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decision pointShould I try cardioversion for atrial fibrillation?

Cardioversion for atrial fibrillation can return your heart rate to a normal sinus rhythm. However, atrial fibrillation often returns. Consider the following when making your decision:

  • If your atrial fibrillation is not caused by a permanent underlying heart condition, cardioversion is often an effective way to restore your heart to a normal rhythm.
  • Cardioversion is less successful if you have had multiple recurrences of atrial fibrillation or if you have long-standing heart disease.
  • The longer you have had atrial fibrillation, the lower your chance is of staying in a normal rhythm after cardioversion.
  • If you have bothersome symptoms while in atrial fibrillation, you may want to try cardioversion.
  • If you do not have bothersome symptoms, your doctor may recommend that you take medications to control your heart rate and anticoagulants to prevent stroke.
  • If atrial fibrillation returns after cardioversion, you can significantly reduce the risk of stroke and symptoms by taking anticoagulants and medications to control heart rate.

What is cardioversion?

There are two ways to convert your heart to a normal rhythm. They are:

  • Electrical cardioversion. An external defibrillator is used in electrical cardioversion. After you are given a sedative, a doctor places metal paddles or patches on your chest wall. The paddles send an electric current to your heart. The electric current resets your heart rhythm and your heart usually starts in a normal rhythm.
  • Chemical cardioversion. Antiarrhythmic medications-such as flecainide, propafenone, or ibutilide-convert your heart to a normal rhythm by reducing atrial excitability and stabilizing the heart muscle tissue. Chemical cardioversion may be used when electrical cardioversion or sedation is considered unsafe or inappropriate. It is less physically traumatic than electrical cardioversion, but it is also less effective. Antiarrhythmic medications also have many potentially serious side effects.

How effective is cardioversion?

Electrical cardioversion successfully restores a normal sinus rhythm in about 85% of people who have recent-onset atrial fibrillation.1 Staying in a normal rhythm is more likely when the underlying cause is not heart disease. However, in many cases, atrial fibrillation is caused by underlying heart disease and is highly likely to recur.

The longer you have had atrial fibrillation, the lower your chance is of staying in a normal rhythm after cardioversion.

What are the risks of cardioversion?

Having a stroke is the most serious risk of cardioversion. Cardioversion may dislodge a blood clot in your heart, causing a stroke. However, this risk can be significantly reduced by taking the following precautions:

  • If your atrial fibrillation has lasted for more than 48 hours, your doctor will probably prescribe anticoagulants for several weeks before attempting cardioversion to reduce the risk of stroke.
  • Your doctor may use a test called transesophageal echocardiography to assess whether you have a clot in your heart that could cause a stroke. If the heart is clear of clots, cardioversion can be attempted.
  • Anticoagulant medication is taken for 4 weeks after cardioversion.

Other risks of cardioversion include the following:

  • You can get a small area of burn on your skin where the paddles are placed.
  • Antiarrhythmic medications used before and after cardioversion or even the cardioversion itself may cause a life-threatening irregular heartbeat.
  • You can have a reaction to the sedative given to you before the procedure. Harmful reactions are rare.
  • The procedure may not work. Additional cardioversion or other treatment may be needed.

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.

You may have heart palpitations, chest pain, or shortness of breath, especially during physical activity or emotional stress. You may also tire easily or have problems with weakness, confusion, dizziness, or fainting.

If you are not bothered by symptoms of atrial fibrillation, your doctor may prescribe medications to slow your heart rate but allow the atrial fibrillation to persist.

You will still probably need to take anticoagulant medications to decrease your risk of stroke. However, these medications increase your risk of developing a serious problem with bleeding. You will need to have your blood tested frequently while you are taking an anticoagulant. With these blood tests, your doctor can tell whether your anticoagulant medication is at an effective and safe level.

For more information, see the topic Atrial Fibrillation.

Your choices are:

  • Try cardioversion in an attempt to convert to a normal rhythm.
  • Do not have cardioversion. Instead, take medications to control your heart rate, and take anticoagulants.

The decision about whether to try cardioversion takes into account your personal feelings and the medical facts.

Deciding about cardioversion
Reasons to try cardioversion Reasons not to try cardioversion
  • Your atrial fibrillation is not related to underlying heart disease.
  • You have had only one episode of atrial fibrillation.
  • You have symptoms of atrial fibrillation that are bothersome, such as palpitations, or that affect the quality of your life, such as shortness of breath with exertion.
  • If cardioversion was successful the first time but you reverted to atrial fibrillation after some time, you may want to try it again.

Are there other reasons you might want to try cardioversion?

  • You have had several atrial fibrillation episodes and have underlying heart disease.
  • You do not have any symptoms of atrial fibrillation.
  • You have tried cardioversion once or twice and atrial fibrillation recurred.
  • You have been in atrial fibrillation for a long time, and cardioversion is unlikely to be successful.

Are there other reasons you might not want to try cardioversion?

These personal stories may help you make your decision.

Use this worksheet to help you make your decision. After completing it, you should have a better idea of how you feel about cardioversion. Discuss the worksheet with your doctor.

Circle the answer that best applies to you.

I have an underlying heart condition. Yes No Unsure
I have recently had episodes of atrial fibrillation. Yes No Unsure
I have not tried cardioversion or have only tried it once. Yes No Unsure
I have fainting spells when my heart is beating irregularly. Yes No Unsure
I feel better when my heart rhythm is normal. Yes No Unsure

Use the following space to list any other important concerns you have about this decision.

 

 

 

 

 

What is your overall impression?

Your answers in the above worksheet are meant to give you a general idea of where you stand on this decision. You may have one overriding reason to try or not to try cardioversion.

Check the box below that represents your overall impression about your decision.

Leaning toward trying cardioversion

 

Leaning toward NOT trying cardioversion

         

Citations

  1. Fuster V, et al. (2006). ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation-Executive summary. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing committee to revise the 2001 guidelines for the management of patients with atrial fibrillation). Circulation, 114(7): 700–752.

Author Robin Parks, MS
Editor Kathleen M. Ariss, MS
Associate Editor Pat Truman, MATC
Primary Medical Reviewer Caroline S. Rhoads, MD - Internal Medicine
Specialist Medical Reviewer John M. Miller, MD - Electrophysiology
Last Updated December 18, 2008

WebMD Medical Reference from Healthwise

Last Updated: December 18, 2008
This information is not intended to replace the advice of a doctor. Healthwise disclaims any liability for the decisions you make based on this information.

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