Ambulant electrocardioversion (restoration of the heart rhythm)

What is an electrocardioversion?

In electrocardioversion, two large electrodes (paddles) are placed on the patient’s chest, which emit a short, directed electric shock towards the heart. By means of these electrical impulses, the normal heart rhythm (the sinus rhythm) can be regulated and normalised, or restored. In order to obtain an effective energy output and prevent burns to the skin, large quantities of the special gel “Xylocin” are applied to the paddles. Electrocardioversion is a non-invasive therapy method which can be carried out easily and usually without any complications.

When is an electrocardioversion necessary?

Electrocardioversion may be indicated for various types of heart rhythm disorders (arrhythmias). It is used for dangerously high heart rate (tachycardia or tachyarrhythmia), for chamber tachycardias, atrial fibrillation and atrial flutter. In the case of atrial fibrillation, the atria of the heart are affected by too rapid and uncoordinated actions. They do not contract sufficiently, or fail to do so at all, and without the usual coordination with the chamber stimulation (absolute arrhythmia).

Procedure

In our “Heidelberg Praxisklinik für Kardiologie für Kardiologie” (HPK), a transoesophageal echocardiography (TEE) is always carried out (see TEE information sheet) before the planned electrocardioversion, in order to exclude blood clots in the atrium or atrial appendage. Following exclusion of blood clots in the heart, so-called i.v. brief anaesthesia is initiated with the patient. In the side position, the paddles are placed on the chest wall and the back at the level of the heart. In coordination with the chamber action, a short, directed shock is then administered in the direction of the heart (in contrast to defibrillation, in which the discharged energy is emitted without regard to the available electrical heart activity). In some cases it may be necessary to repeat this procedure up to two times, and provided that the patient is still sufficiently anaesthetised. After the treatment, the patients remain at the HPK for observation. They are connected to a monitor, which regularly measures vital functions such as blood pressure, heart rate and oxygen saturation. The heart activity is also monitored by ECG.

The examination is carried out at our practice on an out-patient basis.

Duration

Electrocardioversion takes a few minutes. After the cardioversion, patients at the HPK undergo a long-term or “permanent” ECG until the following day, before they are released. Following the assessment of this long-term ECG, the following procedure is discussed thoroughly with the patient.

Risks

Electrocardioversion is relatively harmless, and involves only few, rather theoretical risks. Slight reddening o the skin may occur as a result of the electrical energy application. Slow or rapid heart rhythm disorders may also set in, which can be remedied without problem by suitable treatment.

Note

The patient should not consume any food or fluids for at least six hours before the electrocardioversion treatment.

Patients with false teeth should remove them.

Patients’ reactions may be impaired by the medications administered for the anaesthesia, so that driving a vehicle is prohibited for 24 hours following cardioversion. Patients who are planned to undergo an electrocardioversion should therefore be collected by relatives.

As a rule, the patient can get up again a few hours after the treatment. We do however recommend “relaxed” bed-rest for the next 24 hours.