Date issued: March 2023
Review date: March 2025
Ref: B-350/CS/Cardiology/Cardioversion for Atrial Arrhythmias v3
Atrial Fibrillation / Atrial Flutter / Atrial Tachycardia
We have received a referral for you to have a procedure called a Direct Current Cardioversion (DCCV). This treatment has been requested for you because you have been diagnosed with having an abnormal rhythm in the upper chambers of your heart (i.e. an atrial arrhythmia). The aim of DCCV is to restore a normal, regular heart rhythm called sinus rhythm.
DCCV is typically done as a day case, under general anaesthetic (GA). We will usually invite you in for a pre-assessment appointment to prepare you for the procedure and to answer any queries or concerns that you may have.
On the day, you will be given a short acting general anaesthetic.
You will be attached to a monitor to record your heart rate and rhythm throughout the procedure. Two large sticky pads will be put on your chest and connected to a defibrillator. These pads will deliver an electric shock through your heart, once you are asleep. The aim of this is to change your heart rhythm back to a normal regular rhythm. If a normal rhythm is not restored on the first attempt we may repeat this up to three times whilst you are still asleep.
From start to finish, the whole procedure takes approximately 10-20 minutes. When you wake up after the procedure you may feel drowsy for two or more hours. We will monitor your condition and allow you to eat and drink as soon as you are alert enough. You should be ready to go home approximately 2-3 hours after the procedure. One of the Arrhythmia Care
Co-ordinators will review you and your Electrocardiogram (ECG) before discharge and discuss your onward care.
Atrial Fibrillation or Atrial Flutter can cause symptoms such as tiredness / lethargy, shortness of breath and palpitations. If your cardioversion is successful, symptoms related to the rhythm disturbance should be significantly reduced or eliminated.
We aim to follow up all patients that go through our service with an initial telephone consultation, usually around three weeks after the procedure. After the cardioversion it is important to make a note of how your symptoms have changed and how it has affected your quality of life.
Do you feel less breathless?
Do you feel less tired or more energised?
Make a mental note or write down any changes that you experience. We know from experience that these arrhythmias may recur so it is useful for us to know if you feel better or actually feel no or little difference once a normal heart rhythm has be restored. This will help guide your treatment in the future.
Medications used in atrial arrhythmias
The following is aimed as a quick guide only and is by no means complete but we hope that it will help you better understand the treatments we use.
Anticoagulants are medications used to reduce your risk of stroke from blood clots which may develop in patients with atrial fibrillation / flutter. Appropriate anticoagulation is essential for a safe cardioversion. If your heart rhythm problem has lasted for more than 48 hours, you will usually be required to take anticoagulation medication for at least 4 weeks prior to a cardioversion and at least 30 days after.
APIXABAN, EDOXABAN, RIVAROXABAN or DABIGATRAN
The majority of patients are on one of the above. If you are it is very important that you take them as prescribed. You must tell us if you have missed a dose as this may affect the timing of your Cardioversion. You will need to have taken 4 weeks of uninterrupted anticoagulant.
If you are on Warfarin you will require frequent blood testing by your GP so the dose can be adjusted if necessary. The blood test is called an INR test (International Normalised Ratio). It measures the clotting tendency of your blood. In preparation for a cardioversion we require INR tests for at least three consecutive weeks and the measurement must stay at or above 2.0. Once this has been achieved we can look at offering you a date. It is important to maintain weekly INR measurements up to the date of the cardioversion. You will remain on warfarin for at least four weeks after your cardioversion; this will be discussed at your follow up appointment.
If you are on warfarin, we will ask you to call in weekly with the blood result to our service so that we can see when you are safe and ready for the cardioversion.
You will remain on warfarin for at least four weeks after your cardioversion; this will be discussed at your follow up appointment.
Rate Control Medications
Atrial arrhythmias can sometimes cause the heart to go faster than usual. Several drugs can slow the heart rhythm down if necessary. The most common ones are digoxin, calcium channel blockers (e.g. diltiazem / verapamil) and beta blockers (e.g. bisoprolol / atenolol). These can help relieve those symptoms of AF are secondary to a faster than normal heart beat.
This is a group of medicines that can help keep your heart rhythm normal following a cardioversion or sometimes return it to normal (approx. 20% of people) without the need for a cardioversion. They are usually recommended / prescribed by a Cardiologist. The most commonly prescribed anti-arrhythmics are Amiodarone, Sotalol and Flecainide, although others are sometimes used.
Or please call the Arrhythmia Care Co-ordinator team on 01752 431 806 and we will be happy to discuss your care with you.