591:
675:
is placed along the left midaxillary line. Choosing the right pad placement can be an important aspect when measuring the success of electrical cardioversion. For example, the anterior-posterior pad positioning is commonly used when attempting to restore an atrial arrhythmia as the vector between the pads predominately runs through the atria. The anterior-lateral pad positioning may be used when attempting to restore pulseless ventricular tachycardia or ventricular fibrillation as there may not be enough time or strength to apply an electrode the patient's back.
1046:"ACC/AHA/ESC 2006 Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: a report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (writing committee to develop Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death): developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society"
1005:"ACC/AHA/ESC 2006 Guidelines for the Management of Patients with Atrial Fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation): developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society"
318:
2051:
147:
36:
551:) in order to ensure patient comfort and amnesia during the procedure. Opioid analgesics (e.g., Fentanyl) may be combined with Propofol, although anesthesiology must weight the benefits against adverse effects including apnea. Bite blocks and extremity restraints are then utilized to prevent self-injury during cardioversion. Once these medications are administered, the
128:
666:
However, if the arrhythmia is persistent, the machine may be re-charged to a higher energy level, and the cardioversion attempt may be repeated. It is recommended to wait 60 seconds between subsequent cardioversion attempts, but this amount of time may be adjusted based on the patient and/or provider.
692:
The anterior pad should be placed inferior to the right clavicle while also being vertically centered over at the level of the right 4th intercostal space. The lateral pad should be placed along the left midaxillary line at the level of the left 5th intercostal space. The left nipple can be used as a
594:
665:
should be evenly spaced. If sinus rhythm is restored, the pads may be disconnected, and any other medical equipment is removed from the patients (e.g., bite blocks, restraints, etc.). The patient will regain consciousness soon thereafter (the effects of
Propofol generally last for only 3–8 minutes).
538:
Cardioversion for restoration of sinus rhythm from an atrial rhythm is largely a scheduled procedure. In addition to cardiology, anesthesiology is also usually involved to ensure comfort of the patient for the duration of the shock therapy. The presence of registered nurses, physician associates, or
334:
pads are used (or, alternatively, the traditional hand-held "paddles"), each comprising a metallic plate which is faced with a saline based conductive gel. The pads are placed on the chest of the patient, or one is placed on the chest and one on the back. These are connected by cables to a machine
683:
The anterior pad should be placed inferior to the right clavicle while also being vertically centered over at the level of the right 4th intercostal space. The posterior pad should be placed just lateral to the left side of the spine and vertically centered at the level of T7. The inferior angle of
674:
Pad placement for electrical cardioversion a cardiac arrhythmia may be either anterior-posterior or anterior-lateral. In an anterior-posterior setup one pad is placed on the chest and the other pad is placed on the back. In an anterior-lateral setup, one pad is placed on the chest and the other pad
566:
of the rhythm strip. Although uncommon, sometimes the machine will unintentionally sync to high amplitude T waves, so it is important to ensure that the machine is synced appropriately to R waves. Interpretation of the patient's rhythm is imperative when using cardioversion to restore sinus rhythm
542:
Before starting the procedure, the patient's chest and back will be prepped for electrode placement. The skin should be free of any oily substances (e.g., lotions) and hair which may otherwise interfere with adhesion of the pads. Once this is complete, the medical team will adhere the pads to the
605:
Once the machine is synced with the patient's cardiac rhythm, the machine must be charged. To determine the amount of energy (measured in joules "J") the patient requires, many factors are considered. As a rule of thumb, recent-onset atrial arrhythmias require less energy compared to persistent
524:
may be used for restoration of sinus rhythm in patients with macro-reentrant supraventricular tachycardias. It causes a short-lived cessation of conduction through the atrio-ventricular node breaking the circus movement through the node and the macro-reentrant pathway restoring sinus rhythm.
