My son (43) has been to a and e a few times with a fib. The latest was a couple of days ago, after he had had palpitations for two days. From what he said, he was told that they could not cardiovert because he had been in a fib for more than 48 hours. Apparently the thinking behind this is that cardioversion at this stage might dislodge a clot with bad consequences. So, he was sent home, still in a fib, as they didn't give him any medication either! At this point, I was more than puzzled.
What he has got, is an appointment with the a fib unit, and from that he will be given an anti coagulant for six weeks (!!!!) and THEN they will cardiovert! I'm flabbergasted by now. Are they really going to let him stay in a fib for six weeks?? And surely he'll get some medication very soon?
As it happens, he reverted back to sinus last night, much to everyone's relief.
I'm torn between thinking he or I have misunderstood something, or it has not been explained it very well, and wondering if there's new thinking abroad amongst hospital medics that I've missed somewhere along the way.
Anyone else had this experience?
JanR
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jan-ran
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I was cardioverted 4 times last year, one of those was at 4 in the morning, only an hour before a "12 hour window" shut - after which they wouldn't be able to do it. I was given a theraputic dose of clexane beforehand.
I can fully understand the hospital's position, given the associated stroke risk with AF... however I also can't even begin to imagine sitting in AF for a few weeks either!
Hi Jan - In my experience, you have to wait weeks for a cardioversion. In the last year I've waited twice for 6 weeks and had a constant fast pulse throughout the wait, it was quite disabling and I couldn't walk far at all. I'm now awaiting another cardioversion on 12th November and will have had a fast pulse for around 7 weeks by that time. Not all the hospitals fault, as I usually leave it a week before contacting them in the hope that my pulse will return to normal.
Jan if it can be established that AF has not lasted more than 24 hours DCCV may be attempted, in extreme cases DCCV may be done after that with a TOE (trans oesophageal echocardiogram) to look inside the heart to check for clots. In all other case at least four consecutive INR readings of between 2 and 3 are the norm.
What you must understand here is that he has been treated only by A and E who would normally not medicate but refer to a specialist unit or return to GP. I have a friend who is an A and E doctor who tells me they are not allowed to give medication for such things.
Thanks for your replies, everyone. lallym, I think he has an appt in the af unit within the week, and he is seeing his gp very soon. Thanks ? (name not shown) for the link about magnesium. I need to see this one for myself. Bob, as usual you make sense of things, I understand something about his treatment that I didn't know before. Namely, people have to wait an age for a cardioversion (also thanks to jedimaster and jeanjeanie for info), which I thought was dreadful. I imagined you went to a and e in a state, and they got the paddles out immediately. And I didn't know about the 12 hour window.
Bob, when you say "such things", are you referring to a fib? When I went to a and e the first time, I was given bisoprolol, which was actually a change of medication from sotalol, which my gp had given me. That's why I was surprised my son wasn't sent home with a pack of pills. It would seem that different places have different protocols.
I haven't been in afib that long,no, but when I went into A&E they made it very clear to go back ASAP if it happens again. Basically I believe they have 24 hours to convert back to sinus from the start of the attack.
Don't know whether it will help, but I've recently bought a Sportline Duo 1060 watch with an ECG accurate heart monitor. It's a fantastic way to monitor yourself if you think you've gone into AF. It's got both a touch facility AND chest belt. Maybe that would be re-assuring for your son. Really glad he's back in sinus tho.
Good luck for the future
I was in A & E back in 2008, can't remember the details but I was put on a drip of Flecainide after a few hours the doctor came in and said it wasn't working and he would have to 'shock' me that put me straight back into SR!!
I know they have a window for shocking you back into NSR after which the risk of a clot is considered too high... But when I went to A&E I was given all sorts of drugs to try to get me back into NSR medically, an anticoagulant too. I don't know if this is a new protocol but it's surprising.
It's a bit disconcerting to learn that a and e treatment for sf is so varied. I get the risk of dislodging a clot if af has been going for 12-24 hours. But why do some interns give meds, while others don't? Ah well, we live and learn, eh?
Hi Jan, Like your son I'm 43 years old. I developed AF 2 years ago and exactly what you describe is what happened to me. However, I was prescribed medication also, this took me out of AF, so they stopped the anti coagulation as my CHADS2 score was 0.
We are waiting to find out what meds my son will be given. I haven't mentioned the Chads-vasc score sheet, I don't want to disturb my son unnecessarily, and I'm hoping the gp and/or the af unit will give him all the info. He's quite anxious and keeps wanting to know if he's going to die. How ell we all know that feeling! I just told him Bob's 3 golden maxims: Af won't kill you, x 3. I think he has been told about the stroke risk, but it doesn't seem to worry him as much as the uncomfortable palpitations and tiredness.
Thanks for your input, Jason. JanR
Hi jan-ran,
I've read your post and the various replies. I cannot make any comment other than explain what happened to me. On 6/1/2010 around 9.30am ish I felt unwell. By 4.30 pm ish I had an immediate appointment with my GP, by 6.30 pm to 7 pm I was in A & E (thanks to my GP), once ECG had been undertaken and results known I was being treated for AF. Once my heart rate was reduced from 160 bpm I was transferred to CCU. The following day I had my first meeting with Cardiac Consultant - my medication was reviewed and adjusted and I was put on warfarin. I was kept in for a further 5 days while further tests were made on my heart and related systems. On 6th day I had a new medication 'diet' and was discharged back to the care of my GP.
I have never needed to be returned to any Cardiologist or A & E department for AF.
I really believe that if a 'victim' of AF can't get a diagnosis in a similar time frame to that which I experienced (9 to 10 hours or so from initial onset) then they are on a hiding to nothing.
I know that such a speedy and accurate diagnosis has been significant in minimising the impact of my AF and contributing to my ongoing well being. I must say that I would never regard myself as cured of AF particularly as I'm one of those weirdos who can be in AF and not know it .... but, equally, I know that so long as my chest feels 'light', 'free' and 'relaxed' then I am - at least for the moment - free of AF.
Reading so many posts on this website and the older ( now defunct Yahoo based AFA web forum over the last 4 and half years) I am horrified at the way people are treated. To my mind its almost like moving the deck chairs around on the Titanic .... a total bloody lottery.
I was treated by the way as a bog standard NHS patient ... not 'Private'.
Hi John, thanks for that full and informative reply. The seemingly different approaches to a and e treatment of af is bewildering. But in the end I guess they know what they're doing. We all get there in the end, I suppose. I had a bizarre start in 1996, when, after sending me to the heart consultant in a local hosp, my gp looked at his letter, in my follow up appt, and virtually tore it up, harrumphing it was rubbish. He ignored the treatment suggested, and gave me atenolol. I knew nothing, so followed meekly on. My af stopped dead for about 6 years! He was a disaster of a gp, for many other reasons, but got it right that time!
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