In this article: full information about what is cardioversion, or electropulse therapy( abbreviated EIT).What is the essence of the procedure, when and how is it conducted. Which doctor can prescribe and conduct this type of treatment. Contraindications, complications and prognosis after the procedure.
How the procedure passes
Cardioversion, or electropulse therapy( EIT), is a medical procedure for restoring the normal rhythm of the heart by using an electric discharge. It occurs when tachyarrhythmias of atrial origin occur in two main cases:
- A rhythm disorder with a life-threatening complication in the form of acute myocardial insufficiency.
- Persistent and periodic forms of tachyarrhythmia that do not respond to drug treatment or are accompanied by clinical manifestations on the background of therapy.
Cardioversion allows to restore normal heart rate in 90% of cases, but for a stable result and a low percentage of complications, careful selection of patients for this method of treatment is necessary( the exclusion factors are presented in the relevant part of the article).This procedure of restoring the rhythm according to different clinics is from 60 to 80%.
In violation of the heart rate rhythm by the type of tachyarrhythmias in the conduction system of the heart, pathological circles of electrical pulse circulation are formed, causing the heart and( or) its parts to contract more often than normal. This disruption of the myocardium leads to the depletion of the body and the development of heart failure. The one-time effect of a high-power current discharge allows "to reload" the electric pathways of the myocardium and normalize the passage of the excitation wave.
Carrying out of cardioversion The cardiologists or, in specialized centers, arrhythmologists are engaged in the decision of a question about the necessity of appointment and direct cardioversion. In the case of life-threatening arrhythmia, the procedure is performed by emergency doctors or anesthetists-resuscitators.
How the procedure passes
In an emergency situation, when it comes to saving lives, there is no special preparation for cardioversion. If the time factor allows, an easy intravenous sedation( sedation) is carried out and the procedure begins.
In more than 95% of cases, the restoration of a normal heartbeat using a current is done routinely. The procedure requires hospitalization in a specialized department and certain training. The treatment is carried out under intravenous anesthesia, in connection with the extremely uncomfortable sensations of carrying out.
Before the
- procedure An ultrasonography( ultrasound) of the heart is performed to exclude blood clots in the atria: if present, cardioversion is transferred for 4-6 weeks until the clots dissolve completely.
- For 3-7 days, medications are prescribed for the dilution of blood( Warfarin, Pradaksa, Xarelto, Eliksis) in order to prevent thromboembolic complications( movement of blood clots through the veins into the vessels of the lungs or brain).
- For 5-7 days, cardiac glycosides( Digoxin) are canceled, the level of potassium in the blood is corrected to prevent cardiac arrest after cardioversion.
- Carry out the treatment of concomitant cardiovascular pathology( hypertension, myocardial insufficiency, select drugs for normalizing the rhythm).
- Immediately before the procedure, do not eat food and water for 8-10 hours.
- Premedication( introduction of sedative drugs) before cardioversion is carried out only in emotionally unstable patients, for the prevention of high blood pressure figures.
heart ultrasound, various scanning planes. Click on the image to enlarge Procedure
- The planned treatment is carried out only in the operating room, allowing to give anesthesia, follow the patient's life indications( palpitation, pressure) and, if necessary, carry out a complex of resuscitation measures.
- To monitor the work of the heart, electrodes of the electrocardiogram are applied, and the anesthesia team conducts intravenous anesthesia( short-acting).
- Electrodes of the cardiovector are placed on the anterior and lateral surface of the chest in the projection of the heart.
- All modern devices for conducting electropulse therapy are equipped with a synchronizer with the heart rhythm of the patient: the discharge of the current must be applied in the middle of contraction of the ventricles( R-wave on the ECG), for the prevention of ventricular fibrillation.
- The discharge is applied on exhalation, the initial value is 200 J. If inefficiency is applied, the second discharge is 270 J. If there is no rhythm restoration after it, the electrodes on the chest are located in front and behind, the procedure is repeated first.
ECG procedure After
- procedure, the patient is in the intensive care unit for the first few hours after cardioversion, and is then transferred to the ward of the profile department.
