Arrhythmias - Electrical Cardioversion
DC CARDIOVERSION
PREPARATION:
Your doctor has recommended a treatment called synchronized DC (Direct Current) cardioversion to attempt to correct your heart rhythm. You should report to the Admitting office at Peninsula Hospital on the ground floor by 7:00 AM on your appointed day. On the morning of your cardioversion, you should take ALL your normal medicines with a little bit of water. You should not eat or drink anything for breakfast. If you take insulin, do not take this until after your cardioversion.
You will be given a sedative that will not last long but may dull your reflexes for up to 24 hours after you receive it. This will affect your ability to drive safely for the rest of the day and you must make arrangements for someone to accompany you after your treatment.
WARFARIN (Coumadin): Patients who have planned DC cardioversion must have been given the medicine WARFARIN (Coumadin) and have had a therapeutic INR (International Normalized Ratio) of 2.0 to 3.0 for at least 3 weeks. Your own family doctor or cardiologist will have adjusted this medicine to “thin the blood” prior to your admission. This is to reduce the risk of blood clots, formed within the heart when irregular heartbeats have lasted for longer than 48 hours continuously, from being dislodged into the bloodstream during your treatment. You will remain on warfarin (Coumadin) for a period of time even after successful treatment of your heart rhythm.
BEFORE YOUR TEST:You will be directed to the 5th floor at Peninsula hospital and given a gown to wear. You will normally have already given consent for your cardioversion at your preceding office visit. If not, a nurse will have you sign the consent form at this time. You should tell the nurse if you have ever had any problems with any anesthetic or sedative medicines. While many of these will not be serious problems, it is important for you to point them out.
PROCEDURE:After attaching electrocardiograph (ECG) wires to monitor your heart rhythm, you will receive a sedative so that you will not feel any pain during your cardioversion. You will be given oxygen to breath. The sedative will be administered by an anesthetist or a cardiologist and generally lasts only a few minutes. The cardioversion will be supervised by one of the cardiologists and involves using pads placed across the chest to deliver an electrical current to help restore the heartbeat. The lowest electrical energy is used to achieve the restoration of the normal heart rhythm. The sedative ensures you are completely unaware of this treatment.
RISKS:DC Cardioversion is a routine procedure and is necessary to correct your heart problem. It carries few risks, most of which relate to the administration of the sedative. Facilities are available to deal with any emergency immediately and your doctors will closely monitor you. Your safety is of paramount importance at all times. This treatment would not be performed if it were not essential for your care. The minimal risks are greatly outweighed by the restoration of a regular heartbeat.
Some of the risks include stroke, skin irritation (like a sun burn), respiratory depression and allergic reaction. The risk of stroke is small if you have been on warfarin (Coumadin) for at least 3 weeks at a therapeutic INR.
As with all medical treatment, you are free to withdraw your consent at any time. In general, if you have specific concerns, please discuss these with your doctor.
POST PROCEDURE:After completion of your cardioversion, an ECG will be taken to confirm the return of the normal heart rhythm. When you are feeling back to normal, a nurse will remove the small plastic tube used to give your sedative from your arm.
CONTINUING YOUR MEDICINES:Even after successful DC cardioversion all patients generally stay on their normal medical treatments, most important WARFARIN (Coumadin), for a period of time (usually three months). This is because, in some patients, the irregular heartbeat may return, generally in the first few weeks. If this is the case, the treatment can be repeated on one or more occasions. It does not cause heart damage. You will be seen in the out patient clinic at an appropriate time to assess your individual circumstances and review your treatments.
GOING HOME:As most cardioversions are performed in early morning, patients are generally able to go home by early afternoon. You must not drive your car in case of any small persistent effects of the sedative. You should rest at home on the evening following discharge. You should be able to resume normal activity the following day.
ANY FURTHER WORRIES?:Please feel free to discuss any general concerns you have with your cardiologist or nurse practitioner by calling 650-259-5300.
Ver 1.3/1-31-03