497:
Class II agents are beta blockers which inhibit SA and AV node depolarization and slow heart rate. They also decrease cardiac oxygen demand and can prevent cardiac remodeling. Not all beta blockers are the same; some are cardio selective (affecting only beta 1 receptors) while others are
437:. Pharmacological cardioversion is an especially good option in patients with atrial fibrillation of recent onset. Drugs that are effective at maintaining normal rhythm after electric cardioversion can also be used for pharmacological cardioversion. Drugs like
453:
are frequently given before electrical cardioversion to decrease the heart rate, stabilize the patient and increase the chance that cardioversion is successful. There are various classes of agents that are most effective for pharmacological cardioversion.
374:. If the patient is conscious, various drugs are often used to help sedate the patient and make the procedure more tolerable. However, if the patient is hemodynamically unstable or unconscious, the shock is given immediately upon confirmation of the
457:
Class I agents are sodium (Na) channel blockers (which slow conduction by blocking the Na+ channel) and are divided into 3 subclasses a, b and c. Class Ia slows phase 0 depolarization in the ventricles and increases the absolute refractory period.
513:
is another Class III agent but has a different mechanism of action (acts to promote influx of sodium through slow-sodium channels). It has been shown to be effective in acute cardioversion of recent-onset atrial fibrillation and atrial flutter.
498:
non-selective (affecting beta 1 and 2 receptors). Beta blockers that target the beta-1 receptor are called cardio selective because beta-1 is responsible for increasing heart rate; hence a beta blocker will slow the heart rate.
1129:
Kirchhof P, Eckardt L, Loh P, Weber K, Fischer RJ, Seidl KH, et al. (October 2002). "Anterior-posterior versus anterior-lateral electrode positions for external cardioversion of atrial fibrillation: a randomised trial".
606:
atrial arrhythmias. If the cardiologist suspects that the patient may be less respondent to cardioversion, a higher energy may be utilized. Once the machine is synced and charged, a shock can be delivered to the patient.
1087:"Part 6: electrical therapies: automated external defibrillators, defibrillation, cardioversion, and pacing: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care"
693:
reference for the level of the left 4th intercostal space. From here, the midaxillary 5th intercostal space is identified by moving inferiorly one intercostal space and laterally towards the midaxillary line.
848:
Sado DM, Deakin CD, Petley GW, Clewlow F (January 2004). "Comparison of the effects of removal of chest hair with not doing so before external defibrillation on transthoracic impedance".
590:
562:
The pads are connected to a machine that can interpret the patient's cardiac rate and rhythm and deliver a shock at the appropriate time. The machine should synchronize ('sync') with the
46:
343:. A synchronizing function (either manually operated or automatic) allows the cardioverter to deliver a reversion shock, by way of the pads, of a selected amount of
1290:
1999:
1325:
378:. When synchronized electrical cardioversion is performed as an elective procedure, the shocks can be performed in conjunction with drug therapy until
1421:
271:
805:
583:"v-fib", then a shock is delivered immediately upon connection of the pads. In this application, electrical cardioversion is more properly termed
1819:
1409:
702:
174:
968:
Sirna SJ, Ferguson DW, Charbonnier F, Kerber RE (November 1988). "Factors affecting transthoracic impedance during electrical cardioversion".
1694:
657:
Following electrical cardioversion, the cardiologist will determine if sinus rhythm has been restored. To confirm sinus rhythm, a distinct
1259:
1944:
1620:
1525:
748:
366:
Timing the shock to the R wave prevents the delivery of the shock during the vulnerable period (or relative refractory period) of the
1825:
1283:
713:
1832:
1639:
482:. Class Ic greatly slow phase 0 depolarization in the ventricles (however unlike 1a have no effect on the refractory period).
1932:
1629:
107:
1954:
718:
79:
1455:
1236:
1939:
1927:
1808:
1245:
658:
517:
Class IV drugs are calcium (Ca) channel blockers. They work by inhibiting the action potential of the SA and AV nodes.
