Transcript
Matthew DeVane, DO FACC: [00:00:00] Getting a shock to your heart doesn't have to be a bad thing. In fact, it may be just what your atrial fibrillation needs to get you back into a nice normal rhythm. This is part of our 101 series, the cardioversion. Let's give AFib a shock right now on our podcast. Living heart smart. Hi, I'm Doctor Matt DeVane.
Carolyn Lacey, MD FACC: [00:00:26] And I'm Doctor Carolyn Lacey. We are cardiologists at John Muir Health. And this is our podcast, Living Heart Smart.
Matthew DeVane, DO FACC: [00:00:32] Our physician partners and colleagues are going to help guide you through many different and important cardiovascular topics to help keep your heart happy and healthy.
Carolyn Lacey, MD FACC: [00:00:40] Thank you for listening and we hope you enjoy our show. Hi again everyone! Matt and I are so glad to be back with you today to talk about one of the most common procedures that cardiologists perform the cardioversion. Today we're just focusing on the electrical wiring part of your heart.
Matthew DeVane, DO FACC: [00:01:00] That's right. It's not about the pump today. It's not about your heart valves. It's not about the arteries, just the electrical component of your heart.
Carolyn Lacey, MD FACC: [00:01:07] So your conduction system is what allows your heart to keep pumping in a coordinated fashion, and it has to have perfect timing to work optimally. That lub dub requires a normal electrical impulse running through your heart.
Matthew DeVane, DO FACC: [00:01:20] Okay, but before we dive into Cardioversions, let's just take a minute to talk about the word arrhythmia. It's a term that is thrown around in cardiology a lot. A lot of people don't really know what that means. Arrhythmia just means your heart is out of its normal rhythm. Arrhythmias that come from the upper chambers of your heart, what we call the atria are called supraventricular tachycardia. Or we just call them SVT's. But today's show, we mostly talking about atrial fibrillation, not because it's the only type of arrhythmia, but it's the most common rhythm that we do cardioversions on. But remember atrial fibrillation is only one type of SVT. There's atrial flutter and there's many other types of svts. And all of these types of arrhythmias can be treated with cardioversions.
Carolyn Lacey, MD FACC: [00:02:03] So if we've decided that we want or we need to get you back into a normal rhythm. You may need a cardioversion. So what is this? At its most basic definition, we're trying to convert an abnormal rhythm back into a normal rhythm using either electricity or medications. So today we're going to focus on the cardioversion procedure. So let's hit the basics. First we're going to cover how a cardioversion works to get you out of atrial fibrillation and back into a normal rhythm. And then we'll review sort of the basics of what you can expect before, during and after this procedure. So Matt, how does a cardioversion even work?
Matthew DeVane, DO FACC: [00:02:40] I like to think of a cardioversion sort of as an electrical reboot of your heart. And I tell this to patients, since your body is not equipped with a control alt delete tabs anywhere. I think for atrial fibrillation, this reboot has to come from a cardioversion.
Carolyn Lacey, MD FACC: [00:02:56] Okay, okay.
Matthew DeVane, DO FACC: [00:02:58] That's the way I that's the way I think of it. Anyway, here's how the actual cardioversion part of the procedure works. So we're going to put two special patches on your body, usually one on the front of your chest and one on your back. And through these patches we're able to deliver just a small pulse of energy, a little bit of electricity to the electrical system of your heart. And the key is that we deliver this impulse at the precise time, right down to the millisecond that allows your heart rhythm to convert back to a normal rhythm. Timing is the key for us. This little impulse makes your own electrical system kind of go quiet, or kind of goes to sleep for just a few seconds. The important part is that the abnormal focus that was driving your abnormal rhythm or the AFib also went to sleep during this procedure. And then as your heart wakes back up again, your normal electrical impulses want to take over this rhythm and get you back into a normal rhythm.
Carolyn Lacey, MD FACC: [00:03:50] So another way to think about it too, because going to sleep sounds like a long time. And it's and it's not. Do you think about it? But if you're in a room where there's a lot of chatter going on, you're waiting for a speaker. Someone comes in and says, everybody listen up. Yeah. And the room stops and then the speaker can start talking. I like that. That's sort of like.
