Presented by: Miss

Kusum, MSc. Nursing,2nd

year

Cardioversion is a method to restore

a rapid heart beat back to normal .
Cardioversion is used in
persons who have heart rhythm
problems (arrhythmias), which can
cause the heart to beat too fast.

Most elective or non-emergency

Cardioversions are performed :

To treat atrial fibrillation or atrial flutter

to regain heart rhythm.

To treat disturbances originating in the

upper
Chambers (atria) of the heart.

Cardioversion is used in emergency

situations to correct a rapid abnormal
rhythm associated with faintness,
low blood pressure, chest pain,
difficulty breathing, or loss of
consciousness.

Cardioversion can be "chemical" or

"electrical".

Chemical cardioversion: refers to the

use of antiarrhythmia medications
to restore the heart's normal rhythm.

Electrical cardioversion : (also known

as " direct-current" or DC cardioversion);
is a procedure whereby a synchronized
electrical shock is delivered through the
chest
wall to the heart through special
electrodes
or paddles that are applied to the skin
of the chest and back.

Is to disrupt the abnormal electrical

circuit(s) in the heart.

To restore a normal heart beat .

Cardioversion can be done using drugs

that are taken by mouth or given through
an intravenous line (IV).
It can take several minutes to days for a
successful cardioversion.

 If pharmacological cardioversion is done in

a hospital, your heart rate will be regularly

checked.

Cardioversion using drugs can be done outside

the hospital, but this requires close follow-up

with a cardiologist.

Blood thining medicines may be given

with electrical cardioversion to prevent
clots from moving to the heart.

Possible complications of cardioversion

are uncommon but may include:

Worsening of the arrhythmias .

Blood clots that can cause a stroke or other organ

damage, bruising, burning or pain where the
paddles were used.

Allergic reactions from medicines used in

pharmacologic cardioversion .

Defibrillator with a synchronising button.

Emergency trolley with emergency drugs;

( lignocaine, atropine, and adrenaline ).

Oxygen mask, intubation equipment, airway

Monitor and continuous recording facilities.

 Do not eat or drink for at least eight hours

prior to the procedure.

Take your regularly scheduled medications

the morning of the procedure unless your
medical practitioner has told you otherwise .

Bring a list of all your medications with you.

 Do

not apply any lotions or ointments to

chest or back as this may interfere with the
adhesiveness of the shocking pads.

Do

not drive yourself home after receiving

sedation anesthesia.

 Do

not operate a car, heavy

machinery,
or make any important decisions.
Stop digoxin before 48 hours prior the
procedure.
Apply ointment to the area to reduce the
discomfort.

The procedure will be terminated either by

a successful reversion to sinus rhythm or
when the medical officer determines that
cardioversion will not revert the rhythm.

Is a medical technique used to counter the

onset of ventricular fibrillation, a common
cause of cardiac arrest, and pulseless
ventricular tachycardia,
In simple terms, the process uses an electric
shock to stop the heart arrhythmias, in the
hope that the heart will restart with rhythmic
contractions.

Defibrillation was invented in 1899 by Prevost

and Batelli, two Italian physiologists. They
discovered that electric shocks could convert
ventricular fibrillation to sinus rhythm in dogs.
The first case of a human life saved by
defibrillation was reported by Beck in 1947.

Is to apply a controlled electrical

shock to the heart, which leads to
depolarization of the entire electrical
conductive system of the heart.

Internal Defibrillators
The device may be implanted directly in the
user of the device.
So it is known as an Impalantable
cardioverter-defibrillator or (much less
frequently) an internal cardiac defibrillator
(ICD).
This type of defibrillator is designed to
provide immediate defibrillation to high-risk
patients .

An implantable cardioverter-defibrillator (often

called an ICD) is a device that briefly passes an
electric current through the heart. It is
"implanted," or put in your body surgically. It
includes a pulse generator and one or more
leads. The pulse generator constantly watches
your heartbeat.

Automated External defibrillator

(AEDs)
External defibrillators are typically used in
hospitals or ambulances, but are
increasingly common outside the medical
areas .
As automated external defibrillators
become safer and cheaper.

The shock is generally conducted through

the heart by two electrodes, in the form
of two hand-held paddles or adhesive
patches depending on the variety of the
defibrillator.

One electrode is placed on the right side of

the front of the chest just below the
clavicle.

The other electrode is placed on the left

side of the chest just below the pectoral
muscle of breast.

Open-chest defibrillators also exist, which

have electrodes in the form of two cupshaped paddles that surround the sides
of the heart and shock it directly.
Open-chest defibrillators generally require
less energy to operate due to direct
contact with the heart .

The number of attempts is in practice limited

to a series of three or four attempts at
increasing energies.
The likelihood of restoring normal heart
rhythm is much less in successive attempts.

One

major difference between cardioversion

and defibrillation with the timing of the delivery
of electrical current .

Another

major difference concerns the

circumstance defibrillation usually performed
as an emergency treatment .

Cardioversion

is usually, but not always a

planned procedure .

The most well-known type of electrode is the

traditional metal paddle with an insulated
handle.
This type must be held in place on the
patient's skin while a shock or a series of
shocks is delivered.

 Place

paddles so that they do

not touch pts clothing or bed
linens or not near direct
oxygen supply.
Ensure monitor is attached to
pat.
Do not charge the machine
untill ready to shock.

 Exert

25 pound pressure on the

paddle .

Ensure

you and every body is

free of the pat.Inspect skin for
burns.

Record the delivered energy.

Shock may be delivered, but it is not

regarded as the treatment of choice.
Antiarrhthmic medications such as
amiodarone, cordorone, lidocaine,
magnesium, or pronestly are given if
ventricular dysrhythmia persists.

The probability of a successful conversion is

very small according to the current
guidelines, in this situation, continued CPR in
order to improve the oxygenation of the heart
for a few minutes is preferred before
defibrillation is attempted .

As the nurse applies the shock this is just

a warning to everyone around to stay
away from the patient for risk of
electrical shock.