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DC Cardioversion Information

DC Cardioversion

A DC Cardioversion (Direct Current Cardioversion) is a procedure to convert an abnormal heart rhythm to a normal heart rhythm. 

Atrial Fibrillation (AF) is the most common cardiac arrhythmia (abnormal rhythm).  Patients in AF are often not aware of any symptoms and the condition is not, in itself life threatening.  However, patients are usually given anti-coagulants (blood thinning) medication – most commonly Warfarin, to protect them from having a stroke.
The procedure is carried out under a general anaesthetic and takes just a few minutes.

Prior to the procedure

Patients who are referred for a DC Cardioversion are generally on Warfarin.  Patients on Warfarin have regular INR (blood level) checks and it is imperative that your INR is kept above 2  for 4 consecutive weeks prior to your procedure.  This means there is a possibility that your procedure may be delayed if the INR is not in the required range.  Whilst we understand this may be frustrating, this is purely for your safety. 
 You will be required to have blood tests for your INR level and phone through the results to the Angiography Suite for a minimum of 4 weeks prior to your procedure.  (Please inform the nurse whether the sample was obtained from a finger prick or blood test).  Once the levels are within range for the required duration you will be given an appointment to be seen by a nurse.  DC Cardioversions are carried out once a month - on the second Friday, in the Angiography Suite.

DC Cardioversion Pre-Assessment

Jsr Daniella Bartlett/Jsr Dawn Waples will contact you to arrange an appointment.  Should you have any queries relating to an appointment/the procedure etc, Dani and Dawn can be contacted on 01245 514418 after 2.00pm
The purpose of the pre-assessment is to meet our patients, gain important information to ensure we provide the best possible service, identify any special needs and give our patients the opportunity to ask any questions they may have.

Medication
You will need to bring your medication/list of medication to clinic with you, as well as your INR card. (Orange book).
During the assessment you will have your observations taken and an ECG recorded.  The nurse will go through the procedure with you.

Consent
It is a legal requirement to obtain written consent prior to carrying out a DC Cardioversion.   The nurse will fully explain the procedure, the benefits and possible complications to you prior to obtaining your signature on the consent form.
The Procedure: DC Cardioversion
The intended benefits: To change an irregular heart rhythm to a regular heart rhythm
Complications which may consist of:-
• Skin Soreness
• Arrhythmia
• Stroke
• Unsuccessful up to 50%
You will need to sign the consent form for the procedure to go ahead.
(Reference: British Heart Foundation 18/08/11 bhf.org.uk)
During your assessment you will be asked to find your own transport to bring you to the hospital for your procedure and take you home again. If you are unable to make your own way there please advise the nurse.  We respectfully request that hospital transport is only requested where absolutely necessary.
You will be given the following information for the day of your procedure.
Please leave all jewellery at home (except wedding rings which can be taped) and do not bring any valuables into hospital with you.  It is Mid-Essex Hospitals Trust Policy that we cannot accept responsibility for valuable items.  Every effort is taken to ensure the safety of personal items.  However, once again, we cannot be responsible for the loss or damage to ANY belongings.
Mobile phones must be turned onto silent at all times and it is not possible to get a signal in the unit due to lead lining of the walls etc.
Make-up should not be worn and nail polish should be removed.
Gentlemen please be prepared to be shaved if necessary. (Chest/Back)
Please note it is not possible for friends/relatives to enter the Unit on your arrival. For infection prevention reasons entry into the unit is limited to strictly a `need only’ basis.
During your assessment you will be given an allocated time to arrive at the unit.  Please take a seat in the Cardiac Centre reception area where we will collect you.
It is essential you arrange to have a responsible adult with you at ALL times for the 24 hours following your procedure.  This includes overnight.  If it is not possible for you to have an adult with you at all times, it may be necessary for you to stay over-night in hospital.   However for your own comfort and due to bed demand we ask that you make every effort to have an adult with you at home.  Please note it is possible that on the day of your procedure, if an overnight bed is required, your procedure maybe cancelled if a bed is not available.
You must remain nil-by-mouth (avoiding diet and fluids) from mid-night prior to your procedure
The Day of your procedure