2073:
2054:
1276:
1178:"External cardioversion of atrial fibrillation: role of paddle position on technical efficacy and energy requirements"
385:
Synchronized electrical cardioversion is used to treat hemodynamically unstable supraventricular (or narrow complex)
86:
556:
1579:
1886:
1776:
1530:
1320:
54:
1965:
1949:
1416:
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1961:
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1803:
1768:
1614:
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402:
398:
299:
65:
50:
2007:
418:
75:
2038:
1842:
1763:
708:
2012:
1569:
1382:
1377:
430:
311:
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is attained. After the procedure, the patient is monitored to ensure stability of the sinus rhythm.
1891:
1869:
1555:
1394:
1367:
572:
390:
251:
1874:
1787:
1783:
1729:
1724:
1665:
1586:
1494:
1443:
1357:
1155:
595:
LIFEPAK 20e
Defibrillator and Monitor displaying synchronization with QRS complexes. (arrowheads)
239:
937:
Goyal A, Sciammarella JC, Chhabra L, Singhal M (2022). "Synchronized
Electrical Cardioversion".
1253:
1085:
Link MS, Atkins DL, Passman RS, Halperin HR, Samson RA, White RD, et al. (November 2010).
1044:
Zipes DP, Camm AJ, Borggrefe M, Buxton AE, Chaitman B, Fromer M, et al. (September 2006).
1003:
Fuster V, Rydén LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA, et al. (August 2006).
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414:
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227:
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27:
Conversion of a cardiac arrhythmia to a normal rhythm using an electrical shock or medications
2017:
1922:
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1189:
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397:. It is also used in the emergent treatment of wide complex tachycardias, including
1798:
662:
467:
459:
434:
379:
243:
861:
470:
are Class Ia agents. Class 1b drugs lengthen phase 3 repolarization. They include
201:
187:
1975:
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162:
743:(Fourth ed.). Wolters Kluwer Health/Lippincott Williams & Wilkins.
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331:
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1151:
1112:
1071:
1030:
948:
920:
869:
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547:. The anesthesiology team will then administer a general anesthetic (e.g.,
146:
989:
901:
501:
Class III agents (prolong repolarization by blocking outward K+ current):
1193:
548:
211:
506:
64:
if you can. Unsourced or poorly sourced material may be challenged and
1634:
1176:
Botto GL, Politi A, Bonini W, Broffoni T, Bonatti R (December 1999).
563:
543:
patient using a rolling motion to ensure the absence of air pockets.
1983:
1813:
1644:
1489:
1304:
589:
539:
other medical personnel may also be helpful during the procedure.
316:
283:
263:
643:
Pulseless
Ventricular Tachycardia and Ventricular Fibrillation:
1272:
567:
from less emergent arrhythmias where a pulse is present (e.g.,
559:
may be used to determine the patient's level of consciousness.
321:'Burn' mark remaining one day after DC electrical cardioversion
661:
should be seen preceding each QRS complex. Additionally, each
29:
684:
the scapula can be used as a reference for the level of T7.
885:"Propofol for sedation for direct current cardioversion"
61:
409:
are treated with unsynchronized shocks referred to as
330:
To perform synchronized electrical cardioversion, two
290:, and is the most effective resuscitation measure for
2026:
1998:
1855:
1710:
1606:
1346:
1339:
194:
180:
168:
156:
139:
647:for biphasic devices; 360 J for monophasic devices
638:for biphasic devices; 200 J for monophasic devices
629:for biphasic devices; 200 J for monophasic devices
620:for biphasic devices; 100 J for monophasic devices
339:display screen and the electrical function of a
943:. Treasure Island (FL): StatPearls Publishing.
575:). However, if a patient is confirmed to be in
1240:from the American Academy of Family Physicians
60:Please review the contents of the article and
1284:
8:
932:
930:
1343:
1326:Cardiology diagnostic tests and procedures
1291:
1277:
1269:
433:can be used to return the heart to normal
413:. Electrical therapy is inappropriate for
145:
1422:Transcatheter pulmonary valve replacement
1201:
1102:
1061:
1020:
910:
900:
883:Wafae BG, da Silva RM, Veloso HH (2019).
