Cardiology · United Kingdom
Private DC electrical cardioversion, to the NICE NG196 pathway.
A synchronised shock to restore sinus rhythm in atrial fibrillation and flutter - with a consultant cardiologist, an anaesthetist for the sedation, and the three-week DOAC pathway done properly.
Indicative pricing
What a private DC cardioversion costs in the UK.
Indicative ranges across our partner cardiac day units.
In short
£2,200–£3,800, home the same day.
| Procedure | Indicative range | Typical duration | Recovery |
|---|---|---|---|
| Elective DC cardioversion (day case) | £2,200–£3,800 | Half-day | Same visit |
| TOE-guided cardioversion (same visit) | £3,200–£5,200 | Half-day | Same visit |
| Pre-treatment amiodarone loading (outpatient) | £450–£900 | 4 weeks | Before DCCV |
| Consultant electrophysiology review | £250–£450 | 30–45 min | Same visit |
| Holter monitor (24–72h) post-procedure | £280–£550 | 15 min fit | 3–5 working days |
| Implantable loop recorder (ILR) | £3,200–£5,500 | 20 min LA | Continuous |
Prices vary by hospital, by which cardiologist and anaesthetist do the case, by whether a TOE is needed on the day, and by any pre-treatment or post-procedure monitoring.
The problem
The right cardiologist, the right pathway, the right anticoagulation.
Cardioversion looks simple - a shock, a pulse, a discharge letter. The bits that matter are the three-week anticoagulation, the choice of pre-treatment, and the plan for what happens if AF comes back. We line all three up before the day.
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Rhythm or rate control?
For some patients a beta-blocker and a DOAC are the right answer. We say so before you agree to a shock.
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Anticoagulation the right way?
Three weeks pre, four weeks post - or a TOE on the day. Not a rushed A&E DCCV without the paperwork.
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What happens if it comes back?
A named cardiologist, a Holter or ILR plan, and an ablation route ready - not a shrug at the discharge desk.
When it helps
When DC cardioversion is the right step.
The situations we see most, plus the one red flag that means an ambulance rather than an appointment.
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Persistent atrial fibrillation
AF that has lasted more than seven days and has not self-terminated - the commonest reason for elective DCCV.
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Atrial flutter
Typical or atypical flutter, often converted with a lower energy first shock. Ablation is usually offered afterwards.
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Symptomatic paroxysmal AF
A single, well-timed cardioversion can restore quality of life while a longer-term rhythm plan is agreed.
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AF with heart failure
Rhythm control often improves ejection fraction and symptoms - a strong indication for cardioversion in the right patient.
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Reentrant SVT that will not break
Rare, but a synchronised shock ends a stable reentrant tachycardia when drugs and vagal manoeuvres have failed.
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Before an ablation or valve procedure
Restoring sinus rhythm can simplify mapping for an EP study or optimise haemodynamics before valve surgery.
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Failed pharmacological cardioversion
When flecainide, amiodarone or vernakalant have not restored rhythm, DCCV is the definitive next step.
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Red flag: haemodynamic instability
A fast tachyarrhythmia with hypotension, chest pain or altered consciousness is an emergency - 999, not a clinic booking.
Procedure options
One shock, several ways to get there.
What each option on the table actually involves - and which fits which patient.
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Elective DCCV (three-week DOAC pathway)
The standard NICE NG196 route. Three weeks of a DOAC, cardioversion in a day unit, four weeks of DOAC afterwards.
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TOE-guided cardioversion
A transoesophageal echo excludes left-atrial appendage thrombus so the shock can be delivered the same day - useful when onset is uncertain or delay is unsafe.
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Emergency cardioversion
For haemodynamic compromise - done in hospital, not a clinic, and often without prolonged anticoagulation.
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Pre-treated cardioversion
Amiodarone (loaded over weeks) or flecainide before the shock - improves acute success and helps hold sinus rhythm afterwards.
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Repeat cardioversion
A second or third DCCV after recurrence. Reasonable when symptoms are clear and the previous shock gave meaningful time in sinus rhythm.
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Cardioversion + planned ablation
A cardioversion to buy time and confirm the rhythm control benefit, followed by a pulmonary vein isolation ablation.
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Rate control instead
Not everyone benefits from rhythm control. Beta-blockers, digoxin and good anticoagulation are the right answer for some - we say so honestly.
Safety and recovery
What to expect afterwards - honestly.
Electrical cardioversion is a common, safe day-case procedure. The things worth planning are the anticoagulation window, the sedation recovery, and knowing what to do if AF returns.
