Where do I register?
You may call 706/774-2125 to pre-register if you prefer. Please report to registration on the Heart & Vascular Institute's first floor at your scheduled check-in time.
Where do I park?
Patients and visitors can park in the Heart & Vascular Institute's dedicated flat parking lot off St. Sebastian Way. If you need wheelchair assistance, please park in the main hospital parking deck.
- Be prepared to stay at the hospital three to four hours. The time of your arrival is not the time for your procedure. Arriving earlier does not ensure a shorter wait. The prep time is 45 minutes to one hour. It may be shorter if your physician had all the pre-procedure work-up done, including blood work, EKG, history and physical, and consent form signed for the procedure. We diligently strive to stay on schedule but a delay in the case ahead of yours or an emergency can increase wait time.
- If you are to have anesthesia or sedation, consume no food or drink by mouth after midnight before your procedure. Otherwise follow the physician's office instructions regarding eating and drinking.
- If you are having a TEE procedure, ABSOLUTELY do not eat or drink anything except sips of water with medication for at least eight hours before your procedure.
- Follow your physician's instructions on what medications to take. If you are diabetic, ask the office if you should take your medications.
- Bring a list of all medications you are currently taking, including insulin, vitamins and herbal preparations.
- If you are taking the medication Glucophage (Metformin) or a blood thinner (Coumadin or Warfarin), let your doctor know.
- Have an adult come to the hospital with you to drive you home. Arrange for a responsible adult to help you at home for 24 hours.
- Wear comfortable clothing.
- Leave all jewelry and money at home.
- You may wear your eyeglasses, hearing aids and dentures.
- Please DO NOT bring small children.
The day of your procedure
Please check in with the registration staff on the first floor of the Heart & Vascular Institute. After the registration process is finished, the Cardiovascular Care Center nurse will transport you to the second floor where the Cardiovascular Care Center is located. Your visitors may wait in a small waiting room during the procedure. You will be asked to disrobe from the waist up and don a gown. The nurse will apply electrodes to monitor your heart and other equipment to monitor your vital signs. The nurse will also place a large pad on your chest and back. This pad is used to deliver the current that will cardiovert your heart into the normal rhythm. The nurse will obtain a full history and a list of your allergies and medications. The nurse may also ask you to sign a permit if you have discussed the procedure with your physician. The nurse will start an IV and draw any ordered lab work. The nurse may need to clip any hair on a portion of your chest to ensure the electrodes adhere correctly to your skin surface.
The room is typically kept warm but the temperature can be increased and blankets provided as needed. Your family (one to three members) may remain with you until the physician arrives. If more are present they will be asked to wait in the waiting room just down the hallway from the procedure room.
What happens in a cardioversion/TEE?
After the physician sees you he will review your medications and rhythm and then instruct the nurse or person delivering anesthesia to administer a sedative agent. You will receive a sedative medication ordered by your physician from the anesthesia department. This medication will make you very drowsy and place you into a deep slumber. The physician will be present for this portion of the procedure, and the nurse will be monitoring your vital signs frequently. You will be questioned to determine that you are drowsy.
The cardioversion procedure
When you are completely asleep, the physician will administer a very brief current of electricity. This electrical stimulation is intended to stop the irregular heartbeat and replace it with a normal heart rhythm. This is called converting the rhythm. The physician will administer the electrical current one to three times. Most people will convert to a normal rhythm with only one shock. If you do not convert after three attempts, the physician will not attempt any further electrical stimulation. The entire process lasts only a few minutes.
The sedative medication will take from 10 minutes to two hours to wear off depending on the medication used and your individual response. You will be asked to have someone drive you home and to plan a day of rest after the procedure. Your chest may be red after the procedure. You may apply lotion to any reddened areas. The nurse will keep you in the room until you are completely awake and are able to sit up and talk. The nurse will make any follow-up appointments at this time and review any medication changes with you and your family members. On rare occasions the physician will administer special medications that assist in converting an irregular rhythm. If this occurs you may need to stay either in the CVPR room area or be placed on a unit that allows close monitoring of your rhythm for a few hours. This is a precaution that is used whenever this medication is administered. After you are awake the nurse will escort you back to your vehicle. You will be called in one to four weeks after the procedure to see if you are doing well and if you remained in a normal rhythm. Typically, if you have been on blood thinners, these will continue until you see the physician on follow up.