781:
766:"Cardiology patient pages. Cardioversion"
272:electrical conduction system of the heart
1465:shunt from heart chamber to blood vessel
634:Ventricular Tachycardia (with a pulse):
1565:shunt from blood vessel to blood vessel
731:
417:, which should always be a part of the
355:which corresponds to the R wave of the
335:which has the combined functions of an
1232:from the National Institutes of Health
703:Implantable cardioverter-defibrillator
136:
1695:Valve-sparing aortic root replacement
1434:enlargement of existing septal defect
1247:Synchronized Electrical Cardioversion
1171:
1169:
1124:
1122:
401:, when a pulse is present. Pulseless
256:Synchronized electrical cardioversion
7:
1429:production of septal defect in heart
764:Shea JB, Maisel WH (November 2002).
545:(see details on pad placement below)
207:
1526:transposition of the great vessels
1451:creation of septal defect in heart
970:The American Journal of Cardiology
850:The American Journal of Cardiology
783:10.1161/01.CIR.0000040586.24302.B9
25:
1826:Cardiac resynchronization therapy
1104:10.1161/CIRCULATIONAHA.110.970954
1063:10.1161/CIRCULATIONAHA.106.178233
1022:10.1161/circulationaha.106.177292
577:pulseless ventricular tachycardia
2050:
2049:
714:Automated external defibrillator
679:Anterior-Posterior pad placement
509:are effective class III agents.
314:instead of an electrical shock.
270:, restoring the activity of the
126:
34:
1833:Left atrial appendage occlusion
688:Anterior-Lateral pad placement
62:add the appropriate references
1:
1955:Radionuclide ventriculography
1257:from the Heart Rhythm Society
1238:Pharmacological Cardioversion
1144:10.1016/S0140-6736(02)11315-8
889:Annals of Cardiac Anaesthesia
862:10.1016/j.amjcard.2003.09.020
719:Cardiopulmonary resuscitation
351:at the optimal moment in the
151:Illustration of cardioversion
1940:Myocardial perfusion imaging
982:10.1016/0002-9149(88)90546-2
808:. American Heart Association
806:"Medications for Arrhythmia"
347:over a predefined number of
266:at a specific moment in the
230:by which an abnormally fast
304:Pharmacologic cardioversion
278:uses a therapeutic dose of
258:uses a therapeutic dose of
47:reliable medical references
2090:
1547:for univentricular defect
828:"AED recyclen en inruilen"
520:If the patient is stable,
286:at a random moment in the
2047:
1887:Implantable loop recorder
1531:Arterial switch operation
1321:Interventional cardiology
1311:
1097:(18 Suppl 3): S706–S719.
610:Recommended Energy Levels
312:antiarrhythmia medication
208:
144:
53:or relies too heavily on
1966:Coronary catheterization
1456:Blalock–Hanlon procedure
1417:Mitral valve replacement
1400:Aortic valve replacement
616:Atrial Flutter and SVT:
581:ventricular fibrillation
407:ventricular fibrillation
372:ventricular fibrillation
296:ventricular fibrillation
18:Electrical cardioversion
1962:Cardiac catheterization
1904:Electrophysiology study
1804:Radiofrequency ablation
1769:Alcohol septal ablation
670:Electrode pad placement
403:ventricular tachycardia
399:ventricular tachycardia
300:ventricular tachycardia
2008:Impedance cardiography
1630:Coronary artery bypass
597:
419:differential diagnosis
322:
308:chemical cardioversion
2039:Transcutaneous pacing
1843:Heart transplantation
1764:Ventricular reduction
1580:Blalock–Taussig shunt
1249:from eMedicine Online
902:10.4103/aca.ACA_72_18
741:Marino's the ICU book
709:Transcutaneous pacing
625:Atrial Fibrillation:
593:
494:are Class Ic agents.
