Cardioversion

[betsytrawick]

I have been in a-fib since Oct. 31st and since that time have been taking coumadin and finally 1/2 tablet of amiodarone, trying to get me back into sinus rhythm. I feel pretty decent now but still have alot of trouble climbing stairs and walking distances - like down the hall of a school building. I'm tired and winded by the time I get whereever I'm going!
My doctor has been checking coumadin levels and has gotten me to the "right" number to be cardioverted. Has anyone had this procedure? Is it a big deal? And did it get you back into sinus rhythm? Thanks for any information that might help - I'm scheduled for the procedure on Jan. 26.

[shirleymahoney]

Re: Cardioversion

Betsy my husband had it done twice now, they put you out with valium IV there's really nothing to it, my husband converted the first time it last about a year because he had a very stressful job and it coverted he had it done again about five years later and it didn't work the worse is all the blood work before the procedure to get your INR to where they want it, the doctor said the last time they did it he had waited too long and the heart wouldn't convert. I hope this helps you a bit, just tell them to take the patches off before they wake you up that hurts a little and you may be sore for a few days, it will feel like a slight burn
Shirley

[betsytrawick]

Re: Cardioversion

Thanks so much for the information. Doesn't sound too bad! I appreciate the information.

[EpLaurie]

Re: Cardioversion

Hi Betsy,

I'm an EP nurse and have performed lots of Cardioversions. At my institution, this is how we do it:
1. Make sure you have nothing to eat or drink 12 hours before the procedure except for your meds with sips of water (you will want to check with your doctor on his specific orders, though.)
2. Your INR should be between 2.0-3.0 the morning of your procedure. The exact number like maybe your doc might prefer 2.5-3.0 (will depend on him.)
3. They might do a Transesophageal Echo (TEE) , to ensure that there are no blood clots in your atrium before you are cardioverted. You don't want to be cardioverted if you have a clot in your atrium because then it can go to your brain and cause a stroke. But since you've only been in Afib for 3 months, maybe they won't. I can't remember what the guidelines are. Please ask your doc about that.
4. You will have an IV started. an automatic BP cuff placed on your arm, an oxygen saturation sensor (oximeter probe) placed on your finger, 3-5 EKG electrodes placed and hooked up to a defibrillator monitor, 2 large defibrillator electrodes placed (one on your chest and one on your back---that's where the shock will be delivered from.) They will probably ask you to take your teeth out if you have loose dentures. If they are a tight fit then keep them in. Take off any glasses, necklaces and nailpolish off at least one finger (preferably first or 2nd finger).
5. Need to have a current weight, because many institutions give a drug called diprovan to put you to sleep. It looks like "milk" in your IV and is weight based. It's very short acting and works quickly and very well for this type of procedure. Sometimes they have a respiratory therapist come up and assist with airway management (when using diprovan) and sometimes they have an anesthesiologist or nurse anesthetist. They will get an ambubag ready once the doctor is ready. Put your head of bed flat. The doctor will give the IV diprovan, you will go to sleep within a minute or two, the nurse will charge the defibrillator and deliver a shock that is "synchronized" or timed perfectly with your heart beat (electronically) on the monitor. They run a rhythm strip during the cardioversion and then you wake up. The actual procedure takes about 5 minutes from start to finish (from the time you are "put to sleep" to the time you"wake up".) Then they keep you for about an hour after the procedure to make sure you are doing OK from the anesthesia and you get to eat and drink.

You usually go home on Coumadin for another 4-6 weeks (I believe) and hopefully you will stay in your normal rhythm.

Hope that answers your questions.

Feel free to email me at [email protected] if you have any other concerns re: this.

Laurie

[EpLaurie]

Re: Cardioversion

PS '

Forgot to tell you...

When you get home, you can put hydrocortisone cream on the areas where the large defib pads were (on chest and back) because the area may be burned from the shock. put the hydrocortisone cream on 2x/day. If you don't have any at home and want your insurance to cover it, ask the doc to write for it in the hospital and ask the nurse to get it and apply it right after the procedure. Otherwise you'll have to stop and buy some at the drug store, if the area is causing you any discomfort, which most of the time, it does.

Good Luck and let us know how it goes.

Also, take a list of all your current meds and dosages with you to the hospital.

Laurie

[Lisa Salberg]

Re: Cardioversion

It is always good to have someone who does the procedure on the board! Thanks Laurie!!

My dad had been cardioverted about 14 times... not that big of a deal - he was always out of the hospital within a few hours.

Good luck,
Lisa

[Sarah]

Re: Cardioversion

they dont do a TEE when you've been on coumadin long enough to melt any straggler clots unless you have a history of clots

it is a short and easy procedure compared to most --ask them for fresh gel between each shock before the procedure to reduce burns

s

[EpLaurie]

Re: Cardioversion

Sara,

Please let me add to my post: after reviewing the ACC/AHA/ESC Guidelines for Management of Patients with Atrial Fibrillation (2001) which can be found in full text pdf format at this URL:
http://www.naspe.org/pdf_files/ACCFullText.pdf

"TEE is valuable for defining the origin of AF as in HCM and may provide additional information for stratifying thromboembolic risk."

As I said in my post, I suggested that they "might" do a TEE and to ask her doctor about it.

BTW, FYI: Coumadin is not a thrombolytic (so it won't "melt any straggler clots), it is an antithrombotic. An example of a thrombolytic medication would be TPA, Steptokinase, etc. please see definitions below.