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Anticoagulation is not optional
Without three weeks of a DOAC (or a clear TOE), a shock can dislodge a left-atrial clot and cause a stroke. This is the single most important rule.
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Acute success is around 90%
Most patients cardiovert on the first or second shock with a biphasic device. Success falls to roughly 50% at twelve months without an antiarrhythmic to hold rhythm.
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Sedation, not general anaesthetic
Propofol or midazolam by an anaesthetist. You are asleep for the shock and remember nothing of it, but recover quickly.
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Skin burns are the commonest side-effect
Redness under the pads is common and settles in a few days. Simple emollients help. Serious burns are rare with modern self-adhesive pads.
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Ventricular fibrillation is very rare
Because the shock is synchronised to the R wave, inducing VF is uncommon (<1%). A defibrillator is right there if it happens.
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Transient bradycardia after the shock
The sinus node can be slow to wake up. Most cases settle in seconds; a small number need temporary pacing.
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Do not drive for 24 hours
Sedation rules apply. Someone must collect you, and no driving, alcohol or important decisions for a full day.
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Recurrence is normal, not failure
AF recurs in about half of patients within a year. That does not mean the cardioversion was pointless - it means the underlying substrate needs a longer plan.
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Red flags after
Sudden weakness in a limb, facial droop, slurred speech, chest pain or breathlessness are stroke or arrhythmia warnings - 999, not a call to the clinic.
Reading your procedure note
Your cardioversion note in four parts. Read the last one first.
Whichever pathway was used, the note the cardiologist sends you keeps to the same shape.
A quiet reminder
Cardiology language is precise and can read coldly - we translate it for you.
If you would like us to talk you through the note before your review, just ask.
- 01 Header
Indication and rhythm before the shock
Why the procedure was done - persistent AF, flutter, failed pharmacological cardioversion - and the rhythm and rate recorded on the pre-procedure ECG.
- 02 Technique
Energy, pads and sedation used
Biphasic waveform, starting energy (usually 150–200J), pad position (antero-posterior or antero-lateral), number of shocks and the sedation given.
- 03 Findings
Rhythm restored and any complications
Whether sinus rhythm was achieved and held for the recovery period, and any events - skin burn, transient bradycardia, hypotension after sedation.
- 04 Impression
Anticoagulation, follow-up and monitoring
Read this first: how long to continue the DOAC, whether an antiarrhythmic has been started, and when the Holter or ILR review is due.
Recognised by major UK insurers
Cover for cardioversion varies by insurer and by indication - usually funded when medically indicated for symptomatic AF or flutter.
Frequently asked
Everything we get asked about DC cardioversion.
Quick answers on anticoagulation, success rates, sedation, cost and driving.
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What is electrical cardioversion?
A short, synchronised electric shock delivered through pads on the chest to reset the heart’s rhythm - usually from atrial fibrillation or atrial flutter back to normal sinus rhythm. It is done under sedation in a cardiac day unit and takes only a few minutes of active procedure time.
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Why do I need three weeks of anticoagulation first?
If atrial fibrillation has lasted more than 48 hours, a clot can form in the left-atrial appendage. Restoring sinus rhythm can dislodge it and cause a stroke. NICE NG196 and ESC guidance require at least three weeks of a DOAC before, and four weeks after - unless a transoesophageal echo (TOE) confirms no clot on the day.
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How successful is DC cardioversion?
Roughly 90% of patients cardiovert acutely with a modern biphasic device. Without an antiarrhythmic drug to hold rhythm, only around half remain in sinus rhythm at twelve months - pre-treatment with amiodarone or flecainide, or a follow-on ablation, improves that.
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Does it hurt?
No. An anaesthetist gives you propofol or midazolam, you are asleep for the shock and you do not remember it. Some patients have mild skin redness under the pads for a day or two.
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How much does private cardioversion cost in the UK?
Roughly £2,200–£3,800 for an elective day-case DCCV, or £3,200–£5,200 if a TOE-guided pathway is needed. Pre-treatment with amiodarone and post-procedure monitoring are separate line items.
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What are the risks?
The important ones are stroke (very low if anticoagulation is done properly), skin burns under the pads, transient bradycardia after the shock, aspiration under sedation, and - very rarely, under 1% - induced ventricular fibrillation, which the team treats immediately.
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When can I drive and work after cardioversion?
No driving, alcohol or important decisions for 24 hours after sedation. Most patients are back at desk work the next day. The DVLA has separate rules if you had a symptomatic arrhythmia - we go through those with you.
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