Cardioversion is a medical procedure used to restore a normal heart rhythm in patients experiencing certain types of arrhythmias, such as atrial fibrillation or atrial flutter. It can be performed in two ways:
Types of Cardioversion
- Electrical Cardioversion
- Involves delivering a controlled electric shock to the heart using electrode pads or paddles.
- The shock helps reset the heart’s rhythm to a normal pattern.
- Typically performed under sedation to minimize discomfort.
- Chemical Cardioversion
- Uses medications to restore normal heart rhythm.
- Can be administered orally or intravenously.
- Works more gradually compared to electrical cardioversion.
Indications
- To treat fast or irregular heartbeats (arrhythmias).
- Atrial fibrillation.
- Atrial flutter.
- Supraventricular tachycardia.
- Ventricular tachycardia with a pulse.
- Helps improve blood circulation and reduce symptoms like dizziness, fatigue, and shortness of breath.
- Prevents complications such as stroke or heart failure.
Risks and Considerations
- Temporary irregular heartbeats – Rarely, new arrhythmias may occur after cardioversion.
- Blood clot risk – Patients may need blood thinners before the procedure to prevent stroke.
- Skin irritation – Some may experience minor burns from electrode pads.
Procedure
| Nursing action | Rationale | |
| 1. | Explain procedure to the patient and family members. | Alleviates anxiety and facilitates cooperation. |
| 2. | If elective: Obtain informed consent. | To avoid legal and ethical issues. |
| Advise to have nothing by mouth 12 hours before the procedure. | There is a chance that the patient might vomit and aspirate when on a full stomach. | |
| Ensure that the serum potassium level is within normal range. | Low potassium level may precipitate postshock arrhythmias. | |
| Take a 12-lead ECG before and after the procedure. | Ensures that the patient has not had any recent MI or rhythm reversion to normal sinus rhythm. | |
| 3. | Ensure that a patent IV line is present. | To administer sedation and emergency medications. |
| 4. | Switch on the defibrillator, press the SYNC button, and look for markings on the R wave on the monitor. | Confirms synchronization. |
| 5. | Apply gel to the paddles. | Enables better conduction of electric current and avoids burns. |
| 6. | Position paddles on the patient (anterolateral or anteroposterior). | Placing paddles in the specified positions that enable electric current to pass through the myocardium as much as possible. |
| 7. | Choose the appropriate energy level. | The energy levels vary based on the type of defibrillator and the rhythm to be treated A) In monophasic defibrillator: For Initial Dose Unstable atrial fibrillation 200 J Unstable monomorphic VT 100 J Unstable SVT and atrial flutter 50-100J B) Biphasic defibrillator-initial dose of 120-200 J. |
| 8. | Charge the paddles. Once paddles are charged, give the command to the bystanders to stand away from the patient and the bed. Give a verbal alert three times. First call (self): “I am clear.” Second call: “You are clear” (others). Third call: “All clear.” Look again quickly to make sure all are away from the patient and the bed. | When a person touches the bed, he/she may act as a ground for the current and receive a shock, especially if there are electrolyte solutions on the floor. |
| 9. | Press the SHOCK button. | To discharge the impulses. |
| 10. | Look at the monitor after delivering shock. | To look for reversion of abnormal rhythm to normal sinus rhythm. |
| 11. | If subsequent cardioversion is needed, ensure that the defibrillator is in sync mode. | Usually defibrillators go back to unsynchronized mode after each shock delivery. |
| 12. | Clean and replace paddle. | For next use. |
| 13. | Record the procedure and effectiveness. | For ethical issues. |
| 14. | Check for burns on the skin. | To treat at the earliest. |
| 15. | Take a 12-lead ECG. | Rhythm may revert from normal rhythm to dysrhythmias. |
| 16. | Document the following: Neurological, respiratory, and cardiovascular assessment before and after defibrillation.All code-related information should be completed on the code summary flowsheet.Amount of joules delivered.Patient’s response.ECG changes. |
Special Considerations
- Assess for blood clot risk—patients with atrial fibrillation may need anticoagulation therapy before cardioversion to prevent stroke.
- Ensure electrolyte levels (especially potassium and magnesium) are within normal ranges to reduce arrhythmia recurrence.
- Patients should fast for several hours before the procedure to reduce aspiration risk.
- Sedation or anesthesia is typically required for electrical cardioversion to minimize discomfort.
- Ensure IV access for emergency medications and fluids.
- Use defibrillator pads placed correctly to optimize shock delivery and minimize skin burns.
- Maintain continuous cardiac monitoring to detect rhythm changes.
- Keep resuscitation equipment readily available in case of complications.
- Monitor for arrhythmia recurrence—some patients may require additional interventions.
- Assess for skin irritation or burns from electrode pads.
- Continue anticoagulation therapy if indicated to prevent thromboembolic events.
- Cardioversion can interfere with implanted devices, requiring careful placement of defibrillator pads.
- Ensure device function is checked post-procedure to confirm proper operation.
REFERENCES
- Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
- Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
- Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwers, ISBN-13:978-9388313285
- Adrianne Dill Linton, Medical-Surgical Nursing, 8th Edition, 2023, Elsevier Publications, ISBN: 978-0323826716
- Donna Ignatavicius, Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care, 11th Edition ,2024, Elsevier Publications, ISBN: 978-0323878265
- Lewis’s Medical-Surgical Nursing, 12th Edition,2024, Elsevier Publications, ISBN: 978-0323789615
- AACN Essentials of Critical Care Nursing, 5th Ed. Sarah. Delgado, 2023, Published by American Association of Critical-Care Nurses ISBN: 978-1264269884
- Ernstmeyer K, Christman E, editors. Nursing Fundamentals [Internet]. 2nd edition. Eau Claire (WI): Chippewa Valley Technical College; 2024. PART IV, NURSING PROCESS. Available from: https://www.ncbi.nlm.nih.gov/books/NBK610818/
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