IF you also have a TEE ordered
A TEE (Trans-Esophageal Echocardiogram) is a procedure that involves threading a probe down the esophagus (the tube that connects the mouth with the stomach) to allow the physician to view the heart structures including valves and chambers in great detail. This procedure is sometimes done before a cardioversion to check for blood clots within the heart. If a clot is discovered the cardioversion will not be done. You will be asked to swallow a spray to numb your mouth and throat. The nurse will also give you a sedative to prevent gagging and make you drowsy during the procedure. The physician will need you to remain conscious to determine that you are able to swallow. The nurse will have suction readily available for any secretions you may develop in your mouth and assist you in removing these. The procedure lasts 15-30 minutes.
A TEE is done if you have gone into an abnormal heart rhythm called atrial fibrillation within the past few days. If the cardioversion procedure is delayed, the physician will place you on anti-coagulant (blood thinner) medication to decrease the chance of forming a clot. You will need to have blood work drawn weekly to adjust the level until it is safe for the cardioversion to be performed. This will take two to six weeks. You will be rescheduled for a cardioversion when it is safe to perform the procedure.
Frequently Asked Questions
What is atrial fibrillation?
Atrial fibrillation is an irregular heartbeat that causes the top chambers of the heart (the atria) to beat very irregularly and contract ineffectively. This causes several effects. First, the heart may have palpitations that cause the bottom, larger chambers (ventricles) to beat very rapidly in response to the atria. The rapid rate prevents the ventricles from having time to fill adequately with blood. This may cause dizziness or weakness. Secondly, if the atria are not contracting normally, blood does not empty completely and this reduction in blood flow increases the risk of a blood clot forming in the atria of the heart.
Why does my doctor want to cardiovert me? Why can't I just stay in atrial fibrillation?
The physician wants to cardiovert you because atrial fibrillation presents several risks for patients. First, many people have fatigue or shortness of breath associated with this condition. Secondly, there is a risk of rapid heartbeats due to stimulation of the ventricles by the irritable atria. Finally, the atria not contracting properly place you at a much higher risk of developing a clot in this chamber of the heart. The clot could dislodge at any time amd the blood clot may travel to another part of the body, causing a clot in the lung (pulmonary embolus) or the brain (stroke).
What are the risks involved with this procedure?
The most common risk is irregular heartbeats secondary to the delivery of the electrical stimulation of the heart. Typically, the heartbeat will be slow for one to two seconds after the shock is delivered and rapidly resume a normal rhythm. The other risks include the possibility of a stroke if a blood clot is dislodged during the procedure. The physician may place you on blood thinners or use a special test called TEE to look for clots before performing the procedure. This is why your blood tests must reflect that you are adequately anticoagulated (thinned) before the procedure is done.
The risks associated with a TEE include damage or irritation to the esophagus. The nurse will be sure that you are able to swallow liquids before you are discharged.
What blood work is drawn? What if it is not adequate?
Typically, a PT and INR level are drawn and occasionally electrolyte levels are obtained. The INR should be 2.0 or greater. If not, the physician may decide to reschedule the procedure. If your electrolyte levels are abnormal, the physician may order supplementation or reschedule the procedure. If you are just starting on Coumadin you will need weekly lab work to adjust the dose.
How long will the cardioversion last?
There is no specific way to tell. It depends on several factors including how long you were in atrial fibrillation, the condition of your heart, and your overall medical condition.
How long will I remain on Coumadin after my cardioversion?
Two to four weeks. The physician will see you in the office and decide whether you will need to continue on Coumadin or other blood thinner medication after this time. The physician will want to make certain that you are staying in a normal rhythm. PLEASE report any bleeding problems to your physician. This includes bruising, gum bleeding with tooth care, or any blood in your stool or urine. Avoid going barefoot and shave with caution. You may need to hold pressure longer than normal on any cuts that you incur.
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We hope your experience with us is an excellent one.