Cardioversion in ICU

OVERVIEW

  • cardioversion is the delivery of electrical energy that is synchronised with the QRS complex in an attempt to revert an abnormal rhythm
  • defibrillation is the non-synchronised delivery of electrical energy and is used in unstable rhythms (pulseless VT or VF)
  • benefits and risks need to weighed
  • may be monophasic or biphasic
  • low to high energy (150-200J biphasic) can be used

SUCCESS RATES

  • high success rates in SVT and atrial flutter
  • less successful in AF, especially with: large atria, long duration, precipitating cause still present

PROS

  • quick, easy, available and familiar
  • repeatable
  • correction of underlying rhythm
  • high success rates in SVT and atrial flutter
  • improved LVEF, cardiac output and haemodynamics
  • improved exercise tolerance
  • decreased hospitalisation
  • improved quality of life
  • avoid side effects of anti-arrhythmic drugs

CONS

  • failure (less successful on AF, with large atria, if chronic or precipitant still present)
  • requirement for sedation and analgesia (potential for awareness)
  • hypotension
  • myocardial damage (ST changes and myocardial stunning short term)
  • arrhythmia (SVT, non-sustained VT)
  • conduction abnormalities (bradycardia, heart block); may require temporary pacing
  • embolisation (AF > 48 hrs without anticoagulation; can exclude by performing TOE)
  • damage to permanent pacemaker if present
  • skin burns
  • pulmonary oedema
  • spark/fire risk
  • electrocution of staff risk
CCC 700 6

Critical Care

Compendium

Chris is an Intensivist and ECMO specialist at The Alfred ICU, where he is Deputy Director (Education). He is a Clinical Adjunct Associate Professor at Monash University, the Lead for the  Clinician Educator Incubator programme, and a CICM First Part Examiner.

He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives. He was one of the founders of the FOAM movement (Free Open-Access Medical education) has been recognised for his contributions to education with awards from ANZICS, ANZAHPE, and ACEM.

His one great achievement is being the father of three amazing children.

On Bluesky, he is @precordialthump.bsky.social and on the site that Elon has screwed up, he is @precordialthump.

| INTENSIVE | RAGE | Resuscitology | SMACC

One comment

  1. An anteroposterior paddle placement may help achieve success with cardioversion in some difficult situations.

Leave a Reply

This site uses Akismet to reduce spam. Learn how your comment data is processed.