Atrial Fibrillation

Home » Atrial Fibrillation » Treatment - Unstable Patients

Unstable Patients

In unstable patients with atrial fibrillation, those experiencing severe shortness of breath, chest pains, or lightheadedness due to low blood pressure, it may be necessary to "shock" the heart back into sinus rhythm.

Cardioversion is used to attempt to convert the patient with atrial fibrillation back into sinus rhythm by electrically shocking the heart. During this procedure, the patient is usually sedated or put to sleep through intravenous infusion of one of several new short-acting medications. Special pads or paddles are then applied to the chest and increasing energy levels of electrical charge are produced in an attempt to shock the heart back into sinus rhythm. Although the shocks can cause significant discomfort, most patients are asleep during the procedure and remember little, if anything, about the experience afterward.

Complications
Some patients who are converted from atrial fibrillation to sinus rhythm, either by medicines or by shocking the heart, have a small risk that a clot has already formed in the left atrium. Once the heart is converted back into sinus rhythm, this clot may travel to the left ventricle and then be pumped to the brain, causing a stroke.

It is generally believed that patients at risk for this complication are those that have been in atrial fibrillation, without being treated with blood-thinning agents, for more than two or three days or for some unknown duration. In these patients, two approaches are utilized. The first is to place the patient on the blood thinner warfarin (Coumadin®) for 3 to 4 weeks before attempting to convert the atrial fibrillation back to sinus rhythm. Treatment during this time prevents the formation of additional blood clots and allows the body to more or less dissolve any blood clot that may have formed in the left atrium. Many factors influence the decision to treat a patient with 3 to 4 weeks of blood-thinning therapy before attempting to convert the heart, or to perform a TEE and then attempt to convert the heart.

The second approach to treating an unstable patient is a procedure called transesophageal echo (TEE) During a TEE, a special microphone device is passed down the mouth into the esophagus, which is located directly behind the heart. Special sound waves are sent through this microphone-like device to image the heart and its chambers. The excellent quality of the pictures of the heart's chambers obtained by this process can be used to assess whether or not a clot has formed in the left atrium. If no clot is seen, an attempt is made to convert the heart back into sinus rhythm. Patients undergoing TEE are usually given an intravenously administered sedative to relax them during the procedure and have their throats sprayed with a numbing medication, making it easier to tolerate the procedure.

© 1998-2009 Healthcommunities.com, Inc. All Rights Reserved.

Atrial Fibrillation Resources

	Questions to Ask Your Cardiac Care Team The more knowledge you have, the easier it is to make decisions about your heart condition. Print this free handout to take with you on your next office visit.	Advertising Disclaimer
	Join Our Atrial Fibrillation Forum Do you have a question, want to share medical advice, or just need to discuss your situation with someone else having a similar experience? The healthchannels forum is a resource for everyone to share and discuss their health and medical needs with others.
	Living with...Share your story Do you have a personal health story that you would like to share with others? As a source of free patient education, our goal is to provide our users with trustworthy information and support from others. That's why we've started our "Living with..." sections.
	Our "Living With..." support pages are a place to share experiences about living with a certain condition, disease, disorder, or illness and for loved ones of those dealing with health-related issues. Many people, especially when newly diagnosed, find comfort in knowing that others are having a similar experience. Help others by sharing your story. View stories already submitted.
	Stay Updated Sign up for our newsletter and receive important updates on the medical conditions that are most important to you.
To quickly access health information from your website's browser, download Healthcommunities.com's healthchannels toolbar. Advertising Disclaimer