Atrial fibrillation: Should I try electrical cardioversion?
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.
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 blood thinners to prevent a stroke.
Even if cardioversion works, you may still need to take blood
thinners to prevent a stroke.
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 medicines alone—without 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.
After this
treatment, most people get back into a normal heart rhythm right away. But the
rhythm problem usually returns sooner or later. 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 iscaused by heart disease and is very
likely to return.
The longer you have had atrial fibrillation, the
less likely you are to stay in a normal rhythm after cardioversion.
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.
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 ahead
of time.
Your doctor may use a test called
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.
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 a
blood thinner to lower your risk of stroke. But these
medicines raise your risk of a serious bleeding problem. So you'll need to have
your blood tested often to make sure the medicine is working safely.
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.
Raymond, age 45
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.
Tom, age
61
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.
Manny,
age 78
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.
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?
Check the facts
1.
Does cardioversion work for everyone?
YesSorry, that's wrong. Cardioversion doesn't work as well when you also have another heart disease or when you have had atrial fibrillation for a long time.
NoYou'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.
I'm not sureIt may help to go back and read "Key points to remember." 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?
YesNo, that's wrong. Although cardioversion may return your heart to its normal rhythm, atrial fibrillation often returns.
NoThat's correct. Although cardioversion may return your heart to its normal rhythm, atrial fibrillation often returns.
I'm not sureIt may help to go back and read "Key points to remember." Although cardioversion may return your heart to its normal rhythm, atrial fibrillation often returns.
3.
Is there another way to treat atrial fibrillation?
YesRight. Taking medicines to control your heart rate and prevent stroke is another way to treat atrial fibrillation.
NoSorry, that's wrong. Taking medicines to control your heart rate and prevent stroke is another way to treat atrial fibrillation.
I'm not sureIt may help to go back and read "Key points to remember." 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.
Atrial fibrillation: Should I try electrical cardioversion?
You can use this information 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 blood thinners to prevent a stroke.
Even if cardioversion works, you may still need to take blood
thinners to prevent a stroke.
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 medicines alone—without 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.
After this
treatment, most people get back into a normal heart rhythm right away. But the
rhythm problem usually returns sooner or later. 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 iscaused by heart disease and is very
likely to return.
The longer you have had atrial fibrillation, the
less likely you are to stay in a normal rhythm after cardioversion.
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.
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 ahead
of time.
Your doctor may use a test called
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.
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 a
blood thinner to lower your risk of stroke. But these
medicines raise your risk of a serious bleeding problem. So you'll need to have
your blood tested often to make sure the medicine is working safely.
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. "
— Raymond, age 45
" 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.
"
— Tom, age
61
" 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. "
— Manny,
age 78
" 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. "
— Margarita, age 82
3. Your Feelings
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. Your Decision
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. Quiz Yourself
Check the facts
1.
Does cardioversion work for everyone?
Yes
No
I'm not sure
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?
Yes
No
I'm not sure
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?
Yes
No
I'm not sure
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.
I'm ready to take action.
I want to discuss the options with others.
I want to learn more about my options.
3.
Use the following space to list questions, concerns, and next steps.
Credits and references
Credits
Author
Robin Parks, MS
Editor
Kathleen M. Ariss, MS
Associate Editor
Pat Truman, MATC
Primary Medical Reviewer
Caroline S. Rhoads, MD - Internal Medicine
Specialist Medical Reviewer
John M. Miller, MD - Electrophysiology
References
Citations
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