In this article, we are going to talk about cardioversion for Afib. Who should have cardioversion, who should not, and what are the risks and benefits?


Rhythm control strategies for Afib

For those who pursue a rhythm control strategy for Afib, which means that their treatment plan is to stay in regular (or sinus) rhythm, there are three treatment options.

  1. Cardioversion
  2. Medication
  3. Ablation or surgery


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In this article, we are going to talk about cardioversion. Cardioversion for Afib is a medical procedure, usually done when the patient is sedated, where an electrical shock is applied to the heart to attempt to convert or change Afib into regular or sinus rhythm. More rarely, cardioversion can be done with medications.

Cardioversion is used in patients with symptoms from Afib who are following a rhythm control strategy. Cardioversion can be done with or without Afib medications.


Reasons why you should NOT have cardioversion

Some patients are not good candidates for cardioversion. These include situations where cardioversion may be dangerous:

  • When there is a blood clot in the heart.
  • When it is not safe to take blood thinners (although exceptions are sometimes made if the Afib is under 48 hours in duration or the patient has no stroke risk factors.)


Or when cardioversion is unlikely to be successful:

  • Those with permanent Afib, particularly if the left atrium is severely enlarged
  • Have failed prior cardioversion attempts
  • Have an underlying medical issue that is not resolved like infection or high thyroid levels).


Effectiveness of cardioversion

The initial success of cardioversion (achieving sinus rhythm) is usually high, about 90%. However, the risk of recurrent Afib in the weeks and months after the cardioversion is also high.

Typically, cardioversion is done after the patient is adequately sedated. Often, a transesophageal echocardiogram (TEE) is done before cardioversion to rule out a blood clot in the heart (called a thrombus in the left atrial appendage). Blood thinner medication is given before and after the cardioversion in most, but not all, cases.


Complications from cardioversion

Complications from cardioversion are uncommon. The most worrisome side effect is stroke, but in the setting of appropriate blood thinner use, this is exceedingly rare. Heart rhythm problems can also occur immediately after cardioversion, although these are usually easily treatable.


Preparation for cardioversion

In preparation for cardioversion, your doctor will usually ask that you not eat or drink anything for 8 hours before the procedure. Be sure and ask about taking your medications. When the procedure is done, you will be monitored for some time and usually go home the same day. You will need someone to drive you if you received sedation.


In summary

Cardioversion can be part of a rhythm control strategy for Afib. It has a high success rate and a low complication rate. Talk to your doctor if you have questions about cardioversion for your Afib.

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