Heart arrhythmia, also known as irregular heartbeat or cardiac dysrhythmia, is a group of conditions where the heartbeat is irregular(flutter or fibrillation), too slow(bradycardia), or too fast(tachycardia) super ventricular tachycardia, Sick sinus syndrome and early heartbeat(premature contraction). Most arrhythmias are not serious, but some can predispose the individual to stroke or cardiac arrest. A healthy person will hardly ever suffer from long-term arrhythmia unless they have an external trigger, such as drug abuse or an electric shock. If there is an underlying problem, however, the electrical impulses may not be able to travel through the heart correctly, increasing the likelihood of arrhythmia (Gan-Xin and Peter, 2011; hopkinsmedicine.org).
TREATMENT FOR ARRHYTHMIAS THROUGH THE CARDIOVERSION
Arrhythmias can be treated through the following;
First, Anti-arrhythmic Medications such as beta blockers to help return your heart rate to a normal rhythm. Medicines, such as digitalis, calcium channel blockers or amiodarone and digoxin to help slow your heart rate and improve blood flow to the heart. Blood thinners to keep blood clots from forming. Second , Catheter Ablation is a procedure that is used to destroy (ablate) areas of the heart that are causing arrhythmias. Third , Cardiac Pacemakers -A pacemaker is used primarily to correct some types of bradycardia, or slow heart rhythms. The pacemaker is implanted in the body, usually below the collarbone, where it monitors the heart rhythm and triggers an electrical impulse if the heart is beating too slowly. Fourth, Electrical cardioversion (an electric shock) to change the beat of your heart back to normal through a shock to convert it from irregular rhythm back into a normal sinus rhythm (Gan-Xin and Peter, 2011; Prof Michael Parr, 2018).
The fourth treatment, Cardioversion would be discussed in details on the blog now. Cardioversion is a common procedure to shock the heart back into normal rhythm. Most patients who undergo a cardioversion procedure have either atrial fibrillation or atrial flutter. The procedure is done in the electrophysiology lab under the direction of a team of highly trained doctors, nurses and technologists. The patient should avoid eating or drinking anything after midnight the night before the treatment except for the normal medications, unless otherwise directed by the doctor or nurse. Most patients who undergo this procedure are placed on a blood thinner, such as Warfarin, for at least four weeks before and following cardioversion (hopkinsmedicine.org; Prof Michael Parr, 2018).
Electrical hazards such as jewelry, water, ECG electrodes, GTN patches must be removed before discharge of defibrillator. Blood pressure cuff on, Spo2 meter clip on your figure to check your oxygen level. When Cardioversion procedure is going to be performed the “SYNC” mode must be activated. ECG is taken because, the illustration shows what the heart rhythm looks like before and after cardioversion and cardioversion procedure must be explained to the patient (Prof Michael Parr, 2018)
EQUIPMENT NEEDED BEFORE THE PROCEDURE INCLUDE:
Defibrillator, multi-function adult pads, emergency trolley, IV access, Mask size 3 or 4 and resuscitation bag, suction equipment, sedative agent for cardioversion as appropriate (Prof Michael Parr, 2018).
THE CARDIOVERSION PROCEDURE
Upon arrival to the shock room the following things will take place:
A tracing of your heart (ECG) will be taken.
The cardioversion procedure will be explained and any questions will be answered.
The patient will then be asked to sign a consent form.
An intravenous line (IV line) will be inserted into your arm.
Sedation may be required if the patient is fully conscious
Follow ARC Algorithm for Tachycardia’s
Place ECG electrodes from the defibrillator behind the shoulders and away from where the defibrillation pads are placed
Pay careful attention to skin preparation; make sure the surface is dry, free of hair and lotions that can impact adhesion.
Remove pads from the package and separate the lead wires
Smooth the pads from the center outwards to ensure there is no air between the pads and patients skin
If patient has implantable cardioverter defibrillator (ICD) or permanent pacemaker the pads should be placed on chest wall at least 8cms from the device
Ensure there are no IV lines or ECG electrodes under the pads
Smooth the pads from the center outward to the edges with finger tips to ensure there are no air pockets under the pads
Pads are not repositionable. Replace with new pads if they need to be repositioned
Replace pads every 24 hours if the treatment travels beyond a day
The defibrillation pads for Cardioversion can be placed either Anterior–Posterior (AP) or Anterior-Anterior (AA), though AP placement is preferable for maximum current flow through the atria
Posterior pad is placed left lateral of the spine and just under the scapula
Anterior pad is placed mid clavicular,4th intercostal space, lateral to the stern
The cardioversion will be performed and this will take about 10-20 minutes
Select energy required 50 – 100 joules (for cardioversion of SVT, AF and conscious VT) depending on patients weight
Press Charge button
In a loud clear voice say STAND CLEAR (iriti potilasta) and ensure all staff have moved away from the bed
Follow ARC Algorithm for Tachycardia’s
(Cardioversion Patient Information Booklet, 2012; Prof Michael Parr, 2018).
AFTER THE SHOCK
Doctor checks to see if the heart rhythm has gone back to its normal and then 12 lead Ekg is performed to read the illustration and rhythms are compared before and after the shock. Glascoma scale examination is done to see if the patient is conscious and then the patient is transferred from the shock room to the emergency ward for about 2 hours for monitoring the patient’s condition. During recovery, recording of blood pressure and monitoring heart rhythm regularly done by the nurse. Patient can eat and drink when awake. The doctor then decides based on the condition whether the patient stay for continuous monitoring or be discharged. Patient may leave after a short recovery period depending on his or her situation and can resume full activities one day following the procedure. It is important the patient arrange for someone to drive them home after this procedure. Unless the doctor says otherwise, continue all usual medications should be continued as advised. The patient will have a follow up with his or her GP or Cardiologist (hopkinsmedicine.org; Prof Michael Parr, 2018.).
Gan-Xin Yan, Peter R. Kowey, 2011. Management of Cardiac Arrhythmias. Second Education. Pages 41-65. http://midnurse.umsha.ac.ir/uploads/Management_of_Cardiac_Arrhythmias.pdf
Cardioversion Patient Information Booklet. 2012. http://www.scgh.health.wa.gov.au/OurServices/CardiovascularMedicine/pdf/Cardioversion.pdf
Prof Michael Parr, 2018. ICU Guideline: Defibrillation and Cardioversion. Pages 1-12. https://www.aci.health.nsw.gov.au/__data/assets/pdf_file/0008/380285/Defibrillation_and_Cardioversion.pdf