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To perform synchronized electrical cardioversion, two electrode pads are used (or, alternatively, the traditional hand-held "paddles"), each comprising a metallic plate which is faced with a saline based conductive gel. The pads are placed on the chest of the patient, or one is placed on the chest and one on the back.
In addition to synchronized transcutaneous pacing offered by newer cardiac monitor/defibrillators, there is also an option for asynchronous pacing. Sometimes in the prehospital setting a situation may arise where ECG electrodes are not available or something interferes with their adhesion to the patient's skin.
Treatment may be with specific physical maneuvers, medications, or, rarely, synchronized cardioversion. Frequent attacks may require radiofrequency ablation, in which the abnormally conducting tissue in the heart is destroyed. AVNRT occurs when a reentrant circuit forms within or just next to the atrioventricular node.
Cardioversion should be synchronized to the R wave in order to avoid degeneration of the rhythm to ventricular fibrillation, if possible. [15] An initial energy of 100J is recommended. [ 15 ] If the waveform is polymorphic, then higher energies and an unsynchronized shock should be provided (also known as defibrillation).
In contrast to defibrillation, synchronized electrical cardioversion is an electrical shock delivered in synchrony to the cardiac cycle. [4] Although the person may still be critically ill, cardioversion normally aims to end poorly perfusing cardiac arrhythmias, such as supraventricular tachycardia. [1] [2]
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A similar concept, cardioversion, utilizes the same defibrillation machine but is used for other rhythms such as atrial fibrillation and supraventricular tachycardia. In these rhythms, the machine is "synchronized" to the QRS complex to avoid shocking on the T wave (and inducing VT or VF).
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