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Cardioversion for Atrial Fibrillation

Welcome to our comprehensive guide on cardioversion for atrial fibrillation (AF). In this article, we’ll delve into the essentials of cardioversion, including what it is, its success rates, and its advantages and disadvantages. If you’re considering or scheduled for cardioversion, this guide will provide you with valuable insights into the procedure. 

What is Cardioversion for Atrial Fibrillation?

Cardioversion is a procedure to restore the heart’s normal rhythm from an abnormal rhythm, by delivering a ‘shock’ to the heart. A cardioversion is like a ‘reset’ for the heart – the shock provided to the heart overrides the heart’s electrical system and in most cases, enables the heart to restart in Sinus Rhythm.

In the context of atrial fibrillation, cardioversion is usually performed through an electrical shock, usually delivered through electric pads on the chest. It’s sometimes known as electrical cardioversion or direct current cardioversion.

This procedure is typically performed in a hospital’s procedure room under the supervision of an anesthetist.

During electrical cardioversion for atrial fibrillation, the patient is given intravenous sedation to induce a state of deep sleep. Electrodes or paddles are placed on the chest to deliver a high-energy shock to the heart, resetting the abnormal rhythm to normal sinus rhythm. The entire process is brief, with the patient being asleep for less than 5 minutes. Following the procedure, patients can usually leave the hospital after a brief observation period of around 2 hours.

When might a Cardioversion be recommended?

A cardioversion is one of the multiple treatment options for people with Atrial Fibrillation. While treatment selection is always tailored to the specific circumstances of a patient, there are some general situations in which It may be recommended.

Firstly, a cardioversion may be recommended for a patient with Paroxysmal or Persistent Atrial Fibrillation if the arrhythmia is not resolving by itself or after taking antiarrhythmic medications. Cardioversion is generally not used in permanent AFib.

Secondly, cardioversion may be used in the short-term as a strategy following Atrial Fibrillation Ablation. In the recovery period following an ablation, people do sometimes still have episodes of AFib, particularly as the heart is healing. During this period, your Electrophysiologist may want to keep a close eye on any episodes and may organise a cardioversion to help reset the heart and maintain normal rhythm as much as possible during the healing process.

Success Rate of Cardioversion for Atrial Fibrillation

The success rates of cardioversion for atrial fibrillation vary depending on the patient’s specific condition and other factors. People with more infrequent and shorter episodes of AFib (paroxsymal AFib) are more likely to have higher success rates, compared to people with more frequent and longstanding episodes – those who have Persistent AFib.   

A cardioversion is more like a ‘reset’ for the heart, rather than a definitive treatment for AFib, so a successful cardioversion usually means that the heart has returned to normal rhythm. There is no lasting prevention benefit from the procedure as it doesn’t impact the causes of AFib or make any lasting changes to the heart.

Advantages and Disadvantages of Cardioversion for Atrial Fibrillation

Advantages:

A cardioversion is a relatively simple procedure that can be effective in restoring normal rhythm. It’s advantages are:

  • Effective in restoring normal heart rhythm in many patients.
  • Can be performed as an elective, day-case procedure with a short hospital stays.
  • Generally considered safe, with low rates of primary safety adverse events.

Disadvantages:

The main disadvantage of cardioversion for Atrial Fibrillation is that it may have only a short term effect – it is a reset of the heart rhythm, but not a definitive treatment. Even if it is successful in restoring normal rhythm, it does not specifically prevent the rhythm from coming back – so people with AFib may find that they need multiple cardioversions over time.

Conclusion

Cardioversion for atrial fibrillation is a well-established procedure aimed at restoring normal heart rhythm in patients with AF. It’s essential to discuss the procedure thoroughly with your healthcare provider to understand its potential benefits and limitations in your specific circumstances.