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Atrial Fibrillation: Should I Try Electrical Cardioversion?
You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.
Atrial Fibrillation: Should I Try Electrical Cardioversion?
Get the facts
- Try electrical cardioversion to return your heart to a normal rhythm.
- Do not have this treatment. Instead, take medicines to control your heart rate and prevent stroke.
Key points to remember
- Cardioversion can return your heart to a normal rhythm. But atrial fibrillation often comes back.
- This treatment doesn't work as well when atrial fibrillation is caused by another heart disease, such as heart failure, or when you have had atrial fibrillation many times.
- The longer you have had atrial fibrillation, the more likely it is to come back after cardioversion.
- If your symptoms bother you a lot, you may want to try cardioversion.
- If you don't have symptoms, or if they don't bother you much, you can try medicines to control your heart rate and an anticoagulant medicine (also called a blood thinner) to prevent a stroke.
- Even if cardioversion works, you may still need to take blood thinners to prevent a stroke.
Cardioversion uses an external defibrillator to return your heart to a normal rhythm.
First you are given a sedative. Then a doctor places paddles or patches either on your chest or on your chest and back. They send an electric current to your heart. This resets your heart rhythm. The rhythm is more likely to return to normal and stay there if you also take antiarrhythmic medicines before and after this treatment.
Taking antiarrhythmic medicines alone—without electrical cardioversion—is another way to get back your normal heart rhythm. But they don't work as well as cardioversion. And they can have serious side effects.
The success of electrical cardioversion depends on how long you have had atrial fibrillation and what is causing it. Cardioversion is less successful if you have had atrial fibrillation for longer than 1 year.
After this treatment, about 9 out of 10 people get back into a normal heart rhythm right away. But for many people, atrial fibrillation returns. About 3 to 5 out of 10 people still have a normal heart rhythm a year after cardioversion.1 Normal rhythm may last less than a day or for weeks or months. It depends on your other health problems.
Staying in a normal rhythm is more likely when the cause of your rhythm problem is not heart disease. But for most people, atrial fibrillation is caused by heart disease and is very likely to return.
If your atrial fibrillation returns, you may be able to have cardioversion again. But if the problem comes back quickly (within a week or so), having the treatment yet again is less likely to help you.
If you take antiarrhythmic medicines too, they can help you stay in a normal rhythm longer.
Having a stroke is the most serious risk. Cardioversion may dislodge a blood clot in your heart. This can cause a stroke. But you can lower this risk quite a bit by taking certain steps:
- If your atrial fibrillation has lasted for more than 48 hours, your doctor may have you take anticoagulants, or blood thinners, several weeks before cardioversion.
- Your doctor may use a test called transesophageal echocardiogram to see if you have a clot in your heart. If you don't, you won't have to take a blood thinner first.
- Your doctor may have you take a blood thinner for a few weeks after the treatment.
Cardioversion also has other risks:
- You can get a small area of burn on your skin where the paddles are placed.
- Antiarrhythmic medicines used before and after this treatment may cause a deadly irregular heartbeat. The cardioversion itself may also cause this.
- You could have a reaction to the sedative given to you before the procedure. But harmful reactions are rare.
- The procedure may not work. You may need more cardioversion or other treatment.
If you choose not to try cardioversion, you still will be at risk for problems from atrial fibrillation, such as:
- A fast or irregular heartbeat, chest pain, or shortness of breath, especially during physical activity or when you feel stressed.
- Tiring easily, feeling weak or confused, feeling dizzy, or fainting.
If your symptoms don't bother you, your doctor may have you take medicines to slow your heart rate.
You will still probably need to take an anticoagulant (also called a blood thinner) to lower your risk of stroke. But these medicines raise your risk of a serious bleeding problem. If you take warfarin (Coumadin), you'll need to have your blood tested often to make sure the medicine is working safely.
Your doctor may recommend this treatment if:
- Your atrial fibrillation is not related to another heart problem.
- You have had only one episode of atrial fibrillation.
- You have symptoms that bother you a lot, such as shortness of breath.
Compare your options
What is usually involved?
What are the benefits?
What are the risks and side effects?
- A doctor or nurse gives you medicine to make you sleepy. You should not feel any pain.
- Your doctor puts paddles or patches on your chest or on your chest and back.
