First Cardioversion on the 21st - how to prepare?

Hello everyone.

Wound up in AF at the end june, pos. due to a rare night out drinking followed by a charity footie match the next day in which I thought I was 18 again. (I'm 37).

So I'm wondering if anyone knows of any research about increasing your odds of staying out of AF afterwards? I've seen vitamin c at 2000mgs 12 hours before can help your odds so any tips like this would be great.

I'm currently supplementing magnesium, having lots of omega 3/6 and all the electrolytes in my diet and drinking plenty of water a day.

(Takings Pradaxa only - resting beat about 70)

Many thanks for your positive suggestions.

26 Replies

  • Hi Mark, sounds like you are doing everything possible to help yourself. AF can hit as a one off in such circumstances but is usually (some say always) a progressive condition. Once your heart establishes rogue pathways they may not vanish on their own. If you are needing cardioversion it sounds like you must have been in AF since your first event so you should be prepared to find that the cardioversion may not be a permanent fix. It could last a few minutes, a few hours or a few years , there is no way of knowing since AF is such a mongrel condition and so few people suffer the same. At least it will establish that you can be returned to NSR and this would aid any decision to go the ablation route which has a far greater chance of ridding you of any symptoms. Read all you can of the fact sheets on the main AFA website and ask any questions here that we may be able to answer.

    Good luck


  • It's interesting when you mention rogue pathways, one thinks you should be able to stimulate the original heart circuitry to become the strongest path. As opposed to destroying rogue paths around it.

    No one has really explained to me why the junction box which is the AV node breaks and stops passing the pulse to the lower chambers. Does anyone know?

  • Mark, the AV node is not broken in AF. What happens is that extra chaotic pathways form, usually from the four pulmonary veins, which trigger the left atria into spasm. Instead of contracting in a regular fashion it writhes like a bag of worms. This then means that the left ventricle is not being supplied with blood in an orderly fashion and can't pump properly round the body. In effect an extra set of impulses has formed regardless of the function of the AV node. This can results from genetic pre-disposition, chemical imbalance, or stretching of the atria either by excess exercise (endurance athletes, or similar) over working of the heart. This may include those who are massively over weight or strangely you might think, jet fighter pilots who along with endurance athletes show a marked increase in AF against normal people.

    You might like to know that those people who have AV node ablation and a pacemaker(Pace and ablate) will still get AF. They will experience the small furry animals rushing around but the pacemaker will ensure that the ventricular rate remains stable and the feelings of fatigue, dizzyness etc will not be present. That's the theory anyway!



  • Thanks for shedding light on that Rob, I confess the Doctor probably told me and in my state it went right over me. I really pushed myself in the football match. Played right back but wanted to score for old times sake hence running the full length of the pitch for 90 + extra time. Probably dehydrated and nutrient deficient with the previous nights damage already done. I wonder if my case was over stretching..

  • There's quite a lot of research coming out now suggesting that a lifelong history of endurance training is substantial risk factor for developing AF in middle age. I don't think one single exercise session will cause AF, but it may well trigger an episode.

    I've clocked up about 8000 hours of exercise, and I'm at the stage where the slightest whiff of exertion seems to be making my AF deteriorate.

  • I think you are right to concentrate on electrolyte balance- low sodium, high potassium and magnesium. Jacket potato ,orange juice, banana, mushrooms and tomatoes, salmon, - all good for potassium.

    have just found flaxseed, which you can sprinkle on any food, good for magnesium,

    hope all goes well with the cardioversion-

  • Thanks Rosy, just ordered some flax seed! I've read you can soak them over night which will better extract the nutrients, but apparently if you simply crush them and take them with water they have better anti inflammatory properties. Not sure how true that is, but I'll give it ago.

  • <I crush them as well---- in an herb grinder!

  • You can't win, bananas are one of the foodstuffs listed has high in tyramine, which is reputedly a risk factor for AF! They test my bloods every time I'm in with AF, but they've never found any deficiencies, so I'm not too worried about diet for the time being.

    I reduced my fat intake at about the same time I started developing AF, and then last year I read a study finding an association between AF and low cholesterol! Ho hum, you can't do right for doing wrong.

  • I drastically reduced my caffeine intake, my salt levels, stopped drinking cider/any alcohol after my 3rd Cardioversion was needed inside 3 months. However, I still needed a 4th DC Cardioversion 4 weeks later.....

  • Goodness did you ever identify the cause? and with the changes in diet, did you manage longer periods of remission? I've cut down/out all you have mentioned.

  • The cause was never identified though diet/stress were believed to be causes, I had just moved onto 12 hour shifts as a healthcare assistant and wasn't eating properly or resting properly.

