Cardioversion delayed due to lack of weekly INR data

[AFCyclist]

I have been in persistent AF for 6 weeks but yesterday at my pre-op for cardioversion I was told that they could not proceed because I did not have weekly INR checks for the past 4 weeks. This was extremely frustrating as there had been no mention of this when I saw the cardiologist 4 weeks ago and nor when I phoned the hospital to chase up a date for my cardioversion and actually read the person my last 4, six weekly INR results with dates and they gave me appointments for pre-op and cardioversion ! Yesterday I was given the AFA booklet on cardioversion where it clearly states the need for weekly INR checks. I am kicking myself for not picking this up as I am a regular reader of this site and try and keep myself in the know.

I guess this is a disadvantage of Warfarin over a NOAC.

I now have a further 4 week delay before cardioversion while I get the necessary INR results. I wanted to get a cardioversion as quickly as possible.

Anybody know if a delay reduces the chance of a successful proceedure? I will have been in persistent AF for 10 weeks.

[BobD Volunteer]

This is frustrating and a bad attack of poor communication but I very much doubt that a further four weeks will make much difference. Many people struggle to get four weekly INR checks in range so often face long delays. I'm sure that you understand that DCCV is not a cure for AF but merely points out that you CAN be reverted to NSR and therefore makes future treatment plans such as ablation more easily judged. The length of time that you may or may not remain in NSR is also unknown although we all hope it will be considerable. For some it may only be a few hours whilst for others a matter of months or even years.

Regarding NOACs I think the jury is still out on that. I have a feeling that many hospitals would still want you on warfarin as it is a quantifiable situation whilst being on NOACs relies on them believing you when you say that you haven't missed any doses and have been taking it as prescribed for such and such length of time as there is no way to check. They can always do a TOE (trans oesophagial echocardiogram) to look into your heart to check for clots if in an emergency if they have that facility where you are being treated. I doubt my local cottage hospital does even though they have done DCCVs for me.

[AFCyclist in reply to BobD]

Bob, thanks for your detailed and informative reply. I picked up at the Birmingham Patients Day the point about some hospitals prefer you on Warfarin for an ablation. I am now going to focus on getting my 4 INR ducks in a row for the cardioversion. Good start, first one on target at 2.9.

[Mrspat]

I hope you have a steady INR. If you are out of range on even one of the tests it may delay the cardioversion further. Mine went out of range a week beforehand and I had a battle to get the procedure done and to get in range in time. It was successful and lasted 16 months. On an NOAC now.

[PeterWh]

I was and am in persistent AF. I was lucky in that my consultant did my cardioversion when I was on apixaban. I only lasted 24 hours in NSR. However the key things for the consultant's perspective was that I could be returned to NSR and that I felt a lot better in NSR (apparently some people don't notice any or very little difference).

When I had my first ablation I had been having weekly blood tests and my INR was swinging all over the place and was only 2.2 on the morning of the ablation even though warfarin was taken as usual the previous evening. I certainly hadn't had the previous 5 readings in range!!!! However they did a TOE (as my hospital does normally) and adjusted by injection.

However not that different hospitals have different policies and practices and also different consultants in the same hospital likewise.

If you want more info see some of the other responses that I have written on this topic (in case you don't know go to my profile).

[MarkS]

I'm afraid that's yet another example of the NHS falling down.It's so simple to give people the right information in a leaflet. It just requires someone to take responsibility to join all the dots up. Does the doctor have a supply of forms and give one out to every patient? When patients are added to the cardioversion system, is a letter automatically produced with the right details in it? It's not rocket science.

[AFCyclist in reply to MarkS]

Agreed. I take the view now that I have to try and "project manage" my own health treatment between all the different areas including my own GP. At least I am physically and mentally able to do that at present.

[Hidden in reply to AFCyclist]

You're right,( AFCyclist) on target. For me, the key to getting what I need is taking charge that i's are dotted and t's are crossed. Sometime caregivers get annoyed but I don't care. I don't want extra problems or suffering because someone doesn't do their job. I don't mind taking on this responsibility if it means things get done properly for me. I also nag really well, (LOL, but not really!) irina1975

[ILowe in reply to MarkS]

I know it is difficult to argue back: they have the power. But I fail to understand why four weeks of stable INR is relevant to a cardioversion. Any INR higher than 2.5 should do, and the higher the better. It is the day of operation and the month or so following that count. I have an artificial heart valve therefore tend to run higher INR than advised for AF, and the doctor doing my cardioversion said, the higher the better. We were both happy that for my CV I had an INR of 4.3.

I was told by a British Cardiologist that should AF start again, abroad, I could go to any emergency unit within 48 hours and ask for a Cardioversion, since I was anticoagulated anyway.