cardioversion failed

[Steveh6874]

hi can anybody tell me what happens next after my cardioversion failed

what treatments will i be given ,

Thank You

[Beancounter Volunteer]

Hi Steve

I too had a failed cardioversion, and what happens next will really depend on what your symptons are and how it's affecting your life.

In my case I am almost completely asymptomatic, so for me I am remaining on warfarin, and taking diltiazem solely to keep my heart rate low.

If you are suffering from AF attacks, then they might try one of the control drugs such as Flecainide or stronger, it really depends on how you are feeling, and also potentially may talk to you about an ablation.

Ther's no one answer to be honest, if I remember you had a bad experience with your Cardio and hopefully you are changing, and seeing someone new, I would be preparing all my questions now to ask about what the next steps might be, when is your next appointment?

Be well

Ian

[Steveh6874 in reply to Beancounter]

Thanks for the reply Ian

ive insisted i see another consultant but that wont be for a couple of months

i am really struggling at work i do a physical job and i am exhausted even on reduced hours , i am on bisopropol flecanide and ramipril and i feel terrible , does everybody have a right to be considered for ablation i dont think its available at my hospital

thanks again for your advise its a great help and very much appreciated

[Beancounter Volunteer in reply to Steveh6874]

Hi Steve

With a failed CV you should ask for your appointment with the Cardio to be brought forward, right now it's a balance between controlling your heart and controlling the drugs, all those drugs are very powerful and are used to control the rhythm and rate of your heart, and will make you feel tired, but is the AF itself making you feel tired?, are you having attacks or a raised heart rate?

If they cannot control by drugs, and it's affecting your lifestyle (and this is contentious as some say even if not affecting your lifestyle) then an ablation is currently the most likely treatment.

You say they do not do ablations?, then playing devils advocate what are you doing at this hospital? why haven't they referred you to a specialist hospital which does have EPs and the ability to do ablations,? They are unlikely to have the expertise to treat you properly unless in their bag of options is an ablation to be honest. I could be mistaken, but I thought most heart units had catheter labs nowadays, as they need to do stents and suchlike, so I am surprised that they do not perform ablations. In the UK you have a choice however, you can choose which hosipital and consultant treats you.

Can I recommend you speak to the AFA, they have a helpine on their website, and their very knowledgeable staff will help you out and answer many of these questions, and perhaps even point you in the direction of the right treatment.

Be well

Ian

[BobD Volunteer in reply to Beancounter]

Ian, cath labs apart the number of RF or Cryo ablations carried out in UK per year is very low in relation to the number of diagnosed cases of AF. We are talking low tens of thousands against hundreds of thousands of patients so by the nature of things not everybody will get the chance for it. There has also been considerable strain on NHS funds and ablation being costly will always be considered a luxury treatment. I'm not a

[BobD Volunteer in reply to Beancounter]

Ian, cath labs apart the number of RF or Cryo ablations carried out in UK per year is very low in relation to the number of diagnosed cases of AF. We are talking low tens of thousands against hundreds of thousands of patients so by the nature of things not everybody will get the chance for it. There has also been considerable strain on NHS funds and ablation being costly will always be considered a luxury treatment. I'm not aware of the number of EP centres in UK but it would be wishful thinking to expect every cardiology department to have the facility for doing ablations. I know of several who do flutter ablation which are done in the right atria but who shy away from AF ablations/PVI due to the complexity. It would be great to live in an ideal world but as I keep reminding people this is still relatively new science, only about twenty years old at best and progress s being made albeit not as fast as some of us would wish.

[Beancounter Volunteer in reply to BobD]

Thanks Bob

I suppose I so easily assume, as I live very close to a great cardio centre at Harefield with all the facilities and fantastic staff, so thank you for reminding me that not everyone is so lucky.

Ian

[BobD Volunteer in reply to Steveh6874]

Steve, NICE say that you have to have two failed drug regimes before you can be considered for ablation but whilst I am a fan of the procedure I do warn people not to think of it as a cure. There is no "cure" for AF, just maybe a reduction in symptoms.. You should get to see an electrophysiologist. an EP and there is a list by area of these on the main AFA website. Get your doctor to refer you as this is your right.but there is no automatic right to ablation. Many people do get relief from symptoms following ablation but there is a 50% chance of AF returning within five years of successful ablation and it is important to recognise that fact.My view is that the drugs are probably accounting for a fair amount of your lack of va va voom so you might discuss options with your doctor.

BobD

[Steveh6874 in reply to BobD]

thank you more great advise

is it my GP or cardiologist who would have to refer me to an Electrophysiogist ive just looked into it and they dont have those services and facilities at my hospital and judging from my experience with the consultant i dont think he would have the skill or knowledge to perform these anyway and my GP seems to have little understanding of afib

I was in constant afib brfore my cardioversion and its constant again now so the bisopropol and flecanade dont seem to be doing anything for me only making me exhausted , ide just love to be able to get back to something like my old self , i dont really want to have to take all these drugs for the rest of my life

ive always been active i was a pro footballer for a while when i was younger and have looked after myself and considered myself very fit so all this is a massive shock to me

Ide like to thank you Bob and Ian for your advise its really great to be able to turn to someone who knows how all this works

Thanks again

[steve60 in reply to Steveh6874]

Hi there, I have been told that I can not have an ablation as it is not suitable for Paroxysml Afib, so I just have to persevere with Flecainide ?

