How long before a cardioversion?

I can't believe this has happened, yesterday I was feeling good and decided to tackle the renovation of a giant rambling rose. It did cross my mind that stretching up to do pruning had set AF off before but I ignored the thought.....this morning I woke up in AF and it has been going on and off all day. When I had the last major episode my GP said that if I felt as bad as that again I should go straight to AandE for a zap as she put it. Well I don't feel so bad thanks to the extra meds but I wouldn't want this to go on much longer.

What I'd like to ask if anyone has any idea how long it would be before I'm likely to be 'zapped' as I do not want to sit in hospital being fed ham sandwiches or worse nothing at all until they 'see if it settles'. By the way I am anticoagulated so that's OK.

19 Replies

  • I very much doubt that A and E would do cardioversion as this is usually done in the anti room to an operating theatre or cath lab. In emergency they may along with a TOE to check for no clots but unless you have the last four weeks INR results they may not wish to do this even if you are on anticoagulants. Sorry but that would be my experience.


  • Bob, some A andEs do do cardio versions, but not many

  • I'm on Riveroxaban so assuming INR is irrelevant? No need to be sorry, I am not falling over myself to have a cardioversion! I know very little about how it is organized, assumed you go to A and E and then get passed on, not a happy experience.....

  • Just to ask ...what does TOE stand for, please?

  • Trans oesophegeal echocardiogram. They put a small device down your throat and do an ultrasound scan of your heart form behind. All done under sedation to ensure that there are not clots therein.


  • Thank you Bob! Have never heard of that! Do you mean "looking for clots in the heart"? If so, what a good idea!

  • I'm not an expert but I think they would want to see you last few INR readings before proceeding with cardioversion- others who have had it will advise you further.

    It is only 50% success rates so do persist with meds and relaxation and vagal manourves if you find them useful when in AF

    Hope you feel better soon

  • Rivaroxaban doesnt require an INR reading! i am so pleased i was able to go on Riva! I was told by several cardios that I could wait up to 48 hours before DC cardioversion when I wasn't on anti-coagulants. Though they did indicate I would be required to do a TOE/TEE prior to the cardioversion.

  • I have had several cardia visions in A& E . I'm talking about New Zealand so it may be quite different from England, but hereThey seem to be quite happy to do it without anticoagulants as long as it is within 48 hours of the atrial fibrillation starting. The normal procedure here is to attempt cardioversion using drugs and if that fails they move to electrical cardioversion. I can't remember how long but it was certainly several hours of nil by mouth before the procedure. I was highly symptomatic so maybe that made a difference.

  • I have found that when I've been to A&E if my HR is fast I've been moved to the Resus area for cardio version or transferred up to the Coronary Care Unit. It can be reassuring but CV had no lasting effect for me. I believe they prefer to do a CV within 48 hours of an episode starting and agree with the INR records.

  • Hi Buffafly, I went into AF 12 weeks ago and it has not returned to SR. I wasn't anticoagulated at the time so started Warfarin and Bisoprolol and awaited a cardio appointment which I didn't get for 10 weeks. He has booked me in for a cardioversion but have to be in range for 4 weeks as Bob has already said. I am now into my 2nd week in range so am keeping my fingers crossed it stays for the next 2 weeks. Am under a lot of stress at the moment as my 94 year old Mother is very poorly in hospital so it is daily visits up there so my own problems have taken a back seat and have almost forgotten about my leaping heart on many occasions. I am wondering if you can actually get used to it because in the beginning I thought I would not be able to manage, but manage I have! All the best and hope you get sorted soon.


  • I've always returned to NSR within 24 hours, but I did find that making AF take a back seat when it cropped up was an OK way forward. When my husband was having sessions of radiotherapy, I just omitted to mention that my heart was astray and carried on as if I was fine and then when he'd left the house I would take it easy. I've never been struck down (except once) or breathless or dizzy - just a very silly, rapid, irregular and noticeable heartbeat.

  • I had a similar experience when my husband was waiting for a very dangerous operation. Although it was caused by a virus the stress did not help and trying to get the INR right did not help the stress! I never had the CV in the end.

    I hope yours is successful, best wishes.

  • I've been offered a cardioversion in A+E.

    For me a cardioversion is an instant and wonderful cure. Last had one in March and been fine since.

    How are you now?

  • Hi jean

    As a newbie on this forum can you tell me what a cardioversion is? I have only ever been put on a drip in A&E i dont know what drug they use in it but it has worked for me. I was told that if it failed to work the next step would be to have my heart stopped and re started .

    Thanks John.

  • Hi John

    A Cardioversion is sort of what you describe, which is an electrical shock to the heart to try and put in back into Rhythm, sounds really scary when you talk about stopping and re-starting the heart, but that's not quite what happens.

    First understand this is done usually in an operating theatre annex room, and secondly you are always put under prior to the procedure, and it only takes less than 5 minutes.

    They wire up your heart using the usual ECG type leads on your chest and your back, and then put two pads on you, sometimes both on the front, more usually one front one back. You are then put under.

    The computer then "reads" your existing heartbeat, and delivers a shock to the heart at the point that it "should not beat" if that makes sense. In other words it tries to force your heart to beat normally, at no point do they actually stop and re-start the heart as the whole thing happens in less than a heart beat (literally)

    Many people here have had CVs and some multiple times, it's a very easy procedure, and nothing to be scared about, but you must be anti-coagulated prior to a planned CV they will insist on that to prevent stroke.

    Hope this helps


  • Thanks a lot Ian,


  • Ian has described it perfectly. Jean

  • Thanks all, it seems experiences are different so if I ever have to go to A and E I shall find out what the system is in our local hospital! Fortunately my heart reverted to SR in the evening so I was able to come to visit my daughter and grandchildren today. I did not want to risk the train and a different area if I was not fit. I was torn between Keep Calm And Carry On and Ophelia but when my heart rate went up to 110 I thought I'd go for the second option for a bit.

    Reading the remarks about INR I can see why they went for Rivaroxaban as it could save me a long episode with angina like the last one. AF seems to be an individual experience as well, mine is like a Mozart composition 'too many notes'!

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