Internal Cardioversion

[bluebell111]

Has anyone had an internal cardioversion...I am very undecided whether to have this procedure......the only effects I have from persistant Af are brethlessness & the occasional fleeting chest & neck pain......which I could live with (does it get worse).......I am taking warfarin & digoxin.

[Beancounter Volunteer]

Hi Bluebell

I may be wrong and happy to be corrected, but do you mean a cardioversion inside the heart administered after putting a catheter in through the groin?

What's the point? Most CVs never last for ever, sometimes a few days, weeks months or even seldom years, but they almost all come back to AF at some point, unless you are very young and then why do an internal one when they can do it externally?

Or do you mean a drug induced CV using one of the rhythm control drugs almost always prescribed only by EPs or Cardios.

I am like you in peristent AF, with almost no symptoms, I too have the dilemma that some say it will only ever get worse, and that ablations are best done earlier rather then later. But right now having an invasive procedure will certianly make me feel worse, so the argument does come down on the side or stay on the drugs (especially anti-coagulants) and wait and see.

I do think that your heart needs careful monitoring, some say for example that persistent AF will enlarge the left atria (and some don't including some very senior EPs) but that can be monitored with regular echocardiograms. Some say it will only ever get worse, and some call me a "lucky bugger" as happened in conference last year when I asked a question about persistent AF and the ramifications.

Does it get worse?, well we are all different, mine hasn't it's got better as I have learned to cope with it to be honest. Underlying hasn't changed much but my attitude has.

Hope this helps

Ian

[bluebell111 in reply to Beancounter]

Hi Ian,

Thank you....your reply has helped me in making the decision, (not to have it) I have had two external cardioversion's with no effect......yes, this one being offered is with the catheter in the groin.....I have been on amiodarone, sotalol & viazem xl, none of which I could tolerate......now being asked to take Flecainide before the procedure....I am with you what's the point if you have to keep having more......

I think as you have ....I will learn to cope....

I was frightened at first but now two years on I have accepted it as part of life's rich pattern......& after all I have had my three score years & ten....so everyday now is a bonus.

thank you for taking the trouble to answer.

Jan

[Beancounter Volunteer in reply to bluebell111]

Hi bluebell, if you have been on amiodarone etc, then surely your symptoms are quite bad?. They don't usually prescribe that for asymptomatic AF, so I am little troubled about influencing such a decision, it doesn't sound like something that can be ignored. Are you sure that they are not suggesting an internal CV and some sort of ablation at the same time?

Ian

[bluebell111 in reply to Beancounter]

Hi Ian,

Don't worry I was thinking the same before your kind reply...It just seems I have got on a treadmill, I'm not sure how to say no thanks not at the moment without offending.

Symptoms are just breathless & like you a fast rising heart rate when exercising, a small amount of neck & chest pain occasionally.

The amiodarone was presribed to aid the second cardioversion.

Just an internal cardioversion first.... seems like the waiting list for ablation is nine months.

When I asked my GP about this, the comment was he did'nt know of anyone with AF who had this procedure (not much help there).

Anyway yet another CT gated scan appointment so will see what happens after that one.

take care

Jan

[fuzzflyer in reply to Beancounter]

We seem to be twins. Medically and by name, PAF/warfarin and just been prescribed ramiprin.

No real issues. Just a bit breathless on steep hill climbs with the odd mild chest pain, only found I had AF after an annual medical for flying.

I was offered cardio version last week. But I declined it and decided to give the ramipril a go. Not too keen on taking Two drugs. But seems like the choices get less @ 68

Ian

[Beancounter Volunteer]

Hi Ectopic

Yes I have a very slightly higher rate of resting at 80, but when I exercise if very quickly (and I mean like a rocket) will shoot up to 130 or so but then appears to stay within resaonable boundaries.

Ian

[cyrilbarnes]

Hi ectopic,

I have an ICD, and can assure you it’s not as bad as being kicked in the chest by a donkey. Being kicked by a donkey would not only be painful but would be painful for a long time – bruising, possible broken ribs etc. Being zapped by an ICD is painful yes, but only for seconds and it definitely better than the alternative of falling into a deep sleep and never waking up! It’s rather akin to an electric shock (which of course it actually is). If you touch a bare mains lead, all your body muscles seem to jump at the same time and you get thrown back a yard or two. The same thing happens if you get zapped by an ICD. It’s happened twice to me but as I am reasonably fit I can just get up, take a few deep breaths to recover myself, and carry on with life (although I have to let cardiology know and they have to interrogate the ICD to find out why it went off). For someone older and frailer than me I guess it would be a lot worse, especially if they get thrown against something hard or sharp and there is no one there to help them.

Cyril.

[excalibur]

Hi Bluebell

As someone who has had 4 successful internal cardioversions following a failed external cardioversion, I have a contrary view to Beancounter. They gave me nearly 8 years in NSR, and once I had been put on Amiodarone as well they worked with the longest period in NSR being nearly 5 years.

Give it a try and see if you can get back into NSR and stay there before accepting to stay in permanent AF so you have can understand the difference.

I've had to stop taking Amiodarone, and slipped back into permanent AF but I enjoyed yhe 8 years of being AF free

Best wishes

Lance

[bluebell111 in reply to excalibur]

Hi Lance,

Thanks for your information.......I'm not good on the medication, have tried Sotalol, Viazem xl, Amiodarone, now on Digoxin & Warfarin, now being asked to take Flecainide prior to having the internal cardioversion.

I'm not to bad just breathless & the occasional chest & neck discomfort.......think I have been offered this procedure because of my intolerance to meds.

Would just like to postpone for a while, still undecided.

best wishes

Jan

[Hidden in reply to bluebell111]

Hi Jan,I am due for my Ablation this Wednesday .For the past 2 yrs since being diagnosed I have attributed most of my symptoms to meds.ie Flec and Bisoprolol.

Since last Friday following the pre-op I was instructed to cease all meds apart from Warfarin. It has been an eye opener for me and realization how efficiently these meds have kept my AF under control.Four days on now without the meds I am almost crawling on my hands and knee.Dizziness,sweating, tightness across the chest and increased tinnitus not to mention peeing every 5 mins I have been advised by the L.H.C.H if it becomes unbearable to go to the local hospital...and on no circumstance to reinstate the meds.

To think I refused this offer of an Ablation 6 months ago..I was even contradicting my cardiologist that all the above symptoms where from the meds and not the AF more fool me.

The only symptom that has improved whilst off the meds are the visual problems I had(sensitivity to sunlight and a shimmering of the road and pavement) that has gone completely and first time for months have not

had to wear my sunglasses..

So roll on Wednesday that is all I say.

Good luck in your choice of treatment...

Carol.

[excalibur in reply to bluebell111]

Thanks - clerarly it's your call, but if you are unhappy with your current state, I believe an internal cardioversion could help. My understanding is that they have a very high success rate in getting you into NSR (greater than 90%) - the issue then is how long you stay in NSR which is where in my case the Amiodarone helped.

The procedure is similar to that for an angiogram from a patient point of view except that they will knock you out with a light anaesthetic prior to doing the shock.

Take care

Lance

[Offcut]

I have had 12 external CV and 2 internal after Ablation I was out for all of them?