- Cardioversion itself takes about 5 minutes. But the whole procedure, including recovery, will probably take 30 to 45 minutes.
- You may need to take an anticoagulant medicine for a few weeks after.
- Cardioversion restores normal heart rhythm for most people.
- Stroke is the most serious risk.
- The procedure might not work.
- You may not stay in normal rhythm for long. Atrial fibrillation returns in many people.
- You can get small burns where the paddles were placed.
- You take rate-control medicines to control your heart rate and an anticoagulant medicine to prevent stroke.
- Rate-control medicines keep many people from having symptoms.
- Anticoagulants lower the risk of stroke.
- If medicines don't work, you can decide to have cardioversion then.
- Many of the medicines have side effects, such as serious bleeding, fatigue, headache, dizziness, and nausea. And many of them interact with other medicines.
Personal stories about cardioversion
These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.
I am only 45 and I don't want to spend the rest of my life feeling tired, out of breath, and like I have butterflies in my chest. I've decided to try cardioversion one time, to see if it will fix my atrial fibrillation.
Raymond, age 45
I didn't even know I had atrial fibrillation until my doctor found it during a physical exam. I have a couple of friends who went through a lot to get back to a normal rhythm, and it just seemed like too much trouble and then it didn't even work. Since I am not having symptoms, I think I will just take the medications to control my heart rate and prevent strokes and not worry about it.
Tom, age 61
Managing my heart failure has become more difficult since I developed atrial fibrillation. My doctor has encouraged me to try cardioversion, because she hopes it will help my heart work better and help me feel better.
Manny, age 78
I have other health conditions that I am managing well with medicines. I don't have any symptoms. So, taking another drug won't change my life.
Margarita, age 82
What matters most to you?
Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.
Reasons to try cardioversion
Reasons not to try cardioversion
The idea of having an electrical shock doesn't bother me.
I'm scared at the idea of having an electrical shock.
My symptoms bother me a lot.
My symptoms don't really bother me.
I'm not worried about taking a drug that will put me to sleep during the procedure.
I don't like the idea of taking a drug that will put me to sleep.
I'd rather have cardioversion than take medicines for a long time.
I'd rather take medicines than have cardioversion.
I'm not worried about the risk of a stroke from cardioversion.
I'm worried about the risk of a stroke from cardioversion.
My other important reasons:
My other important reasons:
Where are you leaning now?
Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.
NOT trying cardioversion
What else do you need to make your decision?
Check the facts
Does cardioversion work for everyone?
- YesSorry, that's wrong. Cardioversion doesn't work as well when you also have another heart disease or when you have had atrial fibrillation for a long time.
- NoYou're right. Cardioversion doesn't work as well when you also have another heart disease or when you have had atrial fibrillation for a long time.
- I'm not sureIt may help to go back and read "Key points to remember." Cardioversion doesn't work as well when you also have another heart disease or when you have had atrial fibrillation for a long time.
Will cardioversion get your heart to a normal rhythm for good?
- YesNo, that's wrong. Although cardioversion may return your heart to its normal rhythm, atrial fibrillation often returns.
- NoThat's correct. Although cardioversion may return your heart to its normal rhythm, atrial fibrillation often returns.
- I'm not sureIt may help to go back and read "Key points to remember." Although cardioversion may return your heart to its normal rhythm, atrial fibrillation often returns.
Is there another way to treat atrial fibrillation?
- YesRight. Taking medicines to control your heart rate and prevent stroke is another way to treat atrial fibrillation.
- NoSorry, that's wrong. Taking medicines to control your heart rate and prevent stroke is another way to treat atrial fibrillation.
- I'm not sureIt may help to go back and read "Key points to remember." Taking medicines to control your heart rate and prevent stroke is another way to treat atrial fibrillation.
Decide what's next
Do you understand the options available to you?
Are you clear about which benefits and side effects matter most to you?
Do you have enough support and advice from others to make a choice?
How sure do you feel right now about your decision?
Use the following space to list questions, concerns, and next steps.
Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.
|Primary Medical Reviewer||E. Gregory Thompson, MD - Internal Medicine|
|Specialist Medical Reviewer||John M. Miller, MD, FACC - Cardiology, Electrophysiology|
Last Updated:January 31, 2011