Critical Care Unit (CCU)

The Horton General Hospital

Elective Cardioversion
Information for patients
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What is a cardioversion?
Cardioversion is a procedure for treating abnormal heart rhythms
such as Atrial Fibrillation and Atrial Flutter. It is an alternative to
long term drug therapy for some patients.
The aim is to convert the heart to a normal rhythm by delivering
a controlled electric shock to the heart. The procedure is carried
out under general anaesthetic as a day case procedure. The
procedure is performed by a senior Critical Care Unit (CCU)
nurse, in the presence of a doctor.

What are the benefits of cardioversion?

Some abnormal heart rhythms can result in the heart not
pumping blood properly. This may lead to blood clots forming
and may increase the chance of having a stroke. Some people
are not aware of their abnormal heart rhythm but others have
symptoms such as shortness of breath, fast heart rates and
tiredness. These symptoms may improve after the cardioversion
procedure. There is also the benefit of not having to take
medications to help control the heart rhythm.
The possible benefits of having a cardioversion are:
• Relief from the symptoms of atrial fibrillation or atrial flutter,
such as tiredness, breathlessness and awareness of the heart
beat (palpitations).
• Improvement in exercise capacity.

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Risks
Complications from a cardioversion are rare. The only common
complication is temporary skin redness over the chest area at the
site of the electric shock. This can be relieved by a skin cream
and we will tell you if this is necessary.
Serious complications are very rare. As long as
blood-thinning treatment has been given appropriately
beforehand, the risk of stroke occurring at the time of the
cardioversion is less than 0.5% (1 in every 200 patients).
Immediate success (the return of a normal, regular heart rhythm)
is achieved in more than 90% of patients (9 out of 10) having
cardioversion. However the abnormal heart rhythm (atrial
fibrillation / atrial flutter) may return. In a few people this
happens within hours or days of the cardioversion; in others it
happens weeks or months later. After 12 months, 50-70% of
patients (between 5 and 7 out of 10) will still have a normal
heart rhythm.
Due to the risk of the abnormal heart rhythm returning we
usually advise that Warfarin and other cardiac drugs are
continued for a minimum of 3 months, and often longer, after
the cardioversion.
Your doctor will only recommend that you have a
cardioversion if he/she feels that the benefits of the
procedure outweigh these small risks.

Pre-Cardioversion investigations
Before you have cardioversion we need to carry out some
investigations. We will ask you to come to the pre-assessment
clinic about one week before the procedure, when we will carry
out an ECG (electrocardiogram) - which measures the electrical
activity in your heart.

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Preparation for the procedure
• Your GP will prescribe anti-coagulation medicine to take for
six weeks before the procedure to thin your blood and reduce
the risk of blood clots. You will need to continue to take this
medicine after the procedure, until you are seen in clinic about
six weeks later.
• We will tell you if you need to stop taking any of your
medicines before the procedure.
• You will need a relative or friend to bring you to hospital and
take you home afterwards.
• You should have nothing to eat or drink after midnight the day
before, but you may take your medicines with a small sip of
water.
• At 8.30am on the day of the procedure please telephone the
CCU on (01295) 229192/3 to confirm that a bed is available
for you.
• You should bring a dressing gown & slippers with you. (We will
give you a theatre gown for the procedure.) Please also bring
your medicines with you.

Admission
We will ask you to come to the Critical Care Unit, where the
procedure will be carried out. You will meet the nurse who will
care for you during you procedure. The nurse will explain the
procedure to you and will carry out an ECG, and also take your
blood pressure, temperature and pulse.

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A cannula (a very fine tube) will be put into a vein in your arm by
either the nurse or the anaesthetist. This will be used, before the
procedure, to give you the anaesthetic medication.
A medical Doctor will see you to check that you understand the
procedure before asking you to sign a consent form. If you have
any questions, this is the time to ask.
The anaesthetist will see you and will talk to you about the
anaesthetic and ask you to sign the consent form for the
anaesthetic.

During the procedure

We will connect you to a cardiac monitor and give you oxygen
to breath. We will then put two sticky pads (defibrillation
pads), onto your chest. The anaesthetist will then give you the
anaesthetic through the cannula in your arm. When you are
asleep we will give a controlled shock to your heart. You will not
feel anything.

After the procedure

You will wake up 5-10 minutes after the procedure. Occasionally
there may be a red mark on your chest where the defibrillation
pads were placed. If this happens we will give you advice.
We will carry out an ECG after the procedure, and monitor your
blood pressure, pulse, temperature and breathing for 2 hours.
Once you are awake we will give you something to eat and
drink. You will need to pass urine before you are discharged.
You should be discharged 3-4 hours after the procedure.
The anaesthetic can make you clumsy, slow or forgetful for
about 24 hours. For 48 hours DO NOT drive, operate machinery
or make important decisions.

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How to contact us
If you have any questions or concerns, please contact the CCU
on (01295) 229192 or 229193.

Further information
Further information about cardioversion may be found at the
following websites:

http://www.nhsdirect.nhs.uk/articles/article.aspx?articleId=39&

sectionId=11

http://www.hrspatients.org/patients/treatments/cardioversion.asp

http://www.patient.co.uk/showdoc/40024482/

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If you need an interpreter or need a document in
another language, large print, Braille or
audio version, please call 01865 221473 or
email PALSJR@orh.nhs.uk

Karen Richardson, Junior Sister

Dr Ian Arnold, Consultant Cardiologist
Oxford Radcliffe Hospitals NHS Trust
Oxford OX3 9DU
Version 2, July 2010
Review date July 2013
OMI 2130