431:antiarrhythmic agents
370:, which could induce
320:
2013:Ballistocardiography
1570:systemic circulation
1194:10.1136/hrt.82.6.726
1892:Cardiac stress test
1870:Electrocardiography
1809:Pacemaker insertion
1556:Kawashima procedure
1520:compound procedures
1395:Aortic valve repair
1368:Mitral valve repair
1138:(9342): 1275–1279.
653:After cardioversion
573:atrial fibrillation
391:atrial fibrillation
2074:Cardiac procedures
1945:Cardiovascular MRI
1875:Vectorcardiography
1730:Pericardial window
1725:Pericardiocentesis
1666:Drug-eluting stent
1495:Rastelli procedure
1444:Balloon septostomy
1262:2010-11-29 at the
739:Marino PL (2014).
598:
323:
242:is converted to a
240:cardiac arrhythmia
2061:
2060:
1918:Angiocardiography
1864:Electrophysiology
1851:
1850:
1794:Catheter ablation
1777:Conduction system
1702:LeCompte maneuver
1690:Bentall procedure
1551:Norwood procedure
1541:Senning procedure
1536:Mustard procedure
1439:Atrial septostomy
1390:Valve replacement
1056:(10): e385–e484.
976:(16): 1048–1052.
776:(22): e176–e178.
415:sinus tachycardia
228:medical procedure
219:
218:
135:
134:
111:
16:(Redirected from
2081:
2053:
2052:
2018:Cardiotocography
1986:
1950:Ventriculography
1923:Echocardiography
1914:
1866:
1782:Maze procedure (
1779:
1745:
1721:
1674:
1673:Obstacle removal
1661:Bare-metal stent
1657:
1617:
1574:pulmonary artery
1566:
1521:
1506:pulmonary artery
1479:Fontan procedure
1474:pulmonary artery
1466:
1430:
1344:
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1286:
1279:
1270:
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1205:
1173:
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1117:
1116:
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1082:
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1024:
1015:(7): e257–e354.
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736:
553:glabellar reflex
345:electric current
294:associated with
280:electric current
260:electric current
212:edit on Wikidata
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1994:
1990:Phonocardiogram
1982:
1912:Cardiac imaging
1910:
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1847:
1775:
1759:Septal myectomy
1749:Cardiomyoplasty
1741:
1735:Pericardiectomy
1717:
1706:
1672:
1653:
1613:
1607:Cardiac vessels
1602:
1596:Glenn procedure
1564:
1519:
1502:right ventricle
1464:
1428:
1350:
1335:
1331:Cardiac imaging
1316:Cardiac surgery
1307:
1297:
1264:Wayback Machine
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76:"Cardioversion"
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55:primary sources
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2000:Function tests
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1678:Endarterectomy
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1486:left ventricle
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1405:Ross procedure
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1303:involving the
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411:defibrillation
395:atrial flutter
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298:and pulseless
292:cardiac arrest
276:Defibrillation
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78: –
77:
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72:Find sources:
67:
63:
57:
56:
52:
48:
43:This article
41:
32:
31:
19:
2033:
1822:implantation
1816:implantation
1799:Cryoablation
1640:Off-pump CAB
1450:
1433:
1358:Valve repair
1348:Heart valves
1254:
1246:
1237:
1229:
1185:
1181:
1135:
1131:
1094:
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973:
