What if cardioversion fails

Electrical cardioversion works better and is used more often than chemical cardioversion. Your healthcare provider may not want you to have cardioversion if you have minor symptoms. It also may not be recommended if you are elderly, if you have had AFib a long time, or if you have other major medical problems.

Other treatments might be better for you, like heart rate control with medicines. Electrical cardioversion is also useful for treating other abnormal heart rhythms, like atrial flutter, which is similar to AFib. It can also be used to treat certain kinds of supraventricular tachycardias and ventricular tachycardia VT.

These types of heart rhythms can cause heart rates that are too fast. This can prevent the heart from pumping enough blood. Before trying electrical cardioversion, your healthcare provider may try to reset the heart rate in other ways. This might include the Valsalva maneuver. This is a method where you hold your breath and increase the pressure in your belly. This can help bring the heart rate down.

Your healthcare provider may then try medicines to change the rhythm to normal. If these methods don't work, electrical cardioversion is often the next step.

In other cases electrical cardioversion is the first recommended step. You may need an emergency electrical cardioversion right away if you have severe symptoms from your heart rhythm. Although most people have a successful electrical cardioversion, it does have certain risks. Your own risks may vary based on your age, the type of abnormal heart rhythm you have, and your other medical conditions.

Ask your healthcare provider about your risks. Rarely, the procedure causes a more dangerous heart rhythm. If that happens, someone will give you medicines or a stronger electric shock to stop this rhythm. Some other risks are:.

In certain situations, healthcare providers lower this last risk by giving medicines to help prevent clots blood thinners. They give people these medicines before and after the procedure for some types of abnormal rhythms. In some cases, the cardioversion may not reset a normal heart rhythm. There is also a risk that you might go back to your abnormal rhythm shortly after your cardioversion. Rivaroxaban Xarelto is taken once daily and does not require a regular blood test.

Click here to learn more about rivaroxaban. Apixaban Eliquis has proven very effective at reducing the risk of stroke. Read more about apixaban here. Beta blockers are a class of medications that are commonly used for heart rate control. These medications block some of the effects of adrenaline, which tends to make the heart beat faster. Metoprolol is an example of a commonly used beta blocker. Calcium channel blockers are another frequently used medication for heart rate control.

Diltiazem is an example of a calcium channel blocker. These drugs affect a channel in the cells of the heart that controls the flow of calcium in and out of these cells.

Blocking the transport of calcium through these channels slows the rate of the heart. Digoxin is an older drug that is still used to assist in the overall heart rate control for people with Afib. Amiodarone is a medication prescribed to restore the heart to normal sinus rhythm. Or it may be used to keep the heart in normal rhythm after a procedure called electrical cardioversion , where the heart is shocked into normal rhythm.

Sotalol may be used for rhythm management. Propafenone and flecainide are referred to as class IC medications. Class I medications effect sodium transport across cell membranes in the heart. These medications are reserved for rhythm control in people whose only heart problem is Afib.. That is, people with known blockages in their heart arteries and people who have weakened and dysfunctional heart muscle are generally not prescribed these medications.

Quinidine may be used for rhythm control. Dronedarone is a rhythm control medication. If Medications Fail to Control Atrial Fibrillation Following a heart-healthy lifestyle and taking medications as prescribed works for many people who have Afib. They may be able to refer you to a cardiac rehabilitation program, which helps people with heart problems to make and stick with healthy habits.

You can learn more about cardiac rehab here. This website includes several articles on how to keep track of your medications and how to work with your pharmacist and other healthcare providers to make taking medications easier.

Click here to check them out. These include the following: Electrical cardioversion : While the patient is under sedation, the doctor administers a brief shock to the heart, which resets the heart to its normal rhythm. More information about electrical cardioversion can be found here. In this procedure, a specialist called an electrophysiologist guides long, slender tubes catheters through the blood vessels to the heart.

