Asked by Neil, Michigan
I have had two heart bypass surgeries, with five bypasses each time, about 18 years ago and again eight years ago. I have lived a very normal life after the surgeries with several heart medications. Recently, my heart has developed an irregular beat. My cardiologist recommends a cardioversion to get it back to a normal beat. Would you recommend this?
Dr. Otis Brawley
Chief Medical Officer,
American Cancer Society
Dear Marjorie: I encourage you to have a good frank conversation with your cardiologist about cardioversion. It is also appropriate to get a second opinion from another cardiologist. Most insurances will pay for a second opinion.
Electrical pulses from the atrium or upper part of the heart migrate in a series of paths through the healthy heart, causing it to beat or contract in a regular pattern. There are diseases of the heart that manifest as abnormal or irregular heartbeats, which are also called arrhythmias. Often, damaged heart muscle causes arrhythmias. Sometimes it is a metabolic disorder such as thyroid or kidney disease. Sometimes the reason is unknown. Perhaps the most common arrhythmia is called atrial fibrillation. There are a number of others.
Cardioversion and defibrillation are the delivery of an electric current to the heart muscle to affect the current traveling in the heart and convert the abnormal rhythm back to normal. Cardioversion is a shock that is synchronized to a part of the heartbeat, and defibrillation is an electric shock delivered randomly during the heartbeat. Elective cardioversion is a safe procedure routinely done in the management of patients with irregular heartbeats. Although most patients are admitted to hospital for elective cardioversion, it is sometimes done as an outpatient.
Many of us are conditioned by television shows, with the dramatic defibrillation done after someone has a passed out from ventricular tachycardia or ventricular fibrillation. Although these major, life-threatening arrhythmias do occur, people can have a number of heart rhythm problems and be very functional. We treat them because the arrhythmia can cause tiredness and exercise impairment, and there is a risk of forming blood clots in the heart. These blood clots can move to the brain and cause strokes.
The electrical shock or stimulation for cardioversion can often be a small amount of energy and not painful. The cardioversion can be done with paddles placed on the chest or back, but occasionally the cardiologist may choose to place the electrode in the heart through a blood vessel by piercing the skin of the arm or groin and following the vein up to the heart. Some patients may need a small amount of sedation for the procedure.
Patients may be given blood thinners before and after the procedure to decrease risk of blood clots, and the patient may also be given certain medicines to decrease the risk of the rhythm disturbance returning. Some people with recurring arrhythmias are treated with a small defibrillator implanted in the chest or abdomen. It can detect abnormal rhythms and convert them immediately.
Some common conventional medications and some alternative medications, especially herbal remedies, can cause arrhythmias; a careful open-minded review of all medications is a good idea and can sometimes make cardioversion unnecessary. A common cause of atrial fibrillation, for example, is caffeine, found in a number of soft drinks. I have vivid memories of a patient whose atrial fibrillation was due to his love of cream soda, which is high in caffeine. Three cans a day caused him trouble.
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