    I only really went drastic low fat low salt tea total caffeine free after the 2nd cardioversion, however the periods between them still got shorter (down to 4 weeks between number 2-3 and 3-4). But I'm sure the being cautious helped.

  • I'm intrigued by this thread.

    When I was taken into A&E the first time two years ago they were preparing to do an electrical cardioversion after I had been in AF for about 19 hours, then just as they were getting ready it stopped by itself, so I didn't have one then after all.

    However, when I was in last June it was 34 hours before the cardiologist arrived, and after asking me why I hadn't had a ablation he said "so what do you want to do then?". I told him I just wanted to be back in NSR and go home, so he sent me for a cardioversion. I really don't know how long they had been planning to leave me if I hadn't said anything. When I got into angiography I was given a consent form to sign, and then they got quite pushy about me phoning my next of kin before they did it.

    Now I read about people going on waiting lists and waiting months and I'm rather confused. Is this a routine procedure that's normally done on the spot like they were going to do with me in 2012, or is it put off for months because it's a dangerous risky last resort?

    After I had my cardioversion I found out that I been referred to the Warfarin clinic the following day, so I'm left with the impression that they were planning to write me off as permanent AF and send me back home.

  • As I understand it, there is a low stroke risk in carrying out a cardioversion if AF has been present for less than 24 hours. The problem comes if you've been in AF for more than 24 hours or, more usually, they don't know how long you've been in AF for. In that case, you need stable anti-coagulation to minimise the risk of clots causing strokes.

    Now I have no idea how that matches with your experience but it might explain why sometimes they can do a cardioversion quickly and sometimes they have to wait.

  • Generally speaking if a cardioversion is done within 24 hours of AF starting there is little risk of clots forming and a stroke being caused. After that they want you on warfarin with an INR of between 2 and 3 for at least four consecutive weeks before they will do one. The onoy exception is to do a TOE-- Trans oesophegeal echocardiogram to check there are no clots.


  • I'm getting fed up of trying to work out what they're playing at, it's got to the stage where there's little point in even trying to communicate with the NHS. It was 34 hours by the time I was done, not 24, but I'd spent most of that time laid in bed ignored. They gave me Clexane, I don't know how that compares with going on Warfarin for a month.

    After I was done I spent another 6 hours in bed, after which a nurse came in and said they'd just noticed I should have been sent home, and that they'd been waiting because I had originally been put down for a referral to the warfarin clinic next day. I thought that the mention of Warfarin meant that they had been planning to write me off as permanent, and send me home, but perhaps they were going to put me on it before the cardioversion as you describe.

    Trying to wring anything out of the NHS is like getting blood out a stone, a game of twenty questions in which they won't even answer nineteen of them.

  • I think the problem is that most A and E departments actually know very little about AF, hence my never going there. You seem to be unlucky about communication as I have not had any problems since I made myself an expert on me. The more I know the luckier I get!


  • On reflection, I wonder if the time limit and Warfarin before Cardioversion is dependent on your Chads score. Last time I was in A&E a doc suggested I try taking a bit more Flecainide, which has worked a few times since then, but I've been on the go since 11.00 this morning without much sign that it's going to revert. If it's still going in the morning I might go to the GP on the pretext of asking how much Flecainide it's safe to take, and see what reaction I get.

    Re communication I think it has more to do with vindictiveness after previous complaints than luck.

  • When I first found out I had AF ectopic I was placed on Warfarin and Amiodarone with a view to carry out a Cardioversion if the meds didn't work. I was given a 6 week waiting period to make sure my blood was at the right INR level prior to Cardioversion. I came out of AF and subsequently was taken of Warfarin.

    I've since changed to Flecainide, but it doesn't work for me and I've had two months of attacks, currently I'm still 60 hours into an episode that I don't think will subside. I don't feel unwell just short of breath, but the Cardio's office don't seem to concerned, I've been instructed to wait until Monday until my Doc is back from leave. If I thought I could just rock up to A&E tonight for a Cardioverison I'd be straight there.

  • What is your HR Jason? Now I'm on the meds, a typical episode will be about 120 laid down or sitting, and 150-180 standing up.

    The more experience I have, and the more I read from others, the more confused I get about what I should be doing, and what I should be expecting them to do. It doesn't make me feel particularly unwell, but my BP drops so much when I stand that it makes me feel faint, and I wonder if I'm on a fast track to dementia.

