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Electrical (direct current) cardioversion animated demonstration

How to perform electrical (direct current) cardioversion using a defibrillator.

Equipment

  • Defibrillator

  • Cardiac monitor

  • Defibrillator pads

Indications

DC cardioversion may be indicated for the acute treatment of patients with haemodynamically unstable tachyarrhythmia. Unlike defibrillation, which is used in cardiac arrest patients, it is performed on patients with a pulse.[27] [28] [29] Such patients may have life-threatening features such as shock, syncope, myocardial ischaemia, or severe heart failure.[30] [31]

DC cardioversion may also be indicated for the elective treatment of patients with supraventricular tachyarrhythmia who are haemodynamically stable.[32] [28] [33]

Specific considerations for atrial fibrillation

If the onset of the arrhythmia is less than 48 hours, early DC cardioversion may be considered in select patients.[34] [33] If atrial fibrillation has been present for more than 48 hours, electrical cardioversion is preferred to pharmacological cardioversion, but should be delayed until the patient has been fully anticoagulated for at least 3 weeks if the patient is stable.[32] [35]

Contraindications[36] [27]

  • Anaesthetic risk; the benefit of cardioversion should be weighed against risks related to anaesthesia/sedation.

  • No clear onset of the history of palpitations

  • Previous paroxysms of tachyarrhythmia and not on anticoagulation

  • Known atrial thrombus

Complications:

  • Atrial and ventricular premature beats

  • Thromboembolism

  • Muscle soreness

  • Myocyte damage and electromechanical dissociation leading to other arrhythmias

  • Skin burns

  • Sedation/anaesthetic related complications

Aftercare

  • Continue cardiac monitoring and observations.

  • Request a cardiology review for further investigation, medication (including anticoagulation if required) and appropriate follow-up.