest:
Notice my shaved chest and the outline where the pad was placed.5. Be Clean and Wear Clean Clothes
When you arrive to have your cardioversion, you’ll have to remove your shoes and shirt. They usually allow you to keep your pants and socks on. You’re also going to have an audience of about six people before and during the cardioversion. It’s a pretty humbling experience to be half naked in front of six or more strangers.
You don’t want to have smelly feet and holes in your socks! It’s one thing if it’s just you and your doctor, but you’re going to have several people in the room with you. For your own sake, and for the sake of those working on you, you’ll want to be clean and smell clean and have clean clothes on. Have some respect for yourself and those working on you.
6. Go to the Bathroom When You Get to the Hospital
I made the mistake of not going to the bathroom right before my last cardioversion. To make matters worse, I was sipping on water all morning long leading up to my cardioversion. I don’t know what I was thinking.
As soon as they had the IV in my arm, the oxygen tube in my nose, and all kinds of wires attached to me, I suddenly had to go to the bathroom really bad but that wasn’t an option at that point. I was really worried about peeing my pants during the cardioversion. Thankfully, that didn’t happen but when I woke up from my cardioversion, I really had to go but I still had to wait for a while until the anesthesia wore off. It wasn’t comfortable.
I should have gone to the bathroom one last time when I got to the hospital (and I shouldn’t have been sipping on water leading up to the cardioversion)!
7. Ask for Propofol
There are different types of anesthesia they use during a cardioversion. Propofol is very common but not always used. During my last cardioversion they didn’t normally use Propofol. I had to ask them to use it. Fortunately, they were more than happy to accommodate my request.
Why Propofol? The main reason is because it knocks you out completely. If administered properly, you will have zero recollection of your cardioversion. You’ll be awake one minute and then as soon as they give you the Propofol, you’ll be out like a light. Then minutes later you’ll slowly wake up having no idea what just happened. It is the most pleasant experience possible.
Other types of anesthesia may have you semi-conscious during the cardioversion. You’ll be half sleeping and half awake. To be honest, it’s a dreadful experience. You are partially awake during the entire cardioversion so you feel the “thud” of the jolt piercing through your body, but you have zero pain. Needless to say, I will never have a cardioversion again unless Propofol is used!
8. Request a Copy of Your ECG Scans
Whether you have a scheduled cardioversion or go to the ER to have one done, the first thing they will do is take an ECG to confirm what arrhythmia you are experiencing. They usually do another ECG after your cardioversion as well.
Before you leave the hospital, always ask for the physical copies of those ECG scans so you can take them with you along with your discharge papers. Most hospitals will not include these scans with your discharge papers. You have to request them.
You might be wondering why you would need them, especially if your cardiologist is associated with the hospital. One thing I’ve learned over the years is that it’s a good idea to get into the habit of always having hard copies of your medical records. By having physical copies, you not only have quick and easy access to them when you need to refer to them, but you can also quickly and easily share them with anyone you choose. You don’t have to deal with the bureaucracy and delays of making an official request to the hospital to have your medical records sent to you or your doctor.
Here is a real-world example of how having physical copies in your possession can come in handy. After I had my cardioversion, the EP (electrophysiologist) that is going to do my second ablation is in another state. He had no ties to my local hospital and didn’t have access to my medical records, but he wanted to see the ECGs before and after my cardioversion. Because I had copies in my possession, I was able to immediately email them to him directly so he could provide some insight and guidance.
Summary
Cardioversions are awesome because they provide instant relief from your atrial fibrillation or atrial flutter and almost always work. They also aren’t painful, and they won’t kill you.
The problem is they don’t last, and they aren’t a long-term fix. They provide temporary relief at best. They also aren’t terribly convenient or cheap.
Cardioversions are simply one of many tools to use in your atrial fibrillation or atrial flutter tool box. It’s just not the first tool you want to reach for if you have a-fib or atrial flutter. You hope other tools in your tool box will fix the problem, but sometimes cardioversions just can’t be avoided. Hopefully this blog post arms you with the information you need in case you do need to have a cardioversion.
Very interesting and well organized article. Helped me understand the cardioversion process. One suggestion is that you might define “EP” for those who are early in their Afib investigations. I was wondering what you think of automatic external defibrillators. I know these are designed for emergency cardiac arrest-type situations, but could they also be used to mitigate Afib? There are several automatic external defibrillators brands designed for home use.
Stuart:
Thanks for your comments. Good suggestion about defining EP. I will edit the article right after I leave this comment!
Regarding AED’s for a-fib, that isn’t going to work for a couple reasons. One, AEDs are designed NOT to deliver a shock for atrial fibrillation. And even if they were programmed to work with a-fib, it would be a horrible experience. AED’s deliver the same joules that you get in a hospital setting. Even at 200 joules you’d experience a pain you’d never want to experience again! There is a reason they put you under during a cardioversion.
AED’s are designed and used strictly for life threatening situations (i.e. cardiac arrest). While a-fib FEELS like a life-threatening event, it is not. You wouldn’t want to experience the painful shock of an AED nor would you want to be “shocking your heart” at home as needed. There would be all kinds of safety issues with that. As I mentioned in my article, when you have a cardioversion in the hospital, they have a literal team of people surrounding you during the cardioversion “just in case” something goes wrong. You wouldn’t have that safety net if you were using an AED at home!
In theory, however, a guy could use an AED to shock their heart back to normal sinus rhythm but for all the points I’ve highlighted in my comments here, it wouldn’t be a good idea. Having said that, I did run across an article a few years back where a guy in rural Australia or some other country grabbed his electric cattle fence in an attempt to convert his heart when he went into a-fib and it worked. Any sudden large shock to the heart has the potential to reset it. It’s just not a good idea to do so outside a hospital setting:)
Thanks,
Travis