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Discussion

Elective and emergent cardioversion

What's the difference between Elective and emergent cardioversion? I know that if it's elective the pt must be anticoagulated, but why? And would you give adenosine first before doing cardioversion to see if the adenosine will correct the problem, OR is it just standard to give adenosine and then proceed w/ cardioversion?

THANK YOU!

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Cardioversion is the electricaly syncronized shock delivered to the heart to break an unstable rhythm. It is usually used for superventricular arrhythmias. You can have "stable" V tach but it is fairly rare. Unstable v tach is treated like v fib and defibrillated(unsynchronised). The difference is the degree of instability. If a patient has life threatening changes in vital signs you cannot wait to anticoagulate the patient before correcting the rhythm. The problem with superventricular arrhythmais is the atrium do not contract(or not well) and clots can form in the chambers of the heart. When you cardiovert the atrium eject efficiently and chuck out all those clots to all sorts of bad places. The good news is if a patient truely has an unstable rhythm that needs emergent cardioversion odds are they haven't been in it long enough to form clots (they would be dead). With a stable arrhythmia the patient may have poor exercize tollerance, mild dyspnea, treatable diminished cardiac output but isn't going to be made worse by spending a few days or a couple of weeks on a thinner to eliminate those nasty clots. The tricky patients are those who may have been in a stable arrhythmia for weeks then became unstable (from dehydration, change in meds, other illness, whatever..)

As to adenosine- it has largely gone out of use other than a diagnostic tool. If you are sick enough for adenosine you need cardioverted. If you don't have the ability to cardiovert you most likely won't (or shouldn't) have adenosine on hand either. Wasting the time to draw up and give the adenosine is not standard anymore in most situations.

  • Experts

emergency cardioversion is done when a patient is hemodynamically unstable and having tachyarrhythmias such as paroxysmal atrial tachycardia, unstable paroxysmal supraventricular tachycardia, atrial fibrillation, atrial flutter, or ventricular tachycardia with a pulse. elective cardioversion is done after the doctor and patient have discussed the options, pros and cons and made a pre-determined choice to do the procedure and schedule it to be done. cardioversion delivers an electrical charge at the peak of the r wave which results in immediate depolarization and allows the sinoatrial node to resume control of the heartbeat.

anticoagulation is not a requirement of elective cardioversion. i would suggest that it was something that was specifically necessary in the case of the patient you are referring to because of his medical condition. you would have to refer to his chart to find out why. drugs considered with cardioversion are recent digoxin levels of the patient. patients are often mildly sedated if the procedure is elective. potassium and magnesium levels and abgs are usually also evaluated before elective cardioversion.

i would suggest that adenosine was given to this particular patient for his specific problem prior to his cardioversion. adenosine is given to correct supraventricular tachycardia in an attempt to restore normal sinus rhythm, but it may not always work. cardioversion is sometimes necessary to correct the supraventricular tachycardia when adenosine doesn't work. that may have been what happened in the case of this patient. did you read the doctor's history and physical or the cardiologist's consult? what was done was a medical decision and there may have been other factors that the physician felt overrode drug therapy and necessitated performing cardioversion.

sustained supraventricular tachycardia is very stressful on patients and need to be corrected asap. heart rates with these arrhythmias go up over 160 to 250 beats a minute.

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