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 doesn't 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 can try medicines to
control your heart rate and 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
Cardioversion
uses an external defibrillator to return your heart to a normal rhythm.
First you are given a sedative. Then a doctor places paddles or patches
either on your chest or on your chest and back. They 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. But they don't work as well as
cardioversion. And they can have serious side effects.
The success of electrical
cardioversion depends on how long you have had atrial fibrillation and what is
causing it. Cardioversion is less successful if you have had atrial
fibrillation for longer than 1 year.
After this
treatment, about 9 out of 10 people get back into a normal heart rhythm right away. But for many people, atrial fibrillation returns. About 3 to 5 out of 10 people still have a normal heart rhythm a year after cardioversion.1 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 heart disease. But for most people, atrial
fibrillation is caused by heart disease and is very
likely to return.
If your atrial fibrillation returns, you may be able to have
cardioversion again. But if the problem comes back quickly (within a week or
so), having the treatment yet again is less likely to help you.
If
you take
antiarrhythmic medicines too, they can help you stay
in a normal rhythm longer.
Having a
stroke is the most serious risk.
Cardioversion may dislodge a blood clot in your heart.
This can cause a stroke. But you can lower this risk quite a bit by taking
certain steps:
- If your atrial fibrillation has lasted for
more than 48 hours, your doctor may have you take
anticoagulants, or blood thinners, several weeks before cardioversion.
- Your doctor may use a test called
transesophageal echocardiogram to see if you have a clot in your
heart. If you don't, you won't have to take a blood thinner first.
- Your doctor may have you take a blood thinner for a few weeks
after the treatment.
Cardioversion also has other risks:
- You can get a small area of burn on your skin
where the paddles 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 sedative given to you
before the procedure. But harmful reactions are rare.
- The procedure
may not work. You may need more cardioversion or other treatment.
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, your doctor may have
you take medicines to slow your heart rate.
You will still
probably need to take an anticoagulant (also called a blood thinner) to lower your risk of stroke. But these
medicines raise your risk of a serious bleeding problem. If you take warfarin (Coumadin), you'll need to have
your blood tested often to make sure the medicine is working safely.
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.
Compare your options
| | |
|---|
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 paddles or 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 need to take an anticoagulant medicine for a few weeks
after.
- 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 paddles were
placed.
Take medicines instead
Take medicines instead
- You take
rate-control medicines to control your heart rate and
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
Are you interested in what others decided to do? Many people have faced this decision. These personal stories may help you decide.
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.
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 medications to
control my heart rate and prevent strokes and not worry about it.
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.
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.
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?
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?
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.
3.
Use the following space to list questions, concerns, and next steps.
Your Summary
Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.
Key concepts that you understood
Key concepts that may need review
Credits
| Credits | Healthwise Staff |
|---|
| Primary Medical Reviewer | E. Gregory Thompson, MD - Internal Medicine |
|---|
| Specialist Medical Reviewer | John M. Miller, MD, FACC - Cardiology, Electrophysiology |
|---|
References
Citations
- Morady F, Zipes DP (2012). Atrial fibrillation: Clinical features, mechanisms, and management. In RO Bonow et al., eds., Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine, 9th ed., vol. 1, pp. 825–844. 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.
- Get the facts
- Compare your options
- What matters most to you?
- Where are you leaning now?
- 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 doesn't 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 can try medicines to
control your heart rate and 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 sedative. Then a doctor places paddles or patches
either on your chest or on your chest and back. They 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. But they don't 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. Cardioversion is less successful if you have had atrial
fibrillation for longer than 1 year.
After this
treatment, about 9 out of 10 people get back into a normal heart rhythm right away. But for many people, atrial fibrillation returns. About 3 to 5 out of 10 people still have a normal heart rhythm a year after cardioversion.1 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 heart disease. But for most people, atrial
fibrillation is caused by heart disease and is very
likely to return.
If your atrial fibrillation returns, you may be able to have
cardioversion again. But if the problem comes back quickly (within a week or
so), having the treatment yet again is less likely to help you.
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. But you can lower this risk quite a bit by taking
certain steps:
- If your atrial fibrillation has lasted for
more than 48 hours, your doctor may have you take
anticoagulants, or blood thinners, several weeks before cardioversion.
- Your doctor may use a test called
transesophageal echocardiogram to see if you have a clot in your
heart. If you don't, you won't have to take a blood thinner first.
- Your doctor may have you take a blood thinner for a few weeks
after the treatment.
Cardioversion also has other risks:
- You can get a small area of burn on your skin
where the paddles 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 sedative given to you
before the procedure. But harmful reactions are rare.
- The procedure
may not work. You may need more 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, your doctor may have
you take medicines to slow your heart rate.
You will still
probably need to take an anticoagulant (also called a blood thinner) to lower your risk of stroke. But these
medicines raise your risk of a serious bleeding problem. If you take warfarin (Coumadin), you'll need to have
your blood tested often to make sure the medicine is working safely.
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.
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 paddles or 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 need to take an anticoagulant medicine for a few weeks
after.
| - You take
rate-control medicines to control your heart rate and
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 paddles 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
Are you interested in what others decided to do? Many people have faced this decision. These
personal stories
may help you decide.
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."
"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 medications to control my heart rate and prevent strokes and not worry about it."
"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."
"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."
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?
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 long time.
2.
Will cardioversion get your heart to a normal rhythm for good?
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?
Right. Taking medicines to control your heart rate 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.
3.
Use the following space to list questions, concerns, and next steps.
Credits
| By | Healthwise Staff |
|---|
| Primary Medical Reviewer | E. Gregory Thompson, MD - Internal Medicine |
|---|
| Specialist Medical Reviewer | John M. Miller, MD, FACC - Cardiology, Electrophysiology |
|---|
References
Citations
- Morady F, Zipes DP (2012). Atrial fibrillation: Clinical features, mechanisms, and management. In RO Bonow et al., eds., Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine, 9th ed., vol. 1, pp. 825–844. 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.Last Revised:
January 31, 2011
Morady F, Zipes DP (2012). Atrial fibrillation: Clinical features, mechanisms, and management. In RO Bonow et al., eds., Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine, 9th ed., vol. 1, pp. 825–844. Philadelphia: Saunders.