Matthew DeVane, DO FACC: [00:04:12] That's a reboot.
Carolyn Lacey, MD FACC: [00:04:12] That's a reboot.
Matthew DeVane, DO FACC: [00:04:13] Yeah. Yeah. Same. Good, good. Way faster.
Carolyn Lacey, MD FACC: [00:04:15] I like that than the nap.
Matthew DeVane, DO FACC: [00:04:17] Gosh. Oh.
Carolyn Lacey, MD FACC: [00:04:19] There are many factors that determine whether or not your procedure will be successful. But really, broadly speaking, this is a very effective and safe procedure. And I generally tell people that if you have a newly diagnosed tachycardia or atrial fibrillation, we have a really high chance of getting your heart back into a normal rhythm with a cardioversion. Yeah.
Matthew DeVane, DO FACC: [00:04:39] There's always caveats to this. Everyone is a little bit different. It depends on how long you've had it and what medicines you're on and other conditions. But it's generally very, very effective. So that's the actual cardioversion that that part of the process really just takes seconds to do. But there's a lot of other little things that need to happen for you to have this procedure before you have the shock done and even after the procedure. Generally speaking, this is a scheduled elective outpatient hospital procedure. You can expect a few people in the room with you a nurse, an anesthesiologist to administer the sedation medicine.
Carolyn Lacey, MD FACC: [00:05:13] You want to be asleep for this?
Matthew DeVane, DO FACC: [00:05:15] Yeah, you.
Matthew DeVane, DO FACC: [00:05:16] Definitely want to be asleep and comfortable. And you're only out for a few minutes, but you won't feel the procedure. And of course, you're going to have a super, super smart, okay, highly dedicated cardiologist there doing the tedious task of hitting that shock button to get your heart back.
Carolyn Lacey, MD FACC: [00:05:31] That's the glamour part to the procedure.
Matthew DeVane, DO FACC: [00:05:33] It is.
Matthew DeVane, DO FACC: [00:05:34] We take care of that.
Carolyn Lacey, MD FACC: [00:05:35] So when you arrive, though, first to the hospital, one of our great nurses is going to place an IV and do a 12 lead EKG. And we want the EKG. We want to know that you're still in atrial fibrillation before we do the procedure. And when it is time for your cardioversion, the pads will be placed on you. They're like the paddles that you've probably seen on TV. They conduct electrical energy, electrical energy from the defibrillator. And they're cold. Sorry, sorry. They're cold. They're foam pads. They're about the size of your hands. And they're placed on on your chest and on your back. And there's usually a final check that's done.
Matthew DeVane, DO FACC: [00:06:13] Yeah. We call that a timeout. We just want to make sure that you are who we think you are, that we are doing the right procedure on you, and that we're all on the same page and ready to roll.
Carolyn Lacey, MD FACC: [00:06:23] And then your anesthesiologist makes you comfy with sedation. Yes.
Matthew DeVane, DO FACC: [00:06:27] Yes. Want to be comfy? Yes. So then we deliver the shock. And for us, we're standing there. We're watching your rhythm in real time. So we know instantly whether or not the cardioversion has worked. Now, there are times where you don't go back into a normal rhythm right away, and we may do an additional shock or even two shocks just to keep trying to get that rhythm back. Sometimes it may take a few tries for your electrical system to cooperate with us once the sedation has worn off. Your IV is taken out. We watch you in a recovery area for about an hour or so, and then if all is well, you can be driven home.
Carolyn Lacey, MD FACC: [00:07:01] Reminder this is a very important reminder and we're going to keep reminding you through it. After your procedure, you're still going to take your blood thinner as it's prescribed for at least a month. We're super duper serious about this.
Matthew DeVane, DO FACC: [00:07:16] Super duper serious, super.
Carolyn Lacey, MD FACC: [00:07:17] Duper.
Carolyn Lacey, MD FACC: [00:07:18] Serious.
Carolyn Lacey, MD FACC: [00:07:19] For real. But many of my patients want to know what can I do to prepare for my cardioversion. And just like we talked about the blood thinner, after your procedure, you need to take your blood thinner before your procedure as prescribed, without missing doses for at least three weeks.
