When to cardiovert?

[Mrspat]

I think I'm about to find myself in a Catch 22 situation. Two weeks ago, I had my annual cardiology appointment and in the preceding week or so, managed to bring on episodes of AF just by worrying about the appointment. I went for a repeat ECG a few days later at my GP, still in AF, but I believe I had had periods of NSR in between, mainly at night.

Since starting on a new medication nearly a week ago, I have had no symptoms of AF though I could be having silent episodes of course. At the hospital appointment, it was suggested that a second cardioversion (I had a successful one 16 months ago) might be tried "further down the line" - consultant's words. The letter that came from the hospital to me and my GP yesterday makes no mention of cardioversion, just information about the suggested medication and my overall heart health. This includes a request to put me back on anticoagulation as opposed to aspirin. I'm fighting a separate war on the anticoagulation front however I've agreed to go back on it for the time being at least as the cardiologist informed me that I can't be cardioverted otherwise.

My question is: how am I going to know if I need cardioversion, short of wearing a monitor all the time? I'm not addressing the anticoagulation argument in this post - I'm aware of the issues and my particular risks. I am not going back to the hospital for another year so the GP will be managing me.

[Mrspat]

Oh, and I forgot to add ... When I had my cardioversion, I was told that although there was a 40% chance that it would come back within the first year, it was worth doing so that my medications could be reduced. They were reduced, only for the AF to return a year later and now I'm taking a different one! Definitely Catch 22.

[BobD Volunteer]

Cardioversion is a much overused procedure in my view as it does nothing to "cure " the AF and in many cases fails to put the patient back into NSR. I have had three but not for AF,--mainly when post ablation I was in atrial tachycardia.. The relief if successful is not usually permanent although for a first event AF patient it is always worth a go but as a lay man it seem pointless to pursue a procedure with reducing returns. I stress this is only a personal opinion an I have no medical training.. I don't know how many EPs would agree but it seem to me that cardioversions are normally suggested by ordinary cardiologists or emergency doctors.

If I had paroxysmal AF as you appear to I would be looking to have an ablation procedure as soon as possible when success is more likely and the heart has yet to produce multiple pathways. At the very least I would be asking to see an electrophysiologist (EP) to discuss my options.

Bob

[Mrspat]

Thanks Bob. I'd only even think about an ablation if they would agree to do it under GA and via a non-groin route. This is due to previous disastrous procedures and the medical profession ignoring my history. My heart isn't normal structurally and I don't know if this would preclude an ablation.