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Atrial Fibrillation: Should I Try Electrical Cardioversion? - Forrest Health
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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

    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.

    After this treatment, about 9 out of 10 people get back into a normal heart rhythm right away.footnote 1 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.

    Before the procedure, your doctor will check your risk of stroke. To lower the risk of stroke, you might take an anticoagulant (blood thinner) before and after the cardioversion.

    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.

    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 take an anticoagulant medicine before and after cardioversion.
    • 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

    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

    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
    Primary Medical Reviewer John M. Miller MD, FACC - Cardiology, Electrophysiology
    Primary Medical Reviewer Heather Quinn MD - Family Medicine

    References
    Citations
    1. 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.
    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.

    After this treatment, about 9 out of 10 people get back into a normal heart rhythm right away.1 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.

    Before the procedure, your doctor will check your risk of stroke. To lower the risk of stroke, you might take an anticoagulant (blood thinner) before and after the cardioversion.

    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.

    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 take an anticoagulant medicine before and after cardioversion.
    • 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 longtime.

    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
    Primary Medical Reviewer John M. Miller MD, FACC - Cardiology, Electrophysiology
    Primary Medical Reviewer Heather Quinn MD - Family Medicine

    References
    Citations
    1. 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.

    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.

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