Just thinking out loud.

[RoyM]

I am due a cardioversion in the very near future. One thing bothers me. I am at present in persistent AF, luckily being in AF doesn't effect my lifestyle at all and I am completely symptom free. I do take Apixiban. If the cardoversion puts me back into NSR great.....but it seems it's anyone's guess how long I go back into NSR, if at all. I am concerned that if I should slip back into AF after the cardoversion could i be worse off than I am now. Should I let sleeping dogs lie and simply accept I don't suffer symptoms or should the risk that I will end up worse off. Decisions decisions!!!

[Goldfish_]

Well if you can get out of af you will improve your heart function and reduce your stroke risk, but really have nothing to lose as it's a very simple procedure. Even though you say you are symptom free, your heart will not be functioning as well as it would without af and so your exercise ability will improve if af ceases.

[RoyM in reply to Goldfish_]

Thanks goldfish...The worry is that if I go into NSR and then slip back into AF some time later could it leave me worse off, could the persistent AF be worse.

[Goldfish_ in reply to RoyM]

I can't see why it would be any worse than what you are now. Why do you think that?

[saurabh4567 in reply to Goldfish_]

thx

[saurabh4567 in reply to saurabh4567]

thx1

[saurabh4567 in reply to saurabh4567]

thx 2

[creschendo]

Hi Roy - I had one CV about 18 months ago, at the very early stage of my AF journey. It really only held for about 48 hours but my AF was certainly no worse after than my AF before. As for the procedure itself, I've had worse sessions at the dentist If there's any chance it will improve matters I'd not hesitate to go for it. Best regards, Ric

[pottypete1]

Morning Roy

I have had numerous cardioversions and I have always been better rather than worse afterwards.

However the thought of symptom free AF makes me wonder how you were diagnosed in the first place.

Talk to your consultant it is necessary for you to have all the reasons why they suggest a cardioversion.

What Goldfish_ suggests is sound as it is better for you to be AF free for the sake of your long term heart health.

Pete

[offtherecord]

Hello Roy, I seem to have a similar situation to you. Diagnosed in March 16 when having a routine blood pressure test (not high) I remain asymptomatic with a normal if irregular heartbeat and enlarged left atrium after tests. I'm 68. I was prescribed Amioderone by the Electrophysiologist at my recommended heart centre, then expected to have a cardioversion. After thought and research I decided against the amioderone -pretty powerful suff with a raft of possible side effects.

I have a congenital eye condition, both eyes, and a corneal graft on my left eye . I was very concerned about effects on that. The EP then rang me to say I could have the cardioversion without the meds....unexpected. I agreed , partly as unprepared, then again backtracked.

Spoke to the excellent arrhythmia nurse at my centre, who spoke to the consultant EP, who saw no need to press this. My heart rate is fine, the rhythm is not. Pretty fit, no symptoms at this stage. I take edoxaban, anticoagulant, discussed here before, with a multivitamin and multimineral plus one magnesium glycinate per day. Almost vegetarian diet, never smoked, the occasional glass of wine.

I will revisit the hospital in early February and take it from there.

I'll be very interested in your decisions and progress. Best wishes.

[BobD Volunteer]

Lots of personal experiences there but not a lot of reasons why you should go ahead. I agree with Goldfish that DCCV is very unlikely to exacerbate your AF but what it can do is find out a) if you can be put back into NSR and b) is this makes you feel better. If the answer to either is yes then it opens the door to some other treatment options.

Prolonged uncontrolled AF CAN damage the heart long term in the form of enlarged atrium (cardiomyopathy) and of course reduced function which really can't be good even if you are not aware of it going on. Yes there are very small risks in everything we do and this must be balanced against the risk of doing nothing.

[JMannion in reply to BobD]

Hi Bob

This is probably a silly question but reading your reply it has made me worry a little. My father who will be 70 years old in January. He has permanent af and is this is controlled by medication. He has been told cardio version and ablation would most likely be unsuccessful. My question is because he will not be having any treatment for Af just controlled by medication, will his heart damage in time?

