Cardioversion

1
SEMINAR 10/09/2021 CARDIOVERSION
ON
CARDIOVERSION
Presented To Presented By
Dr. Shaveta Sharma Deeksha
Professor MSN M.sc(N)2nd year
SNI, Kurali Medical Surgical Nursing
2
INTRODUCTION
10/09/2021 CARDIOVERSION
• Cardioversion is used in emergency

situations for people who suffer
sudden life threatening arrhythmias.
Cardioversion is a medical procedure
that restores a normal heart rhythm in
people with certain types of abnormal
heartbeats (arrhythmias).
3
CARDIOVERSION 10/09/2021
4
DEFINITION
• Cardioversion is a synchronized
administration of shock during the R
waves or QRS complex of a cardiac
cycle and restore a rapid heart beat
back to normal.
5
INDICATION
• 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.
• To treat atrial fibrillation or atrial

flutter to regain heart rhythm.
• To treat disturbances originating in

the upper Chambers (atria) of the
heart.

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TYPES OF CARDIOVERSION
Chemical Electrical
7
CHEMICAL CARDIOVERSION
If arrhythmia isn’t an emergency, a

doctor will usually use medication to
get your heart back to normal. This is
called chemical or pharmacologic
cardioversion.
8
Class I
• They are sodium channel blockers

(which slow conduction by
blocking the Na+ channel)
• Class I A: Procainamide, Quinidine
And Disopyramide
• Class 1b: Drugs Include Lidocaine,
Mexiletine And Phenytoin.
• Class I C: Flecainide, Moricizine
And Propafenone .
9
Class II
• They are beta blockers which inhibit

SA and AV node depolarization and
slow heart rate.
• They also decrease cardiac oxygen
demand and can prevent cardiac
remodeling.
• Drug include- Metaprolol And Sotalol
10
Class III
• These agents (prolong repolarization

by blocking outward K+ current).
E.g. Amiodarone
11
Class IV
• These drugs are calcium (Ca) channel
blockers. They work by inhibiting the
action potential of the SA and AV
nodes.
• E.g. Diltiazem
12
ELECTRIC CARDIOVERSION
10/09/2021
CARDIOVERSION
• Cardioversion most often an elective

procedure for dysrhythmias caused by
reentry involves the use of synchronized
biphasic direct current electrical counter
back that depolarizes all the myocardial cells
simultaneously allowing the SA node to
resume the pacemaker role.
13
14
BASIC PRINCIPLES
• Transient delivery of electrical current
causes a momentary depolarization of
most cardiac cells allowing the sinus
node to resume normal pacemaker
activity.
• In the presence of reentrant-induced
arrhythmia, such as PSVT and VT,
electrical cardioversion interrupts the
self- perpetuating circuit and restores
a sinus rhythm.
15
INDICATIONS CARDIOVERSION 10/09/2021
• Any patient with narrow or wide

QRS complex tachycardia
(ventricular rate >150) who is
unstable
• Supraventricular tachycardia
due to reentry
• Atrial fibrillation
• Atrial flutter
• Atrial tachycardia
• Monomorphic VT with pulses
16
CONTRAINDICATION
• Presence of left atrial thrombus

• Digitalis toxicity or hypokalemia
• Sinus tachycardia caused by various
clinical conditions
• catecholamine-induced arrhythmia
• multifocal atrial tachycardia
17
TYPES OF ELECTRICAL CARDIOVERSION
External cardioversion
Internal cardioversion
18
EXTERNAL CARDIOVERSION
• Based on advanced cardiac life support

