DIRECT CURRENT CARDIOVERSION (DCR)
What is a Direct Current Cardioversion?
Direct Current Cardioversion (also known as DCR or electrical cardioversion) is a procedure that aims to restore the heart’s abnormal rhythm to a normal rhythm.
Why do I need to have a Direct Current Cardioversion?
Your doctor may recommend DCR if you have atrial fibrillation or atrial flutter that has not responded to medication. Atrial fibrillation can make your heart beat too fast/slow and irregularly, which causes blood to pump less efficiently. Some patients have no symptoms whereas others may feel palpitations shortness of breath or fatigue.
What does it involve?
It involves the delivery of low energy electricity to the heart via specialised pad that are placed on the chest and/or back. The energy level is set to safely “shock” the heart’s abnormal rhythm back into a normal rhythm (sinus rhythm).
Can I eat or drink before my procedure?
You should refrain from eating for 6 hours before your procedure. You may drink water until 2 hours prior to your procedure.
Do I take my medications on the day of the procedure?
Take all your normal medications with a sip of water unless otherwise instructed by your doctor. Importantly, you must take your blood thinning medications on the day of the procedure.
What else might I need to do?
When in atrial fibrillation, there is a possibility for blood clots to form in the upper chambers of your heart in an area called the left atrial appendage. Blood clots can be dislodged by DCR and cause a stroke.
Blood clots can be prevented by thinning the blood prior to DCR. This process is called anticoagulation. You will be asked to take blood-thinning medications called anticoagulants for a minimum of 4 weeks before your scheduled DCR and a minimum of 4 weeks after.
Where do I go to have the procedure?
DCR is performed in the hospital setting at Peninsula Private Hospital. Most DCR’s are day cases, meaning you will be admitted and discharged on the same day of the procedure. However, in some instances, you may be recommended to remain in overnight if you require further heart rate monitoring after DCR.
What do I need to bring?
Your hospital admission paperwork with a signed consent form, health insurance details and Medicare /DVA card. Bring a list of your usual medications. Bring your usual medications in their original packaging and an overnight bag in case further heart rate monitoring is required.
What do I wear?
Wear clothing that is easy to remove, as you will be asked to change into a hospital gown prior to the procedure. Do not apply any lotions or ointments to your chest or back, as this may interfere with the adhesiveness of the shock pads.
What happens during the procedure?
A cardiologist, anaesthetist and a nurse, are present to monitor your breathing, blood pressure and heart rhythm.
You will be given a light general anaesthetic so that you do not feel the shock.
Special cardioversion pads are placed on your chest and back (or, alternatively, both pads can be placed on the front of the chest). Males may need to have their chest hair clipped prior to applying the pads.
The pads are connected to an external defibrillator by a cable. The defibrillator allows the medical team to monitor your heart rhythm and deliver the synchronised electric shock.
The cardiologist activates the defibrillator and delivers the shock through to the pads
Additional shocks at higher energy levels (usually a maximum of three) can be delivered if the first shock does not restore the heart’s rhythm back to normal.
How long does the procedure take?
The procedure takes approximately 30 minutes.
What are the risks?
- A stroke caused by blood clots in the upper chambers of your heart/left atrial appendagewhich are dislodged by sudden reversion of the rhythm during DCR. This is prevented by taking blood-thinning medications for a minimum of 4 weeks prior to and 4 weeks after the procedure.
- Mild skin burns can occur, especially when multiple shocks are required.
- Heart failure can occur due to “stunning” of the heart muscle after cardioversion causing temporary reduction in the strength of heart muscle contraction.
- Worsening of heart rhythm (too slow or pauses) needing monitoring in hospital and rarely pacemaker insertion.
Recovery and follow-up
You will generally wake up quickly and without any recollection of the shocks. You may experience some minor chest discomfort and/or skin irritation or burn. A cool pack or Aloe Vera ointment can be applied to the area to reduce discomfort or “prickly heat”. It should settle over 24 hours.
You will able to go home 1 to 4 hours after the procedure.
You are not allowed to drive yourself home after receiving sedation/anaesthesia. You will need to organise for someone to take you home after the procedure.
You must continue taking anticoagulants, and all other medications, as instructed by your doctor.
You will have a review appointment four weeks after the cardioversion.
Our Cardiologists will give you the result of your cardioversion after the procedure and instructions regarding your medications. A follow up appointment for 4 weeks will be made for you on discharge.
A copy of the procedure will be sent to your referring doctor and a copy stored in your file.