Atrial Fibrillation: Should I Try Electrical Cardioversion?

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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.

Non-Interactive Decision Point

Atrial Fibrillation: Should I Try Electrical Cardioversion?

Get the facts

Your options

  • 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 may not 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 might try medicines to slow your heart rate. And you can take 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.
FAQs

What is cardioversion?

Cardioversion uses an external defibrillator to return your heart to a normal rhythm.

First you are given a medicine that will relax you and control pain. Then a doctor places patches either on your chest or on your chest and back. The patches 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. You may get pills, or the medicine may be put into your arm through an IV. If an IV is used, it will be done in the hospital. These medicines may not work as well as cardioversion. And they can have serious side effects.

How well does cardioversion work?

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. footnote 1

After this treatment, about 9 out of 10 people get back into a normal heart rhythm right away. footnote 2 But for many people, atrial fibrillation returns. 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 another heart problem. But for most people, atrial fibrillation is caused by another heart problem and is very likely to return.

If your atrial fibrillation returns, you may be able to have cardioversion again. But you might not stay in a normal rhythm for very long. If atrial fibrillation comes back quickly (within a week or so), having cardioversion a third time, or more, is less likely to help you. Your doctor might recommend a different treatment, such as a rhythm-control medicine, to get your heart rhythm back to normal.

If you take antiarrhythmic medicines too, they can help you stay in a normal rhythm longer.

What are the risks of cardioversion?

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 at least a few weeks after the treatment.

Cardioversion also has other risks:

  • You can get a small area of burn on your skin where the patches 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 medicine given to you before the procedure. But harmful reactions are rare.
  • The procedure may not work. You may need another cardioversion or other treatment.

What are the risks of NOT having cardioversion?

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 a lot, 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.

Why might your doctor recommend cardioversion?

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.
  • You have tried cardioversion before and it was a long time before atrial fibrillation came back.

Compare your options

Compare

What is usually involved?

















What are the benefits?

















What are the risks and side effects?

















Try cardioversion Try cardioversion
  • A doctor or nurse gives you medicine to make you sleepy. You should not feel any pain.
  • Your doctor puts 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 patches were placed.
Take medicines instead Take medicines instead
  • You take medicines to slow your heart rate.
  • You take 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 medicines 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.

More important
Equally important
More important

My symptoms bother me a lot.

My symptoms don't really bother me.

More important
Equally important
More important

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.

More important
Equally important
More important

I'd rather have cardioversion than take medicines for a long time.

I'd rather take medicines than have cardioversion.

More important
Equally important
More important

I'm not worried about the risk of a stroke from cardioversion.

I'm worried about the risk of a stroke from cardioversion.

More important
Equally important
More important

My other important reasons:

My other important reasons:

More important
Equally important
More important

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.

Trying cardioversion

NOT trying cardioversion

Leaning toward
Undecided
Leaning toward

What else do you need to make your decision?

Check the facts

1, Does cardioversion work for everyone?
2, Will cardioversion get your heart to a normal rhythm for good?
3, Is there another way to treat atrial fibrillation?

Decide what's next

1, Do you understand the options available to you?
2, Are you clear about which benefits and side effects matter most to you?
3, Do you have enough support and advice from others to make a choice?

Certainty

1. How sure do you feel right now about your decision?

Not sure at all
Somewhat sure
Very sure
2, Check what you need to do before you make this decision.

Your Summary

Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.

Your decision  

Next steps

Which way you're leaning

How sure you are

Your comments

Your knowledge of the facts  

Key concepts that you understood

Key concepts that may need review

Getting ready to act  

Patient choices

What matters to you  

Print Summary

Credits and References

Credits
Author Healthwise Staff
Primary Medical Reviewer Rakesh K. Pai, MD, FACC - Cardiology, Electrophysiology
Primary Medical Reviewer E. Gregory Thompson, MD - Internal Medicine
Primary Medical Reviewer Martin J. Gabica, MD - Family Medicine
Primary Medical Reviewer Adam Husney, MD - Family Medicine
Specialist Medical Reviewer John M. Miller, MD, FACC - Cardiology, Electrophysiology
References
Citations
  1. Fuster V, et al. (2011). 2011 ACCF/AHA/HRS focused update incorporated into the ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation: A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation, 123(10): e269-e367.
  2. Morady F, Zipes DP (2015). Atrial fibrillation: Clinical features, mechanisms, and management. In DL Mann et al., eds., Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine, 10th ed., vol. 1, pp. 798-813. Philadelphia: Saunders.
Other Works Consulted
  • January CT, et al. (2014). 2014 AHA/ACC/HRS Guideline for the management of patients with atrial fibrillation: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. Circulation, published online March 28, 2014. DOI: 10.1161/CIR.0000000000000041. Accessed April 18, 2014.
  • Kerber RE (2011). Indications and techniques of electrical defibrillation and cardioversion. In V Fuster et al., eds., Hurst's The Heart, 13th ed., vol. 1, pp. 1088-1093. New York: McGraw-Hill.
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?

Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.
  1. Get the facts
  2. Compare your options
  3. What matters most to you?
  4. Where are you leaning now?
  5. What else do you need to make your decision?

1. Get the Facts

Your options

  • 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 may not 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 might try medicines to slow your heart rate. And you can take 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.
FAQs

What is cardioversion?

Cardioversion uses an external defibrillator to return your heart to a normal rhythm.