(ACLS) guidelines, any patient with a
narrow or wide QRS complex
tachycardia (ventricular rate >150
bpm) who is unstable (e.g. chest pain,
pulmonary edema, lightheadedness,
hypotension) should be immediately
treated with synchronized electrical
cardioversion.
19
20
Cont.......
• Synchronization to an R or S wave
prevents the delivery of a shock
during the vulnerable period of cardiac
repolarization when ventricular
fibrillation can be induced.
21
Cont.......
• Synchronized electrical cardioversion
may also be used to treat stable
ventricular tachycardia (VT, vtach) that
does not respond to a trial of
intravenous medications. It is also
recommended for the treatment of the
following arrhythmias :
• Supraventricular tachycardia (SVT) due
to reentry
22
Cont........
• Atrial fibrillation
• Atrial flutter
• Atrial tachycardia
• Monomorphic ventricular tachycardia
with pulses
• https://youtu.be/dC_i8zuclmQ
23
Specialized equipment required:
• Monitor
• Defibrillator
• Connecting media marred
defibrillator pads
• Emergency cart and
medications
• Emergency pacing equipment
24
PROCEDURE
• The patient should be connected to
monitor and a rhythm strip obtained in
order to verify the type of tacky
dysrhythmias the patient.
• Check to make sure that the patient

has pulse. Determine if he is it
hemodynamically stable.
25
Cont.........
• Rule out hypotension, chest pain,
altered mental status, shortness of
breath, shock or other conditions
which may be related to tachycardia.
• Conscious sedation should be used for

the patient.
26
Cont........
• The patient should be connected to

monitor/defibrillator according to
manufacturers and institutional
recommendations.
• Attach the monitor leads (white to

right, opposite is black, red to ribs) and
choose lead that gives the best R
wave.
27
Cont....
• Select the proper energy level.
• Apply the conductive medium to the

patient and paddles.
• This will prevent burns from the

electrical current and insure of
passage of the current through the
cardiac muscle mass.
28
Cont.....
• Positioned in paddles on the patient by
that apply one at apex to the left of the
nipple in the mid axillary line and other
just below the right clavicle to the
right of the sternum.
• Push the charge button on the

defibrillator and allow it to charge.
• Energy is not available until the

defibrillator is fully charged
29
30
Cont....
• The electrocardiogram recorder should
be on.
• This will establish a visual reporting

and permanent record of the patient
and his response to intervention.
• Apply 25 pounds per square inch

pressure to the paddles.
31
Cont.......
• This decrease is intrathoracic
resistance and improves the flow of
current across axis of the heart.
• If unsuccessful, press synchronization

and increase the amount of energy to
be delivered
32
Cont.....
• If ventricular fibrillation or pulse less
ventricular tachycardia develops,
deactivate the synch button, and
follow the procedures for defibrillation.
• Document the procedure in a clinical

record are cardiac arrest flow sheet
33
INTERNAL CARDIOVERSION
• Internal cardioversion for atrial

fibrillation can be used in patients
whose arrhythmias are resistant to
external cardioversion or is
inadvertently induced during an
electrophysiologic study.
34
Cont.......
• The catheter is temporarily inserted
into your heart through a vein, in your
groin, neck or arm.
35
Cont........
• After the catheter is correctly
positioned, the catheter is connected
to the Energy Delivery Device, and one
or more low energy shocks of less than
30J will be given to convert your heart
into a normal rhythm.
36
Cont....
• The whole procedure takes place in
about 30 minutes and do not usually
require a general anesthetic though
heavy sedation is required.
37
COMPLICATIONS
• Provocation of other fast or slow
arrhythmias
• Sedation related complications:
Aspiration
• Skin Burn/Irritation
• A stroke can occur when the shock
either causes a clot that is already
present to travel to the brain or
elsewhere throughout the body, or
results in formation of a new clot after
the cardioversion. CARDIOVERSION 10/09/2021
38
CARE BEFORE CARDIOVERSION
• The physician evaluates the ECG to

identify the type of dysrhythmias
presents.
• The client and family are explained
well regarding the procedure.
• Informed consent is taken from client.
• The client should be in fasting state
with normal electrolyte balance
39
Cont.......
• For that client receiving digoxin, a
therapeutic drug level must be
maintained.
• Self adhesive pads are used and
placed in the standard apex anterior or
apex posterior positions.
• The client is premedicated with the
rapid short acting sedative.
40
Cont......
• Oxygen is administered before

