Cardioversion questions

If the person has been in atrial fib. for an unknown time it is generally better to try meds first, because there could be a clot in the heart from the atrial fib, and cardioversion would dislodge the clot. An echocardiogram should be done before cardioversion for just that reason so that if there is a clot they will see it, and act accordingly. Everyone is different on how long they stay in rythm sometimes indefinelty, others continue to go in and out.

"heart has shrunk 10%, and ejection fraction has improved from 35 to 49%" this seems to be backwards, because what you said this is good things. did you mean that his heart enlarged by 10% and ej fx decreased. because the higher is better. 49% is good compared to 35.

To know where they will do the chemical without knowing what meds they will be using it is difficult to answer. Most is done in the hospital. Hope this helps. :0

Sorry, this got posted twice by mistake. His heart is almost back to normal size. He has been on a blood thinner for the past year or so. I just want to find out how are his chances that it will stay out of A-fib. Also what setting do they do the chemical cardioversion? In his hospital room or somewhere else. Thanks

The CCU I work in performs chemical- and electro-cardioversions right there in the unit where we can monitor the patients closely.

Research about cardioversions on patients in atrial fib show that 60-80% who are converted to sinus rhythm return to a-fib within a year. Unfortunate statistic.

In our unit, for electrocardioversion, we start out at 50 joules, then to 100 and 150. The majority convert with the first shock, the rest usually convert on the second go 'round. The pain of the shocks is always cushioned with some versed and demerol in scheduled cases. Different physicians start out at different levels, too. Our cardiologists start at 50j, one of our interns goes ahead and shocks at 100j right off, so it differs.

Hope this helps!

:typing

I'm wondering why they haven't tried a cardizem drip and if that works discontinue it in favor of PO cardizem.

We use corvert for chemical cv...sometimes two doses repeated one after the other. If no success....then electrical cv. We do it in any private room on our unit. Anesthesiologist is present..uses propophenol IV. This produces immediate sleep and totally no recall of the event. Pt wakes up anywhere from 5 to 30 minutes, depending on age/ wgt. Very safe procedure. Sustaining SR has somewhere from 75 to 90% success for anywhere from 1-5 yrs. hope things go well!