Cardioversion is a treatment method applied to restore abnormal heart rhythm to normal sinus rhythm. It can be performed electrically or pharmacologically.
What is Cardioversion?#
Cardioversion is a controlled procedure applied to convert the heart’s abnormal rhythm (usually atrial fibrillation or atrial flutter) to normal sinus rhythm.
Types of Cardioversion:
- Electrical cardioversion: Controlled electric shock
- Pharmacological cardioversion: Rhythm correction with medications
Electrical Cardioversion#
How is it Performed?#
- Preparation: Fasting, anticoagulation check
- Sedation: Short-term general anesthesia
- Electrode placement: Adhesive electrodes on chest
- Shock delivery: Shock synchronized with R wave
- Monitoring: Rhythm and vital signs follow-up
Energy Levels#
| Arrhythmia | Starting Energy |
|---|---|
| Atrial fibrillation | 120-200 J (biphasic) |
| Atrial flutter | 50-100 J |
| SVT | 50-100 J |
| VT (stable) | 100-200 J |
Success Rates#
- Atrial fibrillation: 70-90%
- Atrial flutter: >95%
- Success depends on arrhythmia duration and underlying disease
Pharmacological Cardioversion#
Medications Used#
Class IC Antiarrhythmics:
- Flecainide
- Propafenone
Class III Antiarrhythmics:
- Amiodarone
- Ibutilide
- Vernakalant
Indications#
- New-onset AF (<48 hours)
- If electrical cardioversion is contraindicated
- Patient preference
Cardioversion Indications#
Emergency Cardioversion#
- Hemodynamic instability
- Acute heart failure
- Myocardial ischemia
- Hypotension
Elective Cardioversion#
- Symptomatic AF/flutter
- Inadequate rate control
- Rhythm control strategy
Pre-Cardioversion Preparation#
Anticoagulation#
AF >48 hours or unknown duration:
- At least 3 weeks of anticoagulation OR
- TEE to rule out left atrial thrombus
AF <48 hours:
- Anticoagulation with heparin is sufficient
Other Preparations#
- Electrolyte check (especially potassium)
- Digoxin level check
- Thyroid function tests
- Echocardiography
Post-Cardioversion#
Immediately After#
- Rhythm monitoring
- Vital signs follow-up
- Waiting for sedation effect to wear off
Long Term#
- Anticoagulation (at least 4 weeks)
- Antiarrhythmic medication (recurrence prevention)
- Regular check-ups
Cardioversion Risks#
Procedure risks:
- Thromboembolism/stroke (if anticoagulation inadequate)
- Skin burns (rare)
- Bradycardia (temporary)
- Other arrhythmias
- Sedation complications
Recurrence and Prevention#
Recurrence Rates:
- First year: 50-60%
- With antiarrhythmic drugs: 30-40%
Recurrence Prevention:
- Antiarrhythmic medications
- Treatment of underlying causes
- Lifestyle changes
- Ablation (in recurrent cases)
Frequently Asked Questions#
Is cardioversion painful?
How long does cardioversion take?
When can I return to work after cardioversion?
Is cardioversion permanent?
Do I need to take medication after cardioversion?
Appointment and Contact#
If you would like to schedule an appointment for cardioversion evaluation:
📍 Avrasya Hospital - Beştelsiz Mah. 101. Sokak No:107, Zeytinburnu, Istanbul
📞 Phone: +90 212 665 50 50 (Ext: 4012)
This content has been prepared by Assoc. Prof. Dr. Habib Çil for general informational purposes. Please consult a cardiology specialist for definitive diagnosis and treatment.
Related Arrhythmia Treatments#
Other arrhythmia treatments related to cardioversion:
- Ablation - Catheter ablation
- ICD - Implantable cardioverter defibrillator
- Electrophysiology Study - Arrhythmia diagnosis
- Holter - 24-hour rhythm monitoring
- EKG - Electrocardiography