Matthew DeVane, DO FACC: [00:07:36] Yeah. Very important. And if you've missed some doses, even one dose, just speak up. There's a possibility that we may have to reschedule your procedure, but rescheduling your procedure is better than having a stroke. This is not something we mess around with. Just speak up and let us know. Make sure you take your medicine as prescribed.
Carolyn Lacey, MD FACC: [00:07:55] You'll also be instructed to have nothing to eat or drink or what we call quote NPO, end quote, which means nothing to eat or drink besides your normal medications with small sips of water. This is going to be for about 8 to 10 hours prior to your procedure. You won't be able to drive the day after your procedure, and you need someone at home with you overnight after your procedure.
Matthew DeVane, DO FACC: [00:08:17] And Carolyn.
Matthew DeVane, DO FACC: [00:08:17] There are certain times where we're going to need a special procedure called a transesophageal echo or T just before your cardioversion, because in some cases we just want to take an additional look at your heart prior to your cardioversion. Our cardioversions risky. Well, listen, a cardioversion is considered a very low risk procedure. Thankfully, that's why it's so common. In order for the procedure to work, we put these pads on your chest and your back. And these pads have to deliver some electricity towards your heart. And in order to do that, it has to go through the skin first. So one of the more common risks associated with the procedure is some skin irritation, even some light burns on the chest or back. This can be treated just like a sunburn. Most people it's super mild and goes away within a day or two. Another potential risk of the procedure is some respiratory issues. We mentioned that we do have the anesthesiologist putting you under some light sedation, and whenever we do that there's some respiratory risk. But again that's low.
Carolyn Lacey, MD FACC: [00:09:14] There are some worrisome risks. And thankfully these are really rare. Even though we're fixing one rhythm the cardioversion can cause a life threatening heart rhythm. This would be present and treated immediately after your cardioversion. The other is a potential stroke, and this could occur either immediately or even up to a month following your procedure. So this is the really important reason that we ask you to continue your blood thinners for a month, like we did earlier in our very important reminder.
Matthew DeVane, DO FACC: [00:09:44] Even if you're back into normal rhythm, the procedure is a success. Keep taking that blood thinner. Okay, Carolyn, I think we've covered Cardioversions quite nicely so far, but there are a few questions that patients ask frequently that I don't think we've really covered yet. A big question they have is how long will this cardioversion last? Do I get a guarantee? Once you've done the procedure?
Carolyn Lacey, MD FACC: [00:10:03] I get this question too. And hopefully for many the cardioversion will be a one and done procedure, but for others this is probably going to be the on ramp to your AFib journey, followed by more cardioversions or medications, possibly even an ablation. So Matt, another question that I get asked pretty regularly is what happens if my AFib comes back?
Matthew DeVane, DO FACC: [00:10:23] I get that question too. Yeah. First of all, don't panic.
Speaker3: [00:10:26] Don't panic.
Matthew DeVane, DO FACC: [00:10:27] We know A-fib is going to come back in a certain amount of people. Make sure you're taking your blood thinner. As we've told you a million times. And then just let your doctor know you may alter medications that you're taking. He may. Then he or she.
Carolyn Lacey, MD FACC: [00:10:41] He or she may.
Matthew DeVane, DO FACC: [00:10:42] Then plan a different type of procedure another cardioversion, an ablation or another path. What I tell people is, listen, we're on with atrial fibrillation. There is no one plan that works. So we start with plan A, and if that doesn't lead us to where we want to, we'll move to plan B or even to plan C, but we'll get you there one way or the other. All right everybody, thanks so much for listening. We had another great episode.
Carolyn Lacey, MD FACC: [00:11:03] Thanks everyone for listening to us today. We'd love to hear feedback from you about what you'd like to hear us talk about on Living Heart Smart.
Matthew DeVane, DO FACC: [00:11:14] This is Doctor Matt DeVane, and on behalf of my cohost, Doctor Carolyn Lacey and our partners at John Muir Health, we hope that you enjoyed this show, and we really hope that you keep living heart smart.
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