When you arrive at the unit you will be shown to your allocated bed space.  We ask you to undress leaving underpants on and wear pyjama bottoms.  You will be asked to wear a hospital gown which ties at the back. (You will be provided with a basket to store your clothes).  When getting up to use the toilet etc, we ask you put on your dressing gown and slippers.  We make every effort to ensure your dignity is maintained.
When you are comfortable on the bed a nurse will take your observations (blood pressure, pulse, temperature and oxygen saturations), and ask various questions to prepare you for your procedure and an ECG will be performed to ensure that your heart is still in an abnormal rhythm.   A cannula (a small plastic tube) will be inserted into your hand/arm in order that the medication needed during the procedure can be given quickly and efficiently).  We will ask contact details of the person taking you home.
The nurses will check your blood results.  This is an ideal opportunity to check on your cholesterol levels etc.
You will be seen by a doctor prior to your procedure.
 
The Procedure

You will be wheeled into the procedure room on your bed.  There will be an anaesthetist, assistant, doctor and two nurses.  You will be attached to the cardiac monitor and have a blood pressure cuff and a small probe placed on your finger. A mask will be placed on your face to give you oxygen.  This is all to assist the team of highly experienced and qualified staff to monitor you very closely throughout the procedure.  You will have a pad placed on your chest (anterior - front) and (posterior - back) and asked to lie back and relax. 

 


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The medication to make you sleep will be inserted into the cannula in your arm.  We will be chatting to you and you may be asked to count.  It may take a little while.  Please do not worry, we will not proceed until you are fully asleep.
When you are fully asleep a shock will be delivered which will stun your heart and hopefully revert it back into a normal (sinus) rhythm.  The aim of the cardioversion is to disrupt the abnormal electrical circuit in the heart and to restore a normal heart beat. The split second interruption of the abnormal beat allows the heart’s electrical system to take control and restore the normal heartbeat.  Up to three attempts will be made.  Further medication will be inserted into the cannula and you will begin to wake up.  The whole procedure takes only a few minutes.  You will be taken back to your bed space and connected to a monitor and have an oxygen mask placed in position on your face and an ECG will be performed to record your heart’s rhythm. You may be away of the airway in your mouth.  This can be removed as you wake up.  Your observations will be recorded very frequently and you will have a nurse with you at all times until you are reasonably awake.   You will very quickly wake up.
After a short period of time we will be able to give you water to sip and when fully awake you will be offered tea, coffee, toast etc.
After approximately two hours bed rest you will be able to get up and dressed and we will arrange for your family to collect you one hour later.  
 You will be seen by the doctor who will inform you whether the procedure has been successful.  Advice on your medication will also be given to you by the doctor/nurses.  However, regardless of the result you will need to remain on Warfarin (for a short period of time if successful, longer if unsuccessful).  We will provide you with cream to apply to the skin in case of discomfort.
We are unable to discuss the procedure and/or results over the telephone with relatives due to confidentiality, but will be happy to answer any questions when the patient is being collected. 

