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External cardioversion is a medical procedure used to restore a normal heart rhythm in patients experiencing certain types of tachyarrhythmias, particularly atrial fibrillation, atrial flutter, or ventricular tachycardia with a pulse. This technique involves delivering a controlled electrical shock to the heart through electrodes placed on the skin, which helps to reset the heart's electrical system. The procedure is typically performed in a hospital setting where a comprehensive assessment can be conducted to ensure patient safety and effectiveness. Prior to cardioversion, patients undergo an evaluation that may include a detailed medical history, physical examination, and diagnostic tests like an electrocardiogram (ECG) to confirm the type of arrhythmia. Additionally, anticoagulation therapy may be initiated if atrial fibrillation has been present for longer than 48 hours to minimize the risk of thromboembolism, which can lead to stroke. On the day of the procedure, patients are usually given sedatives to help them relax, and the entire process is monitored by healthcare professionals. The cardioversion devices either use direct current (DC) shocks, which are synchronized to the R wave of the ECG to avoid inducing ventricular fibrillation, or do not synchronize, depending on the specific arrhythmia being treated. The amount of energy delivered varies based on the type of arrhythmia and the protocol being followed, ranging typically from 50 to 200 joules. If the initial attempt is unsuccessful, subsequent shocks can be administered at increasing energy levels. While external cardioversion is generally safe and effective, it can come with potential risks, such as skin burns from the electrodes, sinus node dysfunction, or even the possibility of sudden arrhythmias induced by the shock. Following the procedure, patients are monitored for any adverse effects and to ensure the heart rhythm remains stable. If successful, cardioversion can significantly improve symptoms like palpitations, shortness of breath, and fatigue, allowing patients to resume normal activities. In some cases, further outpatient follow-up may be required, along with ongoing management strategies, including medications or lifestyle changes, to maintain normal sinus rhythm and prevent recurrence of arrhythmias. Overall, external cardioversion is an essential tool in the management of cardiac arrhythmias, providing swift restoration of normal heart rhythm, improving the quality of life for many individuals, and reducing the risk of complications associated with persistent abnormal heart rhythms. The careful monitoring and subsequent follow-up are crucial in ensuring optimal outcomes and patient safety.