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I posted 6 weeks ago that I was back in AF and waiting for my referral from GP to Cardiac Consultant. Having had 5 Cardio-versions and 3 Ablations, I was curious to find out the what the next part of the process might be.

I had my meeting with my local hospital Cardiac Unit yesterday and amazingly it took exactly 15 mins from car park to returning to the car. The Doctor I saw decided he would line me up for another cardio-version and suggested lots of different types of alternative to flecanaide. I suggested that I had sort of moved on from Cardio-versions 3 years ago when I had my first ablation and queried whether I should be referred back to my EP for another ablation assessment. he said he would arrange an appointment with the EP but wanted to move forward with the cardio-version asap.

This has left me rather concerned as I kind of got the message after my 5th cardio-version that they didn't like to give too many shocks to the heart muscle, and that was why I was moved to ablation therapy. Additionall, it is extremely difficult to get to see these Senior Doctors or EP as their Secretaries refuse to give appointments unless referred by other doctors. Any advice?

17 Replies

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  • Hi

    You don't say where you are but this sounds promising; to arrange a cardioversion you must be stuck in AF or flutter so it makes sense to convert it and see if you can be brought back to NSR. You have been told you will be referred to an EP but this can take 3 months plus on NHS waiting and it wouldn't seem sensible to leave you in AF until you see them, as this might limit your options or chances of success depending on their opinion when you get to see them.

    Jo

  • If its any help to you I had my 16th dc cardioversion about 10 weeks ago. Have also had 3 ablations ......EP has offered a 4th with of course no guarantee that it would make any difference. At the moment I have elected to stay as I am unless my events get more frequent.

    Sandra

  • Hiya well I have just had my pre assessment appointment for my first cardio-version, on reading these messages wonder should i go through with it. Sorry to read that others are having it done so many times..

  • Oh dear I hope I haven't put you off ! It is unusual to have as many cardioversions as I've had. The point I was trying to make for PapaDon was that it is possible to have multiple cardioversions . It is a very simple procedure and you will be well looked after.

    Some of us prove more challenging than others. Also, my history goes back over 23 years.

    Regards

    Sandra

  • Don't cancel it. The cardioversion tells them quite a bit about your heart and also significantly helps map out your future treatment plan. Don't worry if it only lasts a few weeks or even days. There are two key things that they are looking for. Firstly can you be returned to sinus rhythm (NSR) and do you feel better in NSR.

  • I have only had one cardioversion. This initially worked for a very short time. I did need 5 shocks though to get me back in nsr. (200kjl) . The consultant has since said that there isn't any further point in me having any more because he doesn't think they'll work. So don't understand why others have numerous and I just the one.

  • At the end of the day it depends on the severity of the AF, where the signals are coming from, the condition and structure of your heart and the "electrocs" and many other factors.

    For someone in persistent AF, especially if they have been in AF for months or years, the chances of success in the medium term, are small. SOMETIMES the chances of success are increased if the person is on flecainide or amioderone. The heart is in someways like a piece of foam that's squashed by something in that it endeavours to return to its previous shape unless it has been squashed for a long period of time.

    For someone in persistent AF the two key reasons for performing a cardioversion. Firstly to establish whether or not the person can be returned to NSR and secondly do they feel better in NSR. Those answers significantly help mapping out the future treatment options and plans.

    I was put on flecainide for about 6 weeks. Then I had my cardioversion but I only stayed in NSR for just over 24 hours. Saw the EP again and he said no point in having another cardioversion, no point in continuing taking the flecainide (as it was having no or a very minimal effect. He also said the only realistic option was to have a catheter ablation.

  • Thank u for your reply Peter

    They tried me on flecainide and it was ineffective for me also. I'm now on the waiting list at Leeds general to have an ablation.

  • Did they leave you on flecainide?

    Are you just waiting for the ablation date itself or date to see EP?

    If you are waiting for ablation are they going to put you in amioderone or flecainide for a MINIMUM Of one month beforehand and three months after?

  • Hi Peter, I'm taking 20mg 'Rivaroxoban' 15 mg bisoprolol. 10 mg morning and 5mg night. My GP said this is the highest dose he has ever prescribed. Didn't make me feel too confident. Also 250ncg dioxin. I saw EP in August. 10 mins consultation. Minimal advice, I expected explanation of procedure etc. He appeared uninterested in me. Was extremely unhappy as I felt as though I was an inconvenience to him. 4 month waiting list from seeing him on 1st august. Not heard anything yet. But AF symptoms have taken me to GP on numerous occasions no plan as to what I should do

  • Ok. I would phone up arrhythmia nurse at hospital and ask about procedure, use of amioderone, etc. If no joy write a letter yourself so you get all points addressed but get your GP to send it copying you in on the letter as it's more likely to be answered.

    I am saying this so that you don't get into the situation that they send you a letter with a date for ablation say 3 weeks or just the four weeks in advance and say you need to be on amioderone for a month before which then becomes impossible because certainly in my case my EP write to GP to prescribe it.

    Also you need to make sure now that they will do the ablation with you on rivaroxoban or whether you have to switch to warfarin (less common now than 2 years ago) since someone on here landed in this problem a couple of months ago.

  • Thanks for the advice Peter I'll get onto it straight away.

  • Good. I'd hoped that you wouldn't think that I was teaching you to suck eggs but as I was lying in the bath it seemed to be problems just waiting to happen.

  • Ha no Peter. Your posts are always informative. Keep them coming! Nothing ever goes straightforward, well not for me anyway.

  • I was told that they only shock 3 times

  • They only used to shock a maximum of 3 times but changed to 5 now

  • When I had my first cardioversion another patient was having his 14th. He had AF and sleep apnoea.

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