This destroys the cells that are causing the irregular heart activity. Click here to learn more about catheter ablation. Pacemaker implantation : In some cases, particularly with sick sinus syndrome also known as sinus node disease or sinus node dysfunction , the medical team may recommend implanting a pacemaker to assist in keeping the heart beating in a normal rhythm.

Atrial fibrillation is extraordinarily common, and I see it an insane number of times. But I suggest you read this blog first. Me to the patient: Atrial fibrillation is an irregular, fast heartbeat that comes from the top of the heart. It can make the electricity in the top of the heart go as fast as to beats per minute atrial rate ; fortunately, not all of that electricity gets to the bottom of the heart ventricles , which is the most important part of the heart.

When a patient comes in with atrial fibrillation for the first time, we ask ourselves three questions: Why? Me to the patient: While the most common cause is believed to be long-standing hypertension, obstructive sleep apnea is being recognized more and more as a trigger for atrial fibrillation.

Also, we know that OSA causes hypertension. If you snore or have daytime somnolence, we should do a sleep test to look for sleep apnea. Two other common causes include hyperthyroidism and structural heart problems such as a leaky heart valve. So, we will check a thyroid stimulating hormone, or TSH, level and an echocardiogram to further evaluate for these. Me to the patient: This is where atrial fibrillation can get complicated and frustrating sometimes.

Because atrial fibrillation itself is different from patient to patient, the treatment for atrial fibrillation is also different from patient to patient.

So, we have to take an individualized approach. The fast heart rate during atrial fibrillation sometimes results in symptoms including heart racing palpitations , dizziness, shortness of breath and fatigue. It is important to know that some people have absolutely no symptoms, despite very fast heart rates.

Other people have dramatic symptoms such as passing out syncope and dramatic shortness of breath. Most people fall somewhere in the middle; they are aware of the atrial fibrillation and do not like the feeling, but it is not excruciating. Note for the student: The symptoms of atrial fibrillation are either from fast heart rates or from the decreased cardiac output that occurs due to loss of atrial contraction, as depicted below:.

Me to the patient: What we do is take a simple, step-wise approach to relieve symptoms. If that does not work, we intensify the therapy until you feel better.

I can assure you that we can always relieve the symptoms of atrial fibrillation; it just sometimes takes some effort. We start with first step and proceed all the way to the final step if we have to. Here are the steps we usually follow:. Me to the patient: We will give you medication to slow the heart rate down. We are done! Cardioversion doesn't work as well when you also have another heart disease or when you have had atrial fibrillation for a long time.

No You're right. Cardioversion doesn't work as well when you also have another heart disease or when you have had atrial fibrillation for a longtime. I'm not sure It may help to go back and read "Get the Facts. Yes No, that's wrong. Although cardioversion may return your heart to its normal rhythm, atrial fibrillation often returns.

No That's correct. Yes Right. Taking medicines to control your heart rate or rhythm and prevent stroke is another way to treat atrial fibrillation. No Sorry, that's wrong. Decide what's next. Yes No. I'm ready to take action. I want to discuss the options with others. I want to learn more about my options. Use the following space to list questions, concerns, and next steps.

Your Summary. Your decision Next steps. Which way you're leaning. How sure you are. Your comments. Your knowledge of the facts Key concepts that you understood.

Key concepts that may need review. Getting ready to act Patient choices. What matters to you. Print Summary. Credits and References Credits. Morady F, Zipes DP Atrial fibrillation: Clinical features, mechanisms, and management. In DL Mann et al. Philadelphia: Saunders. Get the facts Compare your options What matters most to you? Get the Facts Your options Try electrical cardioversion to return your heart to a normal rhythm. Compare your options Try cardioversion Take medicines instead What is usually involved?

A doctor or nurse gives you medicine to make you sleepy. You take medicines to slow your heart rate. Check the facts 1. Does cardioversion work for everyone? Yes No I'm not sure. You're right. That's correct. Is there another way to treat atrial fibrillation? Decide what's next 1. Do you understand the options available to you? Certainty 1. Check what you need to do before you make this decision.