How to stay in sinus rhythm after cardioversion?
Cardioversion is a useful medical procedure that restores regular heart action. It is used in certain types of arrhythmia, like atrial fibrillation [1, 2].
This medical procedure not only helps to restore the physiological function of the atria but also eliminates symptoms like heart palpitation, breathing difficulty, fatigue, or chest discomfort [3].
Therefore, the maintenance of the sinus rhythm after cardioversion is very important.
Pharmacotherapy is the most effective way of keeping the heartbeat normal after cardioversion. That is why many patients receive class III antiarrhythmic medication, like amiodarone or sotalol, after cardioversion [4].
A study showed that up to 50% of atrial fibrillation cases could be maintained in the sinus rhythm using class III antiarrhythmics. The patients in this study had arrhythmia for longer than 1 but shorter than 3 years [4].
The duration of the arrhythmia is a key indicator of how likely a patient will maintain a sinus rhythm after cardioversion. Patients with a short duration of the abnormal heart rhythm are more likely to maintain normal sinus heart action after the cardioversion [5].
It is beneficial to maintain a healthy lifestyle to effectively maintain the sinus rhythm after cardioversion. This includes a balanced diet and avoidance of triggers like alcohol, caffeine, and stress [6].
How many patients have to do a second cardioversion?
Not all patients respond to the initial cardioversion. Sometimes, it is necessary to repeat the procedure.
Only less than 15% of patients need repeated cardioversion [7].
From a long-term perspective, more than 50% of patients who undergo a successful cardioversion cannot maintain their sinus rhythm for more than a year. Many patients have to do two or even three cardioversions [8].
The probability of another cardioversion being needed depends on many factors, such as the duration of the arrhythmia before the treatment, the patient's condition, and the cardioversion technique used.
Therefore, it is always important to assess individually the likelihood of another cardioversion.
What causes arrhythmia recurrence after cardioversion?
Several factors contribute to the recurrence of an arrhythmia after cardioversion.
Gender and health conditions play a role in the risk assessment of arrhythmia coming back. Generally, women are at a greater risk of losing the sinus action of the heart [9].
The highest risk of recurrences appears to be in women with thyroid conditions and increased systolic blood pressure after the cardioversion [9].
Also, the patient's individual history is important. Those who have a history of tachycardias have an increased risk of arrhythmia starting again [10].
Also, the autonomic nervous system can affect the risk of arrhythmia relapse after cardioversion. In one study, patients with atrial fibrillation relapse in the first 7 days after cardioversion showed higher sympathetic activity of the heart [11].
Another indicator of an increased risk of arrhythmia recurrence is the presence of premature complexes in the atria after the cardioversion [12].
On the other hand, treatment of atrial fibrillation with calcium-decreasing medication reduces the chance of recurrence of the abnormal heart action after cardioversion [13].
How many cardioversions can I have in one year?
Technically, there is no limit to the amount of cardioversions per year. They generally do not damage the heart and have a low rate of side effects [2].
However, in the case when you need to undergo cardioversion often, your doctor may offer you another therapy option [2]. Among the alternatives are:
However, it is not abnormal if you need a second or even a third cardioversion. This procedure often needs to be repeated [8].
You do not have to worry about the effectiveness of the second cardioversion. It is at least as effective as most patients' first attempt [17].
Always remember that everyone is different. Generally, the number of cardioversions is influenced by many individual factors. Among them are the type of arrhythmia, general health condition, age, and response to therapy.