First you are given a medicine that will relax you and control pain. Then a doctor places patches either on your chest or on your chest and back. The patches 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. You may get pills, or the medicine may be put into your arm through an IV. If an IV is used, it will be done in the hospital. These medicines may not work as well as cardioversion. And they can have serious side effects.

How well does cardioversion work?

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. 1

After this treatment, about 9 out of 10 people get back into a normal heart rhythm right away. 2 But for many people, atrial fibrillation returns. 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 another heart problem. But for most people, atrial fibrillation is caused by another heart problem and is very likely to return.

If your atrial fibrillation returns, you may be able to have cardioversion again. But you might not stay in a normal rhythm for very long. If atrial fibrillation comes back quickly (within a week or so), having cardioversion a third time, or more, is less likely to help you. Your doctor might recommend a different treatment, such as a rhythm-control medicine, to get your heart rhythm back to normal.

If you take antiarrhythmic medicines too, they can help you stay in a normal rhythm longer.

What are the risks of cardioversion?

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 at least a few weeks after the treatment.

Cardioversion also has other risks:

  • You can get a small area of burn on your skin where the patches 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 medicine given to you before the procedure. But harmful reactions are rare.
  • The procedure may not work. You may need another cardioversion or other treatment.

What are the risks of NOT having cardioversion?

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 a lot, 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.

Why might your doctor recommend cardioversion?

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.
  • You have tried cardioversion before and it was a long time before atrial fibrillation came back.

2. Compare your options

  Try cardioversion Take medicines instead
What is usually involved?
  • A doctor or nurse gives you medicine to make you sleepy. You should not feel any pain.
  • Your doctor puts 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.
  • You take medicines to slow your heart rate.
  • You take an anticoagulant medicine to prevent stroke.
What are the benefits?
  • Cardioversion restores normal heart rhythm for most people.
  • 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.
What are the risks and side effects?
  • 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 patches were placed.
  • 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

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 medicines 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

3. 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.

             
More important
Equally important
More important

My symptoms bother me a lot.

My symptoms don't really bother me.

             
More important
Equally important
More important

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.

             
More important
Equally important
More important

I'd rather have cardioversion than take medicines for a long time.

I'd rather take medicines than have cardioversion.

             
More important
Equally important
More important

I'm not worried about the risk of a stroke from cardioversion.

I'm worried about the risk of a stroke from cardioversion.

             
More important
Equally important
More important

My other important reasons:

My other important reasons:

   
             
More important
Equally important
More important

4. 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.

Trying cardioversion

NOT trying cardioversion

             
Leaning toward
Undecided
Leaning toward

5. What else do you need to make your decision?

Check the facts

1. Does cardioversion work for everyone?

  • Yes
  • No
  • I'm not sure
You'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.

2. Will cardioversion get your heart to a normal rhythm for good?

  • Yes
  • No
  • I'm not sure
That's correct. Although cardioversion may return your heart to its normal rhythm, atrial fibrillation often returns.

3. Is there another way to treat atrial fibrillation?

  • Yes
  • No
  • I'm not sure
Right. Taking medicines to control your heart rate or rhythm and prevent stroke is another way to treat atrial fibrillation.

Decide what's next

1. Do you understand the options available to you?

2. Are you clear about which benefits and side effects matter most to you?

3. Do you have enough support and advice from others to make a choice?

Certainty

1. How sure do you feel right now about your decision?

         
Not sure at all
Somewhat sure
Very sure

2. Check what you need to do before you make this decision.

  • I'm ready to take action.
  • I want to discuss the options with others.
  • I want to learn more about my options.
 
Credits
By Healthwise Staff
Primary Medical Reviewer Rakesh K. Pai, MD, FACC - Cardiology, Electrophysiology
Primary Medical Reviewer E. Gregory Thompson, MD - Internal Medicine
Primary Medical Reviewer Martin J. Gabica, MD - Family Medicine
Primary Medical Reviewer Adam Husney, MD - Family Medicine
Specialist Medical Reviewer John M. Miller, MD, FACC - Cardiology, Electrophysiology
References
Citations
  1. Fuster V, et al. (2011). 2011 ACCF/AHA/HRS focused update incorporated into the ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation: A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation, 123(10): e269-e367.
  2. Morady F, Zipes DP (2015). Atrial fibrillation: Clinical features, mechanisms, and management. In DL Mann et al., eds., Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine, 10th ed., vol. 1, pp. 798-813. Philadelphia: Saunders.
Other Works Consulted
  • January CT, et al. (2014). 2014 AHA/ACC/HRS Guideline for the management of patients with atrial fibrillation: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. Circulation, published online March 28, 2014. DOI: 10.1161/CIR.0000000000000041. Accessed April 18, 2014.
  • Kerber RE (2011). Indications and techniques of electrical defibrillation and cardioversion. In V Fuster et al., eds., Hurst's The Heart, 13th ed., vol. 1, pp. 1088-1093. New York: McGraw-Hill.
Note: The "printer friendly" document will not contain all the information available in the online document some Information (e.g. cross-references to other topics, definitions or medical illustrations) is only available in the online version.

Current as of: October 5, 2017

Author: Healthwise Staff

Medical Review: Rakesh K. Pai, MD, FACC - Cardiology, Electrophysiology & E. Gregory Thompson, MD - Internal Medicine & Martin J. Gabica, MD - Family Medicine & Adam Husney, MD - Family Medicine & John M. Miller, MD, FACC - Cardiology, Electrophysiology