New method for terminating cardiac arrhythmias: use of sychronized capacitor discharge. JAMA, Cardioversion of atrial fibrillation: a report on the treatment of 65 episodes in 50 patients.
N Engl J Med, Anterior-posterior versus anterior-lateral electrode positions for external cardioversion of atrial fibrillation. Kirchhof P. Lancet, The technique of cardioversion. External cardioversion of atrial fibrillation: role of paddle position on technique efficacy and energy requirements.
Botto G. Electrode positioning for cardioversion of atrial fibrillation. Myerburg R. Elective cardioversion: influence of paddle-electrode location and size on success rates and energy requirements.
Kerber R. Randomised comparison of electrode positions for cardioversion of atrial fibrillation. Mathew T. Simultaneous double external DC shock technique for refractory atrial fibrillation in concomitant heart disease. Kabukcu M. Jpn Heart J, High energy transcatheter cardioversion of chronic atrial fibrillation. Levy S. Bulent-Gorenek , Ankara, Turkey. Author's disclosures: None declared. Our mission: To reduce the burden of cardiovascular disease. Help centre. All rights reserved.
Did you know that your browser is out of date? To get the best experience using our website we recommend that you upgrade to a newer version. Learn more. Show navigation Hide navigation. Sub menu. Cardioversion in atrial fibrillation described An article from the e-Journal of Cardiology Practice Vol. Topic s : Atrial Fibrillation. Background Direct current cardioversion is one of the most effective means of converting atrial fibrillation into sinus rhythm. They are inversely related to the atrial fibrillation duration, chest wall impedance, and left atrial size.
The ESC guidelines state that internal cardioversion may be helpful in specific situations where a patient will undergo an invasive procedure and cardioversion catheters can be positioned without adding vascular access. However, the guidelines go on to state that this procedure has been largely abandoned as a means for cardioversion, except where implanted defibrillation devices are present.
References 1. Effects of transcatheter cardioversion on chronic lone atrial fibrillation. Kumagai K. Pacing Clin Electrophysiol, Nov 14 11 Pt 1 : Multicenter low energy transvenous atrial defibrillation XAD trial results in different subsets of atrial fibrillation. J Am Coll Cardiol, , Mar A randomized comparison of external and internal cardioversion of chronic atrial fibrillation.
Circulation, Nov. Internal defibrillation: where we have been and where we should be going? J Interv Card Electrophysiol, , Aug. Suppl 1: Low energy intracardiac cardioversion of persistent atrial fibrillation. Santini M. Higher energy synchronized external direct current cardioversion for refractory atrial fibrillation. Saliba W. J Am Coli Cardio, Supplemental oxygen should be removed prior to discharge of any electrical energy due to the risk of fire.
Procedural sedation is commonly performed as cardioversion may cause pain, anxiety, and unpleasant memories. Proper electrode placement is important for successful cardioversion as this determines the pathway of current [ 3 ].
Pads are primarily placed in two positions, antero-lateral and antero-posterior Fig. If an ICD or pacemaker is present pads or paddles should not be placed directly over the device and the antero-posterior position may be favored.
Pad placement should also avoid breast tissue. Cardioversion and Defibrillation. This content does not have an English version. This content does not have an Arabic version. Overview Cardioversion Open pop-up dialog box Close. Cardioversion During cardioversion, shocks are delivered to your chest by the cardioversion machine while your heart rhythm is monitored.
Request an Appointment at Mayo Clinic. Share on: Facebook Twitter. Show references Cardioversion. National Heart, Lung, and Blood Institute. Accessed March 26, American Heart Association. Heart Rhythm Society. Knight BP. Basic principles and technique of electrical cardioversion and defibrillation.
Cardioversion for specific arrhythmias. Al-Khatib SM, et al. Related Atrial flutter Caffeine content Cardioversion Fitness program Heart arrhythmia Heart disease Heart-healthy diet: 8 steps to prevent heart disease Sodium Tachycardia Ventricular tachycardia Show more related content. Mayo Clinic in Rochester, Minn. The presence of a structural cardiac anomaly together with continuous ventricular tachycardia or VF holds a risk for sudden death.
An implantable cardioverter defibrillator ICD should be considered if there is no identifiable cause. Internal cardiac cardioversion is safe and effective in patients with resistant AF. Another proposed reason is myocardial stunning. The risks and benefits of recurrent electrical shock therapy must be taken into account. Unnecessary recurrent DC shock treatment should be avoided.