2 entries found for antithrombotic.
To select an entry, click on it. (Click 'Go' if nothing happens.)
antithrombotic[1,adjective]antithrombotic[2,noun]

Main Entry: 1an·ti·throm·bot·ic
Pronunciation: -thräm-'bät-ik
Function: adjective
: used against or tending to prevent thrombosis <antithrombotic agents> <antithrombotic therapy>


2 entries found for thrombolytic.
To select an entry, click on it. (Click 'Go' if nothing happens.)
thrombolytic[1,adjective]thrombolytic[2,noun]

Main Entry: 1throm·bo·lyt·ic
Pronunciation: "thräm-b&-'lit-ik
Function: adjective
: destroying or breaking up a thrombus <a thrombolytic agent> <thrombolytic therapy>
- throm·bol·y·sis /"thräm-'bäl-&-s&s / noun , plural throm·bol·y·ses /-"sEz/


Also, in my experience of doing 100's of cardioversions over the last 13 years at several institutions, I've never once seen "gel" used or used "extra gel" in between cardioversions. Hands-free electrodes are ALWAYS USED IN ELECTIVE CARDIOVERSIONS. You cannot "add extra gel to them, they would not stick to the skin's surface then.



Thank you,

Laurie

[Sarah]

Re: Cardioversion

dear laurie

i do not dispute the value of TEEs. it is my experience, however, that informs my statement about them not doing them. some places may do them pro forma and others may not. i don't know. my brother was cardioverted 20 times and he probably only had 1 TEE ever. i only got tees after i had already had a stroke.

as for coumadin, it is my understanding that if you have been on it for three weeks, they consider it safe to cardiovert you. i assumed that was because there wouldn't be any clots left by then, for whatever reason.

gel: yes, most places use those stickon pads, but i think they have gel in them to protect you and transfer the charge well. if they have to shock you a lot, it would be nice to get fresh pads after 2 shocks as the burns will be worse otherwise. so i should have said fresh pads, not gel.

i'm not arguing with your experience either; i'm only speaking from my own of 4 cardioversions and my brother's 20 and my mom's dozen.

s

[EpLaurie]

Re: Cardioversion

Sara,

the gel in the hands free pads is there to assist with the conduction of the electrical energy. Taking off the pads and replacing them just causes pain from pulling them off the skin (which many people have an adverse reaction to the adhesive portion) and puts the burns somewhere else. You cannot add gel to those pads.

You are going to get burns no matter what. Some more than others, depending upon how sensitive your skin is and obviously if you were shocked more than once. That's why we put hydrocortisone cream over the site, to help with the inflamation and discomfort.

I don't dispute yours or your families experience with this procedure either. I am a firm believer in the patient having an "expert point of view and vast knowledge base" when they have lived and dealt with a chronic condition, such as HCM, diabetes or whatever.

But maybe you could be a little more tolerant when you reply to my posts. For this wasn't the first time that I felt you were taking the info that I had offered and "poo-poo'd" it, in my opinion.

I believe that patients need to know what their risks are. The greatest percentage of time, as you well know, risks and information are not conveyed to patients in an effective and "layperson's format." That's why I may mention things that you may not feel are relevant, but since you are not this patient's doctor and do not know their exact medical history, I don't think it's right to just blow off something that might make the difference between them living with or without a "stroke" post procedure. That's why I took offense to your reply.

I'm OK now since we've "talked" about it. Please try to remember we are all on this message board for the same reason: Information and support.

Thank you,

Laurie Wasser

[vickie]

Re: Cardioversion

Well said, Laurie.

[Sarah]

Re: Cardioversion

laurie

i'm sorry you feel that way. i have only ever tried to say (in response to your posts, at least what i think you are refering to) that stuff may not go down _exactly_ that way. (a procedure, HCM, tests, whathaveyou.) i know hospitals all have "best practices" they follow but i don't think they are 100% uniform and things change over time, so my experience a few years ago may be different from someone else's today.

you have lots of useful information to share and i know many people appreciate it greatly. however, for some, the wealth of details is scary and intimidating. everyone has their own way of dealing with HCM and we all have our own style of communicating --these styles don't always get along and we need to be sensitive to that.

my answers have been very short lately because i've been teaching myself the Dvorak keyboard and my typing skills were substantially reduced --something that would never occur to anyone for why i have been writing the way i have.

i encourage ANYONE who feels that a post is unkind or dismissive or unpleasant in anyway, Private Message (the PM button) the poster and ask for clarification. you would be surprised at how often stuff just gets misunderstood because there is no tonal value to digital text (versus voice).

in addition, i know that my style is very direct and to-the-point, most of the time. and this can be mis-read as mean or snippy sometimes. i try very hard to avoid this, but am not always successful. please pm me if you ever have any issues with my posts.

by the way, there is an "H" on the end of my name.

S

[Lisa Salberg]

Re: Cardioversion

Thanks to all for the input on this topic - I think we are all clearer on the details of cardioversion now - from the lab side and the patients side.

It is always good to see people share information and thoughts.

Best to all,
Lisa

[Rich Miller]

Re: Cardioversion

not to say any one is wrong but I had been on coumidan for 3.5 months during a-fib episode and they did a tee before they would cardiovert me back into sinus .just to be on the safe side was their explanation.of course i asperated and had to stay in hosp for 3 days ,but hey thats just me .
Rich

[Lisa Salberg]

Re: Cardioversion

Which reminds me...it must have been a good two weeks since I have used my famous line....
REMEMBER WE ARE ALL JUST A LITTLE BIT DIFFERENT

Best to all,
Lisa