Cardioversion is a non-surgical procedure used to correct an abnormal heart rhythm, such as atrial fibrillation (AFib) or atrial flutter, by restoring it to a normal rhythm. This treatment is generally performed in two ways: electrical cardioversion, which uses a controlled electric shock, or chemical cardioversion, which uses medication delivered intravenously. While the actual moment of electrical shock is nearly instantaneous, the total time a patient commits to the process, from arrival at the facility to discharge, is significantly longer, typically encompassing an entire half-day. Understanding this complete timeline, which includes preparation, the brief procedure itself, and a mandatory recovery period, is essential for planning the day.
Essential Pre-Procedure Timeline
The patient’s time commitment begins long before they arrive at the hospital, often with strict medication and dietary requirements. To minimize the risk of stroke, a patient must typically confirm adherence to blood-thinning medication for at least three to four weeks prior to the scheduled procedure. This period ensures that any potential blood clots in the heart’s chambers have either dissolved or stabilized before the rhythm is reset.
On the day of the procedure, patients must adhere to a strict fasting protocol, known as NPO (nil per os), meaning nothing by mouth for about six to eight hours before the scheduled time. This fasting period is a safety precaution against aspiration, which is the inhalation of stomach contents, during the administration of sedation or anesthesia. Upon arrival at the medical facility, the initial administrative phase involves check-in, verification of identity, and obtaining informed consent for the procedure.
The clinical preparation then begins with the placement of an intravenous (IV) line, usually in the arm, which will be used later to administer the sedating medication. Nurses will record a full set of baseline vital signs, including blood pressure, heart rate, and oxygen saturation. This preparation phase, from check-in to being moved into the procedure room, usually takes between one to two hours, depending on the facility’s flow and patient volume.
Time Spent in the Procedure Room
Once the patient is in the procedure room, the focus shifts to setting up the monitoring equipment. The medical team attaches electrocardiogram (EKG) leads to the chest to continuously monitor the heart rhythm, along with a blood pressure cuff and a pulse oximeter for oxygen levels. Large patches, or electrodes, are placed on the chest and sometimes the back, which are connected to the defibrillator machine.
A specialized anesthesia provider then administers a short-acting, intravenous sedative, which quickly induces a deep, sleep-like state lasting only a few minutes. This conscious sedation ensures the patient feels no pain or discomfort during the electrical discharge and has no memory of the event. The entire process of administering sedation, delivering the electrical energy, and allowing the patient to begin waking up is remarkably fast, often lasting only five to fifteen minutes.
The actual electrical shock delivered through the patches is synchronized with the heart’s electrical cycle and lasts for less than a second. This brief pause allows the heart’s natural pacemaker, the sinus node, to ideally restart a normal, organized rhythm. If the first attempt is unsuccessful, the team may administer one or two additional shocks at a slightly higher energy level, which can extend the time under sedation by a few minutes.
Post-Procedure Recovery and Discharge
The recovery phase is the longest part of the total time commitment, as the patient is moved to a dedicated recovery unit for observation once they are stable enough to leave the procedure room. The primary purpose of this period is to allow the effects of the short-acting sedation to wear off completely and to ensure the heart rhythm remains stable. Continuous monitoring of the patient’s heart rhythm and vital signs will continue throughout this time, usually for one to four hours.
During this recovery period, the medical staff checks for any immediate complications and ensures the patient is fully awake, alert, and able to respond appropriately to commands. Patients often experience residual drowsiness and may have some temporary skin irritation, similar to a mild sunburn, where the patches were placed. The patient must also meet specific discharge criteria before being allowed to leave the facility.
Discharge Criteria
- Maintaining a stable heart rhythm and blood pressure.
- Demonstrating the ability to walk without assistance.
- Successfully voiding (urinating) to confirm normal kidney function after the procedure.
Because of the lingering effects of the sedation, the patient is strictly prohibited from driving or operating machinery for 24 hours. A responsible adult must be present to drive the patient home and preferably remain with them for the rest of the day.
Variables That Determine Total Stay Length
The total time a patient spends at the medical facility for a cardioversion can vary widely, extending the stay beyond the typical four to six hours. One of the most significant variables is the need for a Transesophageal Echocardiogram (TEE) on the same day as the procedure. A TEE is an ultrasound test that involves passing a probe down the esophagus to get a closer look at the heart’s chambers, specifically to check for the presence of blood clots before the cardioversion.
If a TEE is required on the day of the procedure, it adds substantial time to the preparation and sedation phases, as the TEE itself is a procedure requiring its own period of conscious sedation. Patient stability following the electrical shock also directly impacts the length of the recovery period. If the patient’s heart rhythm is unstable or their blood pressure drops significantly after the cardioversion, the observation time will be extended, sometimes requiring an overnight stay for closer monitoring.
Facility-specific protocols are another factor, as some hospitals mandate a minimum observation period, regardless of how quickly the patient recovers from the sedation. The necessity of multiple electrical shocks to convert the rhythm can also slightly lengthen the time spent in the procedure room.