[Hidden in reply to steve60]

I wonder who told you this? I have Paroxysmal AF and have had 3 ablations, the last one in July, which has eliminated the AF as far as I can tell. I feel really good apart from tiredness sometimes. Have you been seeing an EP? I am not very knowledgeable medically, but I understand that Catheter Ablation is one of the main treatments for paroxysmal AF. Hope this helps.

Carrie

[steve60 in reply to Hidden]

Thanks for the reply, at my last cardio visit, I did get a bit annoyed and said 'if I was Tony Blair' you would have done an ablation straight away, to which the doctor replied ' you do not have the same condition as him', funny I thought Afib was Afib !!. Thanks anyway my next appointment is in October so may have some news then (or not) !!

[BobD Volunteer in reply to steve60]

More rubbish I'm afraid Steve. You really need to go find a different doctor. Paroxysmal AF has most chance of successful ablation and results tend to be less satisfactory as AF becomes persistent/permanent. If there were other physiological reasons why an EP would not do ablation there are still other drugs to try which may affect you less badly. PLEASE look elsewhere.

Read up all the info fact sheets on AFA main site and go wave them under you doctors nose if he continues to be an difficult. GPs can't know everything about everything and AF tends to be one of those things they don't unless you are lucky like I was with my second GP. My first wasted five years treating me of non existent stomach problems as I always felt the fluttering in my tummy.

BobD

[dleedga in reply to Beancounter]

Hi Steve,

I', in the same boat you are. I take eliquis and (240mg) cardizem everyday. Was cardioverted and it didn't work. My question is can I live with the fib? I'm 53 years old and I'm afraid of ablation but I'll do it if I have to?? Steve, please let me know were you stand...

if you would like to call me to talk about it my number is [phone] I would like to tap;k to someone who is going through what I am.

[jeanjeannie50]

Hi Steve - Sorry your cardioversion failed. How long after having it did your heart go back into AF? You know could always ask if you could have another. I have had three in the period from last Christmas to the end of June, two of which were carried out while I was having an ablation.

I note with interest that you were once very sporty, I'm starting to wonder if this condition tends to affect more of us who have always been sporty and led active lives. A friend of mine who plays football and cricket has just been diagnosed with permanent AF which was discovered through a routine check - he had no symptoms and felt fine. He's now on tablets and has discovered that when out walking the coastal footpaths he gets tired and breathless going up hills. Now that has to be because of the tablets he's taking, because he didn't have it before. Because he's newly diagnosed, when I (6 years with AF) advised him to tell his GP about this I could see he was thinking 'the GP knows best'. He has the same GP as me and I have to say he is brilliant and being a sporty doctor himself I'm he would suggest trying some different medication. So please ring your doctors surgery, ask if there is a GP there who specializes in heart problems and go and see them to ask if you can try different medication. Hope this helps.

Jean

[Bikerboy in reply to jeanjeannie50]

Jean, I also have heard that top, highly tunes athletes can suffer from AF; I was sure I couldn't blame this for my getting it though, LOL,but it did follow a new (well, nearly 2 year) lunchtime half hour-ish cycle regime, and I am a lot fitter than I used to be. I now have the image in my head of JIM ROYAL, sitting on his couch, saying "AF my arse". Sorry for the language - but Jim Royal said it-not!

[jeanjeannie50]

I forgot to say, cut out having anything with artificial sweeteners in. I was able to cure my permanent AF this way, but unfortunately still had the paroxysmal episodes. Because of this I was able to just use what they call 'the pill in the pocket' method whereby you only take tablets when you are having an attack.

I had my second ablation 10 weeks ago, so I'm living in hope that I will soon never have to take medication again.

Jean

[Daboban in reply to jeanjeannie50]

Hi

I am in permanent af. I also have m.e. and am very tired all the time. I still have 10 years to work in a physical and stressful job.

I am not an expert on the subject. but I am looking at Internal cardioversion which is done at a hospital 100 miles away.

Hope this may be a new angle for you.

[dleedga in reply to jeanjeannie50]

Hi Jean,

I was diagnosed with persistent fib in march of this year and was cardioverted once and it didn't convert me. I'm taking rate medication and blood thinners. My question is is there any medications that I can take to be converted. If so do they work or can I live with the fib.

[jeanjeannie50 in reply to dleedga]

There are two drugs you could try for your AF, Amiodarone (considered to be the Domestos of all AF pills) but this can have a harmful effect on other parts of your body, e.g. thyroid, eyes etc. It can however bring your heart back into rhythm.

Or there is Flecainide which is very good at bringing the heart back in to normal rhythm. This is what I and lots of others on this site take. However neither of these pills can be prescribed by your GP, it has to be by a heart consultant.

You can live with AF if it isn't making you feel ill, but an ablation may well help. I've had three and am so much better after the third one last July.