  • My HR isn't too bad whilst having an episode, usually anything between 75 - 100 whilst sitting down and about 100 on the move. My normal HR is between 55-65 resting. However after getting nowhere with the Cardios office today I took it upon myself to try a higher dosage of Flec. Not the brightest thing to do as I had a bit of a moment and my HR was about 130 resting for a good while. My episode ended about an hour ago and it is now a personal best of 61 hours ish. I cannot gauge my episodes. I hear it's a mongrel condition well my mongrel condition is crossed with another mongrel and it's totally unpredictable.

  • I'm going in for my cardio version next wed 13th , this will be my 4th appt as my surgery lost a blood sample for my INR , then I couldn't fit in 4 blood tests , then I was put on waiting lists.! But they told me there is an 80% chance it will work but out of that 80% , 40% go back into A fib. I've had this condition since last Oct and I really don't think about it too much as I'm permanently in A fib and don't have " episodes " . In fact I can barely find my pulse ! So I have a watch type pulse monitor. Re the INR readings, I was told between 2-5 was okay for my cardio, are we all told different ? Mine have been from 2.7-3.3. It's odd that you don't change your diet or regime for a week and 2 different readings pop up. I was told ' it's just one of those things' . As for the flaxseed I've been sprinkling it on my shredded wheat every morning for a few years now. Or in plain low fat yoghurt along with oat bran. It's a very underrated food that has so many valuable benefits. I avoid caffeine and salt, bread as I find this bloating and is loaded with sodium, processed food, take aways and some fruit as it's full of sugar ! Thank goodness I love fish , chicken and vegetables !

    I'll let you know how I get on.


  • Thanks for your message Lisa - ill keep my fingers crossed. Sounds like you deserve a bit of luck! Did you notice any improvements in coping with diet changes and may I ask if the doctors gave a probable course?

  • Thanks. I've always eaten quite healthily , but I do miss the weekly takeaway. I'll never eat a chinese one again, all that msg, now I know why I was awake all night with indigestion and a raging thirst ! Curry, well if you leave a container out overnight you can see all that oil on the surface in the morning ! But I really miss fresh baked baguettes with cheese an pate and dips .......... But you get used to a good diet and feeling slimmer and fitter , my heart deserves it ! My consultant would like me to come off the drugs, I'm on 6 in total, but the reality is I'll be on warfarin for the rest of my life as I've already had a stroke. I'm under no illusion that the cardio will work forever , but the doc's want to give it a whirl , I can go with that, so watch this space !


  • Hi mark , I would see no reason to take any supplements at all, unless a test confirmed that you are deficient. Also, I have read that fish oil should not be taken as it is a stimulant for acetylcholine production ( a neurotransmitter )

    Whilst i am post ablation, it seems fairly common that the illness will return unless one corrects the long term causes. Unfortunately the medical profession cannot tell what they are , so it is for the individual to make their own assessment of the causes in their own case.

    Personally I think that long term poor/ modern diet has been the major cause and so I have effected changes to my diet to exclude as much refined sugar and processed food as possible, and to add more healthy options .

    I suggest you start to read the labels on all packaged foods as the title can confuse. I was having low fat yoghurt thinking that I was eating healthily only to find that they contained six teaspoons of sugar , equivalent to 10 spoons of sugar in a mug of tea.

    A starting point may be:-

    NO - sugar, caffeine, bisquits, salt, soy, msg, pizza, pasta, sausages, ham, wine, cake, chocolate, burger, gluten, processed

    ADD - water, beetroot, fruit, veg, sweet potato, unsalted cashews, whole grains, sea salt, onion, blueberries, coconut, raisins, butchers meat only as it is less likely to have injected preservatives, fresh fish from a fishmonger.

    Look for any research on the role of the neurotransmitter acetylcholine.

    Good luck


  • I have chronic AF and because of some disease within the AV node and Bundle of His my ventricular rate doesn't increase, but tends to be slow. I have found that pushing myself to hard, like rushing around all day and not stopping in the evening, going to bed late several days in a row makes my symptoms of fatigue and lightheadedness worse - so I am trying to avoid this now! My only treatment at the moment is Rivaroxaban.

    I am learning to slow down, although this is hard, I wonder if pacing my activity will have a beneficial effect on my heart in the short and long term? I still work full time, do yoga and now do slow, short walks - does anyone have any thoughts about levels of activity or if we each need to pace ourselves dependent on symptoms? Has anyone else found that by easing back on levels of activity, but still remaining active, has helped reduce their symptoms?

    Can anyone recommend where to go to get accurate advice on diet related to AF heart disease, or is general information about healthy eating sufficient?

    Has anyone had an AV node ablation where they also have some disease within the Bundle of His?

You may also like...