DCR Cardioversion

In DCR (cardioversion) an electric shock is delivered to the heart to restore normal rhythm - usually for atrial fibrillation or flutter. It is performed in hospital as a day case.

Procedure

If you have atrial fibrillation or atrial flutter, you will need to be on an oral anticoagulant medication for at least 3 weeks prior to the procedure. Examples include: apixaban, rivaroxaban, dabigatran, and warfarin. This prevents a blood clot from forming in the heart which has the potential to dislodge after the cardioversion.

It is very important that you do not miss a scheduled dose of your oral anticoagulant in the 3 weeks prior to the cardioversion, including the morning of the procedure. A missed dose increases the risk of a blood clot which may cause stroke.

The length of time on the oral anticoagulant following cardioversion will be decided by your doctor, but will not be less than 1 month.

Most commonly, you will fast from midnight. In the morning you may have ‘clear fluids’ (water, weak tea or coffee) until 4 hours prior to the procedure; this includes your usual medications.

An anaesthetist will place an IV line, and deliver anaesthesia. When you are asleep one or more shocks will be delivered to the heart. Typically this takes 5 minutes.

If all is well you be discharged from the hospital 3-4 hours later with follow up arranged as an outpatient.

Risk of Cardioversion

There is a risk of stroke if you have missed a dose of your oral anticoagulant. Otherwise the risk of stroke is similar to your usual risk of stroke if you had not had the procedure. You may also react to the anaesthetic. There is a small risk of lung aspiration.

Summary

Cardioversion is a simple procedure, and easily arranged, to get your heart back in rhythm. But it does not prevent your heart from going back out of rhythm. You may be given medication to help keep it normal rhythm, or consideration will be given to catheter ablation if atrial fibrillation recurs.