Electrical cardioversion for AF

If you have been diagnosed with persistent atrial fibrillation your doctor may arrange for you to undergo an electrical cardioversion.  This is a procedure performed either under sedation or a general anaesthetic that aims to restore your heart to a normal, regular rhythm.  Your doctor will have taken a number of factors into consideration before choosing this option, for example your preferences, symptoms and results of various tests.

What do I need to do before the procedure?

If you have been AF for at least several days, in most instances your doctor will commence you on an anticoagulant, usually Warfarin or an equivalent, for at least 3 weeks prior to the cardioversion. If you have not been started on anticoagulation you may alternatively have a transoesophageal echocardiogram to ensure there is no evidence of a blood clot in the left atrium of the heart prior to the procedure.

What does the procedure involve?

The normal procedure involves a brief admission to hospital for approximately half a day. You will be required to be nil by mouth. Whilst sedated, a brief, controlled electrical current is passed across the chest wall.  Normally a maximum of three attempts are undertaken. This procedure usually takes approximately 10 minutes. 

Potential adverse effects, which your doctor will discuss with you, include:

- 10% failure to convert to normal rhythm

- Bradyarrhythmias, which may require injection of a drug or brief use of an external pacemaker.

Tachyarrhythmias, which may require another electrical shock superficial burns

- Stroke (approximately 1% risk)

- A reaction to the sedation or anaesthetic. 

- In the long-term, approximately 75% of AF cases AF recur after one year.

What happens after the procedure?

You will normally be observed for several hours following the procedure due to the administration of a local or general anaesthetic. You should arrange for someone to pick you up from hospital and should not drive until the following day. Importantly you will also be required to take Warfarin or an equivalent or at least 4 weeks following the cardioversion. Your Doctor will be able to advise on this further.