Cardioversion Surgery in Delhi, India

Cardioversion uses electrical impulses to regularise heart rhythm. This process is of two types:

1. Chemical cardioversion: 

When cardioversion is performed electively, medicines are prescribed to restore the normal rhythm of the heart. This method is called chemical or pharmacologic cardioversion. The medicine is taken under the doctor's observation.

2. Electrical cardioversion: When medicines fail to correct the heartbeat rhythm, electric cardioversion shocks through paddles can help regulate it.

Cardioversion may be performed as an elective or non-emergency procedure or as an emergency treatment. It is ideal for treating the following conditions:

• Atrial fibrillation
• Atrial flutter
• Atrial tachycardia
• Ventricular tachycardia

Cardioversion or defibrillation is also used in emergencies for people who suffer sudden life-threatening arrhythmias.

Cardioversion can be performed under most conditions. There are no such contraindications of the procedure. Even the presence of a cardiac pacemaker or automated implanted cardiac defibrillator will not affect the procedure.

The cardioversion procedure is usually scheduled in advance. However, if the symptoms are severe, cardioversion may be done in an emergency. Consent and other forms are discussed and signed in the doctor's office. This is to inform the surgeon about the medical history (allergies, medicines/vitamins, ongoing medications, anaesthesia reactions, previous surgeries). The Cardioversion doctor provides a list of instructions to follow before the procedure. The instructions may include:

• Certain medications, such as blood thinners, should be stopped before the surgery to prevent the risk of excessive bleeding. 
• Avoid drinking alcohol at least a week before and two weeks after surgery.
• Avoid eating or drinking 12 hours before surgery (unless the hospital informs otherwise). 
• Reach the hospital two hours before the scheduled surgery to complete the necessary document work and pre-procedure workup. 

Before the cardioversion procedure, a small report transesophageal echocardiogram may be done to check for blood clots in the heart. If blood clots are present, the procedure will be delayed for three to four weeks. Since cardioversion can cause the blood clots to move and cause life-threatening complications, blood thinners are prescribed before the procedure. 

Cardioversion can be done with either medicines or electric shock.

Electrical Cardioversion:

It is carried out with a device that gives electric shocks to the heart through paddles to alter the heart rhythm. The machine used is called a defibrillator. 

A defibrillator can be found in emergency rooms, ambulances, or airports. 

The electrode patches are placed on the chest and back of the patient. The patches are attached to the defibrillator. In some cases, paddles are directly placed on the chest. The defibrillator delivers an electric shock when placed on the chest. The shock stops all electrical activities of the heart and reboots it. This allows the heart to return to its normal rhythm. Some people require more than one shock.

An implantable cardioverter-defibrillator (ICD) is a machine that is placed underneath the skin of the chest or abdomen. It is indicated in people at risk of sudden death. When the device detects an unstable heartbeat, it sends electrical impulses to the heart and alters its rhythms to normal.

Chemical Cardioversion:

Cardioversion can be done using drugs taken orally or intravenously. Seeing significant results can take several minutes to days. This treatment is done in the hospital under the care of a specialist.

Conditions that may lead to ventricular tachycardia are hypertension, coronary artery disease, cardiomyopathy, valvular heart disease, or a blow to the chest.

• Supraventricular Tachycardia (SVT) is usually caused by 
• Blockages in the heart's electrical conduction system
• Premature atrial or ventricular beats
• Cardiac stimulants
• Thyroid conditions
• Valvular 
• Coronary artery disease
• Digoxin toxicity

Complications of electric cardioversion occur seldom. However, the doctor takes the required steps to lower the risk. Some significant risks of cardioversion are:

• Blood clots: People with arrhythmia may have blood clots in their hearts that may travel through blood vessels and damage other parts of the body. These people carry an increased risk of stroke and death. This condition is accelerated by electric cardioversion, which can cause these blood clots to move. Hence, doctors prescribe blood-thinning medications before the procedure or continue the prescription for a few months post-procedure.
• Abnormal heart rhythm: Rarely, cardioversion patients may develop other heart rhythm disorders during or after the procedure. If at all it occurs, it presents within minutes after the procedure. Doctors inject medicines to manage the condition.
• Skin injuries: Rarely, some people may experience minor burns on the skin where the electrodes were placed.

Other complications of cardioversion are:

• Allergic reactions from medicines
• Blood clots causing stroke or organ damage
• Bruising, pain, or burning where the electrodes were used
• Worsening of the arrhythmia

Cardioversion can be done during pregnancy by constantly monitoring the baby's heartbeats.

After the procedure is over, patients can go home on the same day since it is an outpatient procedure. An hour may be spent in the recovery room to monitor any complications. The anaesthesia may compromise the ability to make decisions for several hours post-procedure. Hence, the patient must be accompanied by someone.

Doctors prescribe medicines to maintain the normal rhythm of the heart and to prevent the formation of clots. One must regularly visit the doctor for follow-up appointments as advised. A few weeks after the procedure, an electrocardiogram is taken to ensure regular heartbeats. The life-long treatment plan may include taking anti-arrhythmic drugs. Inform the doctor in case any symptoms are observed. Blood thinners are also prescribed for a few months to prevent the risk of developing blood clots.