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952:. Retrieved
939:
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843:
831:. Retrieved
822:
810:. Retrieved
800:
773:
769:
759:
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734:
691:
682:
673:
663:R-R interval
656:
644:
642:
635:
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626:
624:
617:
615:
604:
579:"v-tach" or
561:
544:
541:
537:
519:
516:
500:
496:
468:disopyramide
460:Procainamide
456:
435:sinus rhythm
428:
389:, including
387:tachycardias
384:
380:sinus rhythm
365:
349:milliseconds
329:
307:
303:
255:
223:
222:
220:
117:January 2022
114:
104:
97:
90:
83:
71:
51:verification
44:
1976:Cardiac PET
1719:Pericardium
1683:Atherectomy
1621:Angioplasty
1363:Valvulotomy
1091:Circulation
1050:Circulation
1009:Circulation
770:Circulation
534:Preparation
492:propafenone
357:QRS complex
248:electricity
238:) or other
236:tachycardia
196:MedlinePlus
45:needs more
1971:Cardiac CT
1838:Cardiotomy
1743:Myocardium
1511:Sano shunt
1301:procedures
1299:Tests and
954:2022-08-12
940:StatPearls
726:References
503:amiodarone
488:moricizine
484:Flecainide
476:mexiletine
451:metoprolol
439:amiodarone
425:Medication
376:arrhythmia
326:Electrical
232:heart rate
163:Cardiology
87:newspapers
1351:and septa
645:120-200 J
627:120-200 J
529:Procedure
522:adenosine
511:Ibutilide
480:phenytoin
472:lidocaine
464:quinidine
447:verapamil
443:diltiazem
332:electrode
158:Specialty
2068:Category
2055:Category
1788:minimaze
1784:Cox maze
1260:Archived
1212:10573502
1160:25083798
1152:12414201
1113:20956222
1072:16935995
1031:16908781
949:29489237
921:30971591
870:14697478
833:15 April
792:12451016
697:See also
618:50-100 J
549:Propofol
429:Various
310:, uses
170:ICD-9-CM
1340:Surgery
1203:1729223
990:3189167
912:6489399
507:sotalol
359:on the
282:to the
262:to the
188:D004554
101:scholar
66:removed
2027:Pacing
1635:MIDCAB
1626:Bypass
1576:shunt
1470:atrium
1383:mitral
1378:aortic
1242:(1998)
1210:
1200:
1158:
1150:
1132:Lancet
1111:
1070:
1029:
988:
947:
919:
909:
868:
812:13 Sep
790:
747:
659:P wave
564:R wave
246:using
202:007110
103:
96:
89:
82:
74:
1984:sound
1856:Tests
1814:S-ICD
1711:Other
1645:TECAB
1490:aorta
1305:heart
1182:Heart
1156:S2CID
721:(CPR)
705:(ICD)
636:100 J
284:heart
264:heart
252:drugs
226:is a
210:[
108:JSTOR
94:books
1786:and
1524:for
1208:PMID
1148:PMID
1109:PMID
1068:PMID
1027:PMID
986:PMID
945:PMID
917:PMID
866:PMID
835:2021
814:2020
788:PMID
745:ISBN
505:and
490:and
478:and
466:and
449:and
405:and
393:and
182:MeSH
175:99.6
80:news
49:for
1933:TEE
1928:TTE
1820:ICD
1615:CHD
1587:SVC
1572:to
1504:to
1488:to
1472:to
1198:PMC
1190:doi
1140:doi
1136:360
1099:doi
1095:122
1058:doi
1054:114
1017:doi
1013:114
978:doi
907:PMC
897:doi
858:doi
778:doi
774:106
555:or
361:ECG
337:ECG
302:.)
274:. (
250:or
2070::
1591:PA
1206:.
1196:.
1186:82
1184:.
1180:.
1168:^
1154:.
1146:.
1134:.
1121:^
1107:.
1093:.
1089:.
1066:.
1052:.
1048:.
1025:.
1011:.
1007:.
984:.
974:62
972:.
929:^
915:.
905:.
893:22
891:.
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854:93
852:.
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772:.
768:.
587:.
571:,
486:,
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462:,
445:,
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363:.
254:.
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1628:/
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780::
753:.
234:(
214:]
119:)
115:(
105:·
98:·
91:·
84:·
58:.
20:)
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