Vocal fold paralysis secondary to cardiac countershock (cardioversion)

Application of electrical energy to the heart is effective in treating many dysrhythmias. There are, however, also disadvantages associated with cardi oversion. Employment of external electrical current has been shown to induc e epicardial and myocardial damage at the site of electrode application. We present the only case in the English literature of vocal fold paralysis in which the single identified associated event was cardioversion. In this ca se of temporary vocal fold paralysis, there was no invasive procedure to di rectly damage the nerve. Echocardiography of the patient revealed a large l eft atrium, placing the recurrent laryngeal nerve in an abnormal anatomic p osition where it was vulnerable to the electric current.