- The first day after the procedure shows a strict bed rest and constant monitoring of the heart and blood pressure.
- Term of hospitalization, if cardioversion was without complications, 3-5 days.
Holter monitoring with ECG monitoring Indications
The procedure is indicated for cardiac arrhythmias of the type of atrial tachycardia or ventricles of a constant and / or paroxysmal form:
- of fibrillation or flicker;
- flutter.
Treatment objectives:
- normalization of the heart rate to prevent the development of chronic myocardial insufficiency;
- improving the quality of life of patients due to the disappearance of clinical manifestations( fatigue, shortness of breath, heart disruptions, inability to exercise physical activity);
- prolonged life due to a high risk of blood clots in the heart chambers against the background of uneven myocardium contractions, which can later move to the vessels of the lungs and brain( thromboembolism, stroke).
Types of tachycardia. Arrows indicate the direction of transmission of the heart pulse. Click on photo to enlarge Contraindications
Absolute, but amenable to correction, contraindications to conducting a planned cardioversion:
- Treatment with cardiac glycosides( glycoside intoxication).
- High content of potassium in blood( hyperkalemia).
- Chronic heart failure in the phase of decompensation.
Factors that are considered as relative contraindications due to a high risk of recurrence of rhythm disturbance and / or an increase in the percentage of complications:
- age greater than 70-75 years;
- duration of heart rhythm disturbance more than one year;
- return of tachyarrhythmia after cardioversion;
- thickening or widening of the left chambers of the heart;
- manifestation of a violation of the function of the atria and( or) ventricles( reduction of the ejection fraction);
- clinically significant manifestations of ischemic myocardial disease( pain in the heart, low resistance to exercise, swelling, shortness of breath);
- chronic lung diseases with respiratory failure phenomena( obstructive disease, emphysema, bronchiectatic disease);
- heart valve defects requiring surgical treatment( stenosis or insufficiency);
- disorders in the conduction system of the heart - bradyarrhythmia;
- extensive cicatricial changes in the myocardium( consequences of a heart attack).
Possible complications and their prevention
The method of restoring rhythm with a current, like any medical procedure, has its complications. To reduce their number is shown the careful selection of patients for this method of treatment, stabilization of all associated cardiovascular diseases.
| Complication | How common percentage | what to do to prevent and( or) cure |
|---|---|---|
| Signs electrical injury of the myocardium( ECG changes) | 10-35 | pass on their own within 5-60 minutes |
| Increase heart muscle damage marker levelsblood( myoglobin, creatine phosphokinase, lactate dehydrogenase) | 7-10 | is normalized without treatment for 3-5 days |
| cardiac arrest( asystole) | & lt;5 | Palpitations recovered within 5-10 seconds |
| Persistent decrease in heart rate( bradycardia) | 3-5 | Atropine administered |
| Ventricular fibrillation | 0.4 | Repeated discharge of current |
| Pulmonary edema( acute heart failure) | 2-3 | Treatment inconditions ICU |
| collapse( disturbance of consciousness, pressure drop) | 3 | Symptomatic therapy in intensive care |
| thromboembolism( blood clots migrating through the vessels with complete overlap of their lumen) | 1-2 | Assign Rev. Rata for diluting blood before and after the procedure is carried ultrasound heart chambers immediately before the procedure to exclude the presence of thrombi |
Pulmonary edema. Processes taking place in the alveoli in a healthy condition and pathology forecast
Electrical cardioversion restores heart rhythm in 90-94% of cases, while the drug therapy - only 40-60%.A normal pulse can significantly improve the quality of life and the ability to perform the usual physical activity, as well as reduce the risk of fatal complications of heart rhythm disturbances( thromboembolism, stroke).
Return of arrhythmias after the procedure is divided on the timing of occurrence:
| recurrence type | time of appearance after cardioversion | Occurrence Percentage |
|---|---|---|
| Immediate | few minutes | & lt; 1 |
| Early | first 5 days | 2-4% |
| Late | After 5 days | 11% |
