Kardioversio

Kardioversio, or cardioversion, is a medical procedure used to restore a normal heart rhythm in people with certain tachyarrhythmias, most commonly atrial fibrillation or atrial flutter and some forms of supraventricular tachycardia. It can be performed electrically (electrical cardioversion) or with medications (pharmacological cardioversion).

Electrical cardioversion involves delivering a synchronized electrical shock to the heart, typically under sedation, through pads or paddles placed on the chest. The goal is to reset the electrical activity and allow the heart’s natural pacemaker to reestablish sinus rhythm. Energy starting levels and number of shocks depend on the arrhythmia and patient factors. Pharmacological cardioversion uses antiarrhythmic drugs such as amiodarone, flecainide, propafenone, ibutilide, or dofetilide, chosen according to the patient’s rhythm and comorbidities.

Preparation and safety considerations include assessing the duration of the arrhythmia, heart structure, and the risk of thromboembolism. For atrial fibrillation lasting more than 48 hours or of unknown duration, anticoagulation for several weeks before electrical cardioversion or performing a transesophageal echocardiogram to exclude left atrial thrombus is often recommended. In unstable patients, urgent synchronized cardioversion may be performed without prior anticoagulation. After the procedure, anticoagulation is typically continued for several weeks if AF is restored.

Risks include thromboembolism, especially if anticoagulation has not been adequately addressed, as well as recurrence of the arrhythmia, skin burns, arrhythmias, heart block, or adverse reactions to anesthesia or medications. Efficacy is generally high for restoring sinus rhythm, but recurrence of atrial fibrillation is common, and long-term management may involve ongoing antiarrhythmic therapy or ablation.

Follow-up includes rhythm monitoring, adjustment of medications, and adherence to anticoagulation guidelines as advised by a clinician.