The upper shock limit applied by several defibrillators currently used is J, and the waveform is monophasic. As technology progresses, biphasic shock waves are employed. ICDs are the best example of such application. The transvenous activity, the accessible implantation, and the smaller dimensions have contributed to the wide therapeutic adoption of ICD devices.
Lown mentioned that higher energy levels were required to terminate AF in congestive heart failure. Restoration of cardiac compensation and achievement of a dry weight before cardioversion increased the success rate. In cases of polycytemia, it may be difficult or impossible to revert until adequate phlebotomy lowers the hematocrit to less than Patients with severe mitral valve disease having giant scarred atria who have had valve repair or replacement are recalcitrant to cardioversion and do not persist in sinus rhythm.
Despite these low energy levels J , sedation and anesthesia are necessary because of the painful procedure. In new devices, the electrodes are placed within the right atrium and the left pulmonary artery for internal cardioversion. Superior homogeneous electrical dispersion and cardioversion effectiveness have been reported with such electrode placement.
Complications are minimal. Potential complications include VF due to general anesthesia or lack of synchronization between the DC shock and the QRS complex, thromboembolus due to insufficient anticoagulant therapy, non-sustained VT, atrial arrhythmia, heart block, bradycardia, transient left bundle branch block, myocardial necrosis, myocardial dysfunction, transient hypotension, pulmonary edema and skin burn. Pain at the application site is associated with the number of applications.
Atrial and ventricular tachycardias are frequent in patients being treated at intensive care units due to the presence of multiple triggers.
Hypoxia, endogenous or exogenous catecholamines, congestive heart failure, fever and pulmonary embolus are particular causes of tachycardia. Patients unable to receive the drugs orally or with poor absorption are more prone to side effects, such as hypotension, which may especially occur with intravenous drugs like amiodarone.
Rapid and through-out examination prior to the electrical cardioversion is important. Improvement of trigger and underlying etiologic factors enhances the success rate of cardioversion.
Some investigators have reported that electrical cardioversion is safe during pregnancy. For this reason, it can be assumed that cardioversion may not affect the fetus. Electrical cardioversion performed in patients with a pacemaker or ICD may lead to dysfunction, namely acute or chronic changes in the pacing or sensitivity threshold. During cardioversion, the defibrillator paddles should be placed at a minimum of 15 cm apart from the pacemaker.
They should be positioned perpendicularly to the anterolateral, anteroposterior or endocardial leads. A 5-minute interval between two shock wave applications is required. The pacemaker battery and lead functions must also be checked after cardioversion. A high threshold should be maintained for at least weeks. In case of pacemaker and lead dysfunction, lead replacement is the advised procedure. Electrical cardioversion is a life-saving when applied in emergency circumstances.
In elective cardioversion, accurate tachycardia diagnosis, careful patient selection, adequate electrode paddles application, determination of the optimal energy and anesthesia levels, prevention of embolic events and arrythmia recurrence, and airway conservation increase the success rate while minimizing possible complications. National Center for Biotechnology Information , U.
Journal List Ann Saudi Med v. Ann Saudi Med. Author information Article notes Copyright and License information Disclaimer. Accepted Jan. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
This article has been cited by other articles in PMC. Abstract External electrical cardioversion was first performed in the s.
Mechanism of external cardioversion and defibrillation The current external electrical cardioversion technique relies on the application of a selected amount of energy, which is generally between J, via two electrodes paddles.
Indications Atrial fibrilation and atrial flutter Currently, electrical cardioversion is mostly performed to convert AF and atrial flutter into sinus rhythm. Venctricular and supraventricular tachycardia Emergency electrical cardioversion is performed in unstable ventricular tachycardia that causes hemodynamic deterioration.
Other rhythm disorders Electrical shock treatment is ineffective in the termination of automaticity related tachycardies. Factors affecting EEC success Energy is a combination of voltage and current.
Electrodes position Defibrillator paddles can be used in different configurations, which affect the success rate of defibrillation. Thoracic impedance Thoracic impedance is another important factor in treatment by electrical cardioversion. Medications and sedations In a pilot study, Sutton et al demonstrated that atropine administration increased the success rate of direct current cardioversion for atrial fibrillation. Energy selection Biphasic shock and monophasic shock Transthoracic monophasic defibrillators have been employed for the management of ventricular arrhythmias.
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