cardioversion and discontinued if
oxygen saturation is within normal
limits.
• X-rays will be taken to guide the proper
placement of the catheter in your heart.
• An INR should between 2.0 and 3.0 after
4-6 weeks of receiving anticoagulation
therapy.
• Start intravenous line for medication
delivery.
41
CARE DURING CARDIOVERSION
• Set the biphasic machine within the

range of 50-200 J.
• Turn the synchronizer switch to on to
deliver the shock during the QRS
complex, not on the down slope of T
wave.
• Call for the care personnel to stand
back from the bed.
42
Cont.....
• While standing back from the bed
depresses and hold s the buttons of the
paddles until the shock is delivered.
• Reassess the cardiac rhythm, rate, BP
and pulse oxymetry and client’s airway
after every shock delivered.
43
CARE AFTER CARDIOVERSION

• Clinician immediately assesses ECG,
pulse, BP and respiratory status after
the procedure.
• In some cases VF or VT occurs,
demanding emergency action.
• Monitor the client’s ECG rhythm and
vital sign continuously at least for 2
hours and carefully assess for rhythm
changes and complications.
44
Cont.....
• A successful response to cardioversion

resolves the dysrhythmias and restores
normal sinus rhythm.
• Client’s airway is protected until
sedation lightens
• With the good response and no
complication the client may be
discharge later that day when fully
awake and able to eat.
45
BIBLIOGRAPHY
• Black M joyce, hawks H jane. Medical

surgical nursing. 8th ed. Vol. 2.
St.Louis missouri: elsevier; page no.
1458-149
• Hariprasath P. Textbook of
cardiovascular and thoracic nursing.
First. Vol. 1. New delhi: jaypee; page
no. 290-299
46
Cont.....
• Cardioversion - Mayo Clinic [Internet].
Available from:
https://www.mayoclinic.org/tests-proce
dures/cardioversion/about/pac-2038512
3
• Cardioversion. In: Wikipedia [Internet].

2020 Available from:
https://en.wikipedia.org/w/index.php?tit
le=Cardioversion&oldid=981367297
47
Cont.......
• Cardioversion (for Atrial Fibrillation)
[Internet]. 2010. Available from:
https://www.youtube.com/watch?v=dC_
i8zuclmQ
• Cardioversion | American Heart

Association [Internet]. Available from:
https://www.heart.org/en/health-topics/
arrhythmia/prevention--treatment-of-arr
hythmia/cardioversion
48
THANKYOU

Cardioversion

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1

SEMINAR 10/09/2021 CARDIOVERSION

• Cardioversion is used in emergency

• Cardioversion is used in emergency

• To treat atrial fibrillation or atrial

• To treat disturbances originating in

If arrhythmia isn’t an emergency, a

• They are sodium channel blockers

• They are beta blockers which inhibit

• These agents (prolong repolarization

• Cardioversion most often an elective

INDICATIONS CARDIOVERSION 10/09/2021

• Any patient with narrow or wide

• Presence of left atrial thrombus

TYPES OF ELECTRICAL CARDIOVERSION

• Based on advanced cardiac life support

Specialized equipment required:

• Check to make sure that the patient

• Conscious sedation should be used for

• The patient should be connected to

• Attach the monitor leads (white to

• Select the proper energy level.

• Apply the conductive medium to the

• This will prevent burns from the

• Push the charge button on the

• Energy is not available until the

• This will establish a visual reporting

• Apply 25 pounds per square inch

• If unsuccessful, press synchronization

• Document the procedure in a clinical

• Internal cardioversion for atrial

CARE BEFORE CARDIOVERSION

• The physician evaluates the ECG to

• Oxygen is administered before

CARE DURING CARDIOVERSION

• Set the biphasic machine within the

CARE AFTER CARDIOVERSION

• A successful response to cardioversion

• Black M joyce, hawks H jane. Medical

• Cardioversion. In: Wikipedia [Internet].

• Cardioversion | American Heart

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