Editing Cardioversion (section)

=== Preparation ===

Cardioversion for restoration of sinus rhythm from an atrial rhythm is largely a scheduled procedure. In addition to cardiology, anesthesiology is also usually involved to ensure comfort of the patient for the duration of the shock therapy. The presence of registered nurses, physician associates, or other medical personnel may also be helpful during the procedure.

Before starting the procedure, the patient's chest and back will be prepped for electrode placement. The skin should be free of any oily substances (e.g., lotions) and hair which may otherwise interfere with adhesion of the pads.<ref>{{cite journal | vauthors = Sado DM, Deakin CD, Petley GW, Clewlow F | title = Comparison of the effects of removal of chest hair with not doing so before external defibrillation on transthoracic impedance | journal = The American Journal of Cardiology | volume = 93 | issue = 1 | pages = 98–100 | date = January 2004 | pmid = 14697478 | doi = 10.1016/j.amjcard.2003.09.020 }}</ref> Once this is complete, the medical team will adhere the pads to the patient using a rolling motion to ensure the absence of air pockets. ''(see details on pad placement below)''. The anesthesiology team will then administer a general anesthetic (e.g., [[Propofol]]) in order to ensure patient comfort and amnesia during the procedure. Opioid analgesics (e.g., Fentanyl) may be combined with Propofol, although anesthesiology must weigh the benefits against adverse effects including apnea.<ref>{{cite journal | vauthors = Wafae BG, da Silva RM, Veloso HH | title = Propofol for sedation for direct current cardioversion | journal = Annals of Cardiac Anaesthesia | volume = 22 | issue = 2 | pages = 113–121 | date = 2019 | pmid = 30971591 | pmc = 6489399 | doi = 10.4103/aca.ACA_72_18 | doi-access = free }}</ref> Bite blocks and extremity restraints are then utilized to prevent self-injury during cardioversion. Once these medications are administered, the [[glabellar reflex]] or [[Guedel's classification|eyelash reflex]] may be used to determine the patient's level of consciousness.

The pads are connected to a machine that can interpret the patient's cardiac rate and rhythm and deliver a shock at the appropriate time. The machine should synchronize ('sync') with the [[R wave]] of the rhythm strip. Although uncommon, sometimes the machine will unintentionally sync to high amplitude T waves, so it is important to ensure that the machine is synced appropriately to R waves.<ref name = "Goyal_2022">{{cite book | vauthors = Goyal A, Sciammarella JC, Chhabra L, Singhal M | chapter = Synchronized Electrical Cardioversion |date=2022 |url=http://www.ncbi.nlm.nih.gov/books/NBK482173/ | title = StatPearls |place=Treasure Island (FL) |publisher=StatPearls Publishing |pmid=29489237 |access-date=2022-08-12 }}</ref> Interpretation of the patient's rhythm is imperative when using cardioversion to restore sinus rhythm from less emergent arrhythmias where a pulse is present (e.g., [[atrial flutter]], [[atrial fibrillation]]). However, if a patient is confirmed to be in [[Ventricular tachycardia|pulseless ventricular tachycardia]] "v-tach" or [[ventricular fibrillation]] "v-fib", then a shock is delivered immediately upon connection of the pads. In this application, electrical cardioversion is more properly termed [[defibrillation]].<ref name = "Goyal_2022" />
[[File:LIFEPAK_20e_Defibrillator_and_Monitor_displaying_synchronization_with_QRS_complexes._(arrowheads).jpg|thumb|[[:File:LIFEPAK 20e Defibrillator and Monitor displaying synchronization with QRS complexes. (arrowheads).jpg|LIFEPAK 20e Defibrillator and Monitor displaying synchronization with QRS complexes. (arrowheads)]]]]