Instructions for post DC Cardioversion Care
• You must not drink alcohol for at least 24 hours
• You must not drive for 24 hours
• You must not operate heavy machinery or sign any legal documents for 24 hours
• You must rest for 24 hours and have someone with you at all times, we advise you have assistance with cooking etc for this time to avoid injury.
• You may have normal pain relief for any aches you may have as a result of your procedure.
• The cream we have provided for your chest and back should be kept in the fridge and used as required.  Please dispose of this when no longer needed.
• You may feel tired and lethargic for 24 hours after your procedure.  This is normal.  Please allow yourself the time to rest and recovery fully.
• You may resume your normal drug regime from later today (day of procedure) unless we advise you differently.  Continue on your Warfarin and have your bloods checked as per your normal clinic.  Weekly bloods are NO LONGER required.  This will be reviewed at your next appointment with your consultant.
• Please do not seek advice about your procedure from your Warfarin Clinic as they will be unable to advise you.
• If you have any queries or concerns please do not hesitate to contact us on the Coronary Angiography Suite 01245 514418
You will be given a leaflet giving advice on how to check your pulse which will contain the following information...............
What is your pulse?
Your pulse is:
 Your heart beat
 Your heart rate
 Your heart rhythm
One of the easiest places to feel your pulse is on your wrist, just below your thumb.  You can feel your pulse in other areas of your body, including the crease of your elbow, in your groin or behind your knee.
Why and when should you check your pulse?
Being aware of your pulse is important because it may indicate an abnormal heart rate or rhythm
It is a good idea to try taking your pulse at various points throughout the day (before and after various activities).  Your pulse rate will change during the day depending on what activity you are doing.  This is normal.  To get your baseline pulse and normal rhythm, try taking your resting pulse when you wake in the morning and before going to bed.
What is a normal pulse?
Between 60 and 100 beats per minute
However, there are normal reasons why your pulse may be slower or faster.  This may be due to your age, medications, caffeine, levels of fitness, and any other illness including heart conditions, stress and anxiety.


When should you seek further advice?
 If your pulse seems to be racing some or most of the time and you are feeling unwell
 If your pulse seems to be slow some or most the time and you are feeling unwell
 If your pulse feels irregular (“jumping around”), even if you do not feel unwell

Everyone is different and it is difficult to give precise guidelines.  Certainly many people may have pulse rates over 100 beats/min (bpm) and less than 60 bpm.  Irregularity is quite difficult to assess since the normal pulse is a bit irregular, varying with the phase of respiration.  You should see your doctor if you have a persistent heart rate above 120 bpm or below 40 bpm.

 


Know your PULSE in four steps

1. To assess your resting pulse rate in your wrist, sit down for 5 minutes beforehand.  Remember that any stimulants taken before the recording will affect the rate (such as caffeine or nicotine).  You will need a watch or clock with a second hand.

2. Take off your watch and hold your left or right hand out with your palm facing up and your elbow slightly bent.

3. With your other hand, place your index and middle fingers on your wrist, at the base of your thumb.  Your fingers should sit between the bone on the edge of your wrist and the stringy tendon attached to your thumb.  You may need to move your fingers around a little to find the pulse.  Keep firm pressure on your wrist with your fingers in order to feel your pulse.

4. Count for 30 seconds and multiply by 2 to get your heart rate in beats per minute.  If your heart rhythm is irregular, you should count for one minute and do not multiply.

(The above are general guidelines as recommended by Arrhythmic Alliance). They can be contacted as follows.....
Arrhythmic Alliance
PO Box 3697, Stratford Upon Avon, Warwickshire, CV37 BYL
Telephone: 01789 450 787
Email: info@heartrhythmcharity.org.uk

The nursing staff will contact your relative/friend an hour before you are ready for discharge.
They are advised to turn left on the roundabout, (first exit) and continue passed the main hospital entrance.  After the multi storey car park there is a right turn.  Take this turning and park close to the Chemotherapy Day Unit and Assessment Unit.  LEAVE YOUR HAZARD LIGHTS ON.  Enter through this outer doorway, follow the corridor and turn left.  Follow the walk way until you reach 210 ‘The Cardiac Dept’.  Report to reception and a nurse will escort your relative out to you.

 

References:
British Heart Foundation. A registered Charity No 225971. Registered as a Company limited by guarantee in England and Wales. Registered office at Greater London House, 180 Road, London NW1 7AW. Registered as a Charity in Scotland.
Eido Healthcare 
National Institute for Health and Clinical  Excellence. Mid City Place, 71 High Holborn, London, WC1V 6NA: www.nice.org.uk. 2011.
Mayo Foundation for Medical Education and Research

 

We look forward to welcoming you/your relative to the Angio Suite and hope this information has given you sufficient insight into the procedure you/your relative will be undertaking in the near future.  (This electronic information is in addition to the written and verbal instructions/information our patients are given).  However if you have ANY queries regarding the procedure, please do not hesitate to contact us on 01245 514418