What Is Synchronized Cardioversion?

Synchronous direct current cardioversion is applicable to atrial fibrillation The duration of atrial fibrillation is less than 1 year. The etiology may include rheumatic heart valve disease and other less common causes such as coronary heart disease, hypertension, cardiomyopathy, idiopathic atrial fibrillation, etc .; Drug control of rapid atrial fibrillation is not satisfactory, and the patient has obvious discomfort; primary After treatment or surgery, patients with atrial fibrillation persist, such as hyperthyroidism is basically controlled, after cardiac surgery; pre-excitation syndrome with rapid atrial fibrillation.

Synchronous DC cardioversion

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Synchronous DC cardioversion for atrium

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2. Atrial flutter non-paroxysmal atrial flutter electrical cardioversion is more effective than drug therapy, has high safety, and has a high success rate of conversion. It is often used as the preferred method.

3 Supraventricular tachycardia is generally used when vagus nerve stimulation methods and medications are ineffective or tachycardia persists, causing circulatory disturbances.

4 Ventricular tachycardia should undergo early cardioversion in the event of a hemodynamic disorder or angina, or in an emergency such as acute myocardial infarction.

1. Arrhythmia due to digitalis poisoning, hypokalemia is not corrected.

2. Cardiac arrhythmias associated with sick sinus node syndrome, the so-called fast-slow syndrome, are generally prohibited from cardioversion. It is very necessary to place an intracardiac electrode for pacing before medication or electroreversion.

3 Obvious heart failure or enlarged heart.

4 Mitral valve disease with a large left atrial or massive reflux.

1. Patient preparation Strictly grasp the indications and contraindications. The blood electrolytes should be routinely checked the day before surgery. If there is low potassium or acidosis, it should be corrected in time to actively control heart failure and improve heart function. Digitalis was stopped 24-48 hours before cardioversion to reduce myocardial stress. Take quinidine 0.2g, 3 / d on the day before conversion. If there is no response, take 0.2g on the day of surgery. The purpose is to understand the patient's tolerance to quinidine and improve the success rate of cardioversion. If it is found that the patient cannot tolerate quinidine, amiodarone 0.2g, 3 / d can be used as a preoperative medication. Do a good job of explaining the patient and family.

2. Instruments and first aid equipment check the defibrillator ground wire, oscilloscope, charge and discharge performance, electrode plate, lead wire, etc. are complete and their functional status, especially whether the synchronization performance is good, that is, whether the R wave can be guaranteed to drop during discharge. Discharge instead of discharging during the vulnerable period. First-aid medicines, oxygen, aspirators, tracheal intubation, electrocardiographs, back pads, etc. must be prepared.

1. The patient was on an empty stomach, emptying urine, establishing a venous channel, lying supine on a wooden bed (or backing a wooden board), measuring blood pressure, observing heart rate, and choosing an electrocardiogram waveguide coupler based on R waves.

2. Insert the lead plug of the electrode plate into the defibrillator socket, and evenly apply conductive paste on the electrode plate or wrap it with normal saline gauze (gauze should be 5-6 layers thick) for later use.

3 Intravenous rapid injection of diazepam (azepam) 20-30mg, if you are still awake after injection, you can add 10mg as usual. If you are not effective or cannot use diazepam (azepam), you can choose thiopental sodium 0.125-0.25g diluted in 20ml liquid slowly Intravenous. At this time, pay close attention to breathing and give sufficient oxygen. When the patient enters the hazy state after the above administration, the operation can be performed.

4 Press the "external defibrillation" button while anesthesia is being charged to charge the defibrillator. Generally, the atrial flutter requires the least power, 50-100Ws is enough. Supraventricular tachycardia is about 100Ws, atrial fibrillation is 100-150Ws, and ventricular tachycardia is 200Ws. If one cardioversion is unsuccessful, you can repeat it or increase the power slightly until the cardioversion 3 times or the power reaches 300Ws.

5. According to the requirements of different defibrillators, the electrode plate is placed behind the apex and left scapula or between the apex and the second intercostal area of the right chest, and the electrode plate must be close to the chest wall to avoid gaps to prevent the skin from being burned by the discharge. Operators and related personnel must be careful not to come into contact with patients and beds to avoid electric shock.

6. Immediately after discharge, observe the oscillometric rhythm, auscultate the heart and make an electrocardiogram record, measure blood pressure, breathing, and observe the state of mind until fully awake. After reversion to sinus rhythm, quinidine 0.2g can be continued every 6-8h or other sinusoidal drugs can be given as appropriate.

1. Sinus bradycardia, borderline escape, and atrial premature beat may occur after arrhythmia is restored. This is caused by sinus node awake or increased vagal nerve tension, which usually disappears in a short time, and generally does not require special treatment. If chronic arrhythmia is present for a long time, it may be sinus node dysfunction and measures must be taken. Ventricular ectopic rhythms are rare. Individual cases with severe conditions such as cardiac arrest or ventricular fibrillation can be treated as cardiopulmonary resuscitation.

2. The incidence of embolism is <1%, and it is common within 1 week after cardioversion. Patients with a history of embolism must be treated with anticoagulation before and after cardioversion. Patients with a recent history of embolism or ultrasonography suspected of having a large thrombus should not undergo cardioversion.

3 Erythema or blisters appear in the discharge area of the skin burn electrode plate. In severe cases, apply scald ointment.

4 A few patients with apnea have an apnea of 1-2 minutes, and most of them can recover on their own or do artificial respiration.

5. Pain in the front chest and limbs accounts for about 40%, and no special treatment is required.

6. Hypotension may be due to original heart damage or myocardial damage caused by repeated electric shocks. The latter may show ST-segment depression or elevation, and serum enzymes CK and LDH slightly increase, and most of them recover after several hours.