Electrical Cardioversion Consent ⚡️
Consent guide for electrical cardioversion. Procedure explanation, risks, benefits, alternatives, and patient information for obtaining informed consent.
🔍 Procedure
- Electrical Cardioversion – controlled electrical shock to restore normal heart rhythm.
💡 Indications
- Atrial fibrillation (AF) or atrial flutter not resolving with medication
- Persistent or symptomatic arrhythmia
- Pre-cardiac surgery rhythm management
📌 Preparation
- Fasting (nil by mouth) for at least 6–8 hours pre-procedure.
- Continue usual medications unless advised otherwise.
- Bring a list of all medicines including over-the-counter or supplements.
- Avoid alcohol, smoking, vaping, or recreational drugs for 24 hours prior.
- You may be asked to remove valuables and wear a gown.
🧾 Procedure Walkthrough
- You will be asked to fast (no food or drink) for at least 6–8 hours beforehand.
- You’ll be asked to change into a gown; chest may be shaved and valuables removed.
- Procedure is done under sedation or general anaesthetic with cardiac monitoring.
- Pads are applied to the chest (anterolateral or anteroposterior); IV access is inserted.
- One or more electrical shocks are delivered to restore sinus rhythm.
- You will be monitored in recovery afterwards and may be discharged same day with an escort.
- You must not drive, operate machinery, or make important decisions for 24 hours post-procedure.
⚠️ Risks & Complications
- Common: skin irritation from pads, muscle aches, arrhythmia recurrence, may not restore normal rhythm.
- Uncommon: physical trauma (e.g. shoulder injury from muscle contraction), bleeding (especially on anticoagulants).
- Rare: new or worsening arrhythmias, bradycardia needing pacing, stroke (if not anticoagulated), anaesthetic reactions.
- Very rare: death.
- Additional risks may apply depending on your condition.
- Risks of not having the procedure include persistent symptoms, ongoing arrhythmia, stroke risk.
💬 Common Patient Questions
- Will I feel the shock? — No, you’ll be asleep or deeply sedated.
- How long will I be in hospital? — Usually same-day discharge.
- Will it fix my AF permanently? — It may restore sinus rhythm, but recurrence is common without further management.
- Do I need to stop any meds? — Continue anticoagulation as advised by cardiology.
✅ Benefits
- Restores normal sinus rhythm in many patients
- May improve symptoms such as palpitations, fatigue, dyspnoea
- Reduces risk of AF-related complications in some patients
🔄 Alternatives
- Medical cardioversion (anti-arrhythmic drugs)
- Rate control strategy with anticoagulation
- Ablation (for recurrent AF, especially if symptomatic)
🧠 Special Considerations
- Ensure adequate anticoagulation pre-procedure (≥3 weeks or TOE confirmed).
- Correct electrolyte abnormalities (especially K+ and Mg²⁺).
- Assess anaesthetic and procedural risk based on comorbidities.
- Interpreter required if language barrier is present.
- Confirm decision-making capacity or involve substitute decision-maker.
- Consent for student involvement or recordings must be discussed separately.
🗣️ Example Consent Script
- "We are recommending electrical cardioversion to restore your normal heart rhythm by delivering a brief electrical shock to the chest."
- "It will be done under sedation or anaesthetic with close monitoring."
- "There are some risks, such as rhythm changes, skin irritation, or rarely, stroke. These are why your medications and preparation are important."
- "If successful, this may improve your symptoms like palpitations or fatigue."
- "A junior doctor or student may assist under supervision. We can also offer support if you have cultural or spiritual needs."
- "Do you have any questions, or is there anything you’d like me to clarify before proceeding?"