What is cardioversion and why has it been recommended?

Your heart has a persistent irregularity of rhythm called ATRIAL FIBRILLATION or ATRIAL FLUTTER. An electrical charge will be passed through your chest through two pads. This will attempt to return the rhythm to normal, improve the function of your heart if it is abnormal and reduce the likelihood of complications in the long term.  Up to four attempts can be made on the day to restore the normal rhythm. We would like to make all patients aware that the frequency and severity of arrhythmia is known to be improved if you can exercise regularly and maintain a BMI of 27 or below. Restrict any alcohol intake to within the recommended guidelines (4 units per week in the context of arrhythmia) or ideally abstain completely. In collaboration with your GP manage the following conditions as efficiently as possible: High blood, obstructive sleep apnoea, high cholesterol and diabetes.

Is the procedure painful?

You will have no recollection of the procedure as you will be given a short acting general anaesthetic, the whole procedure lasting only several minutes.  Following defibrillation, you may experience some itching and you may have some minimal redness to your chest following the procedure. If this becomes uncomfortable, tenderness can be eased with after sun, moisturising cream or simple analgesia such as paracetamol if required.

Will I be allowed home after the procedure?

You will usually be allowed home shortly after you have recovered from the anaesthetic.  In the unlikely event that you have not recovered sufficiently to return home or you have no one with you at home, it may be necessary to remain in hospital overnight. Please drink plenty of fluids this evening/tonight and refrain from exercise, driving or operating machinery for 48 hours.

Advice after an anaesthetic?

An anaesthetic can impair your ability to drive.  You must make arrangements to be driven home from the Surgical Day Unit following the procedure. You must not drink alcohol or operate machinery.

Should I attend if I am unwell?

If you do develop any fever/illness/infection before the cardioversion, please telephone the Cardioversion Secretary 01228 814194

Information relating to COVID 19:

In line with local/ National Guidance: DO NOT attend any face to face appointments if you or any member of your household has experienced COVID 19 type symptoms or have tested positive in the last 14 days.

What will happen on the day of Cardioversion?

On arrival, the Cardiology Specialist Nurse will assess you. You will then be seen by the Anaesthetist. He/she will assess you for the anaesthetic. You will be asked to change into a gown (please bring with you a dressing gown and slippers). You will then wait to be called for your cardioversion.

A nurse will escort you to the theatre room. In the theatre you will be met by the Anaesthetist and Cardiology specialist nurse. You will be given an anaesthetic and once sufficiently “unconscious” the cardioversion will take place.

You will wake up in the recovery room and then be taken to the day surgery recovery area. Here you will be given hot drinks and a snack. Once the nurses are happy with your recovery you will be allowed to dress and wait to see the Cardioversion Doctor.

A Cardiology Consultant or cardiology specialist nurse will see you before you go home. They will inform you if the cardioversion was successful. They will also advise which medication to continue or discontinue. They will arrange follow up or further treatment under the referring Consultant.

What is the likelihood that the procedure will be successful?

Immediate success rate is at least 50-80%. There is a possibility that the heart will return to an irregular rhythm the in first few hours after the procedure, or at any time thereafter.  If this does occur it may be appropriate to consider a further cardioversion on a separate occasion. Some patients may be offered other treatments or medications as an alternative.

Is it safe?

There are always risks associated with any anaesthetic or cardiac procedure although the risks of developing complications such as a stroke or heart attack are small. The nurse will advise you of any risks at your pre-assessment

Why do I need to take an anti-coagulant?

The heart can develop blood clots whilst in the irregular rhythm. At any time the blood clots can be dislodged and move causing stroke or heart attack. These risks are reduced if anti coagulation is taken.

If you are prescribed warfarin, your INR must be within a therapeutic range for at least three consecutive weeks prior to the procedure. It is your responsibility to arrange INR checks and to inform the cardiology specialist nurse of the results

If you are prescribed one of the new anticoagulant medication (apixaban, rivaroxaban, edoxaban, dabigatran), these can be taken on the morning of your procedure before 06:00 (6AM) with a small amount of water. You will be asked to sign a form to confirm you have not missed any doses.

Are there any other precautions?

Please do not eat or drink from midnight the night before your cardioversion. You should have nothing to eat and drink on the morning of defibrillation except a small amount of water if necessary to take your regular/anticoagulant medication. You should take any prescribed inhalers as normal.

Patient information checklist

Things to remember prior to your Elective DC Cardioversion procedure:

  • Anticoagulant medication must be taken before 06:00 (6am) on morning of procedure with small amount of water.
  • Stop Digoxin 72 hours prior to the Cardioversion
  • Regular medication must be brought to the hospital, these can be taken following the procedure
  • Take any inhalers as you would normally on the morning of the procedure. Bring them into hospital with you. You can take Ventolin / salbutamol inhaler prior to the procedure as a precaution.
  • You should not have anything else to eat or drink from 12 midnight prior to the procedure.
  • Up to date blood tests within 3 months of procedure date – full blood count, renal function, thyroid function, liver function.
  • Have you arranged transport to and from the Hospital? This can be hospital transport or a friend/relative. Public transport cannot be used.
  • Refrain from exercise, driving or operating machinery for 48 hours after your procedure.
  • Have you arranged for someone to stay with you after procedure for 24 hours?
  • Men are advised to shave the chest the night before the procedure
  • Small overnight bag should be packed just in case you may need to stay in overnight following your procedure.

The above information has been given to ensure your safety throughout the proposed procedure. The procedure could be cancelled on the day if the statements in bold are not adhered too

 

Confidentiality

‘The Trust’s vision is to keep your information safe in our hands.’ We promise to use your information fairly and legally, and in-line with local and national policies. You have a right to understand how your information is used and you can request a copy of the information we hold about you at any time.

For further information on confidentiality contact the Information Governance Team:

Information.Governance@ncic.nhs.uk | 01228 603961

Feedback

We appreciate and encourage feedback, which helps us to improve our services. If you have any comments, compliments or concerns to make about your care, please contact the Patient, Advice & Liaison Service:

pals@ncic.nhs.uk | 01228 814008 or 01946 523818

If you would like to raise a complaint regarding your care, please contact the Complaints Department:

complaints@ncic.nhs.uk | 01228 936302