Many thanks

[BobD Volunteer in reply to JMannion]

OK So a young man then! (Younger than me anyway) Uncontrolled is what I always say and provided that the heart isn't racing flat out all the time then it may take more years than we have anyway to affect it. There is no way of telling really which is why I feel it is important to have occasional check-ups to monitor this mongrel condition. Sadly one often needs to fight for such things.

[JMannion in reply to BobD]

Thank you Bob for replying.

[Vony in reply to JMannion]

I think your dad would be better discussing this with his GP as Bob is not a doctor. My EP is very experienced and has advised me that permanent AF is usually easier to manage and control than paroxysmal AF. Any concerns re.enlargement of the heart would be better answered by a trained medic. A Cardiologist has advised me that for enlargement to occur, the heart has to be tachycardic persistently for a couple of weeks. Which is why with known permanent AF one is loaded up with drugs for rate control. I am only repeating what I have been told in my case. We are all individual and your dad's medical team know the whole picture about his condition which is why they are best to advise you. Best wishes.

[RoyM]

Thank you all once again to everyone for replying. To answer a few questions my AF was picked up in 2009 with a single event resulting in a visit to A and E I returned to NSR without any intervention. Over the years a had numerous events eventually happening daily with heart rate of anything from 100 to 168. I was scheduled for an Ablation in June this year. However, in early March I went into persistent AF and have been do since. The minute I went into persistent AF all symptoms disappeared and my heart rate fell to an average 60-70 bmp. I had a discussion with my EP who felt the risks associated with an Ablation for outweighed the benefits because I wasn't experiencing and symptoms and the whole purpose of an Ablation is to improve lifestyle. My present persistent AF does not restrict me in anyway...I cycle, I walk, I swim. That's the reason I asked should I let sleeping dogs lie and not bother with the cardioversion and the small risk that if I go ahead will it result in a "worse off" situation for me. Even if the cardioversion works when and if I go back to AF will it be worse, when as it is now I live with it without any impact on my lifestyle. Sorry about the long winded reply....just wanted to share my thoughts . Thank you

[Rellim296 in reply to RoyM]

I rather thought that, as Bob says, the main purpose of cardioversions and ablations was to stop the AF in order to avoid long term damage to one's heart and to reduce the likelihood of stroke. Improved quality of daily life is surely a bonus. But I do see the wisdom of not rocking the boat.

[Hidden in reply to RoyM]

Roy, just saw this after my post. Clearly we can all draw on our own experience, but if I were you, I would arrange to see another EP for a second opinion. It is difficult to advise as I know many people with persistant AF who carry on living a normal life.

John

[Hidden]

Hi Roy, I can understand your dilemma and it is difficult to know what to do for the best. You need to check this out for yourself, but a cardioversion literally stops and restarts the heart. Unlike an ablation, there is no "tinkering", so the general condition of the heart remains unchanged. I was told that if I reverted back into AF, it would be no worse than before the CV and that proved to be the case.

There is a lot of uncertainty about the long term effects of AF and a lot depends on your age, but in truth, I cannot recall anyone saying that they wished they had not had a cardioversion. For the patient, the procedure is simple and straightforward and will be over before you know it. The key point is that it will determine if a patient can return to NSR and that significantly helps with future treatment options.

Hope this helps, but please check it out as we are all different....best wishes, John

[Buffafly]

I think you may be confusing Cardioversion with ablation, not the procedure but the effects. Some people do have worse symptoms after ablation than before but a CV can only improve your QOL.

[gateman]

The cv stops your heart. It then restarts naturally.

I would think the worse that can happen is it restarts as it was before. Don,t see why it would change the rhythm.

I had one which did not work in any case.

Give it a go

[whiststev]

Roy ,

Read this quote from Dr Mandrolas 13 things to know about AF

If your AF heart rate is not excessive, it’s unlikely that you will develop heart failure. Likewise, if you have none of the 5 risks for stroke, or you take anti-coagulant drugs, AF is unlikely to cause a stroke. In these cases, you don’t have to take an AF-rhythm drug(s) or have an ablation. You can live with AF. You might not be as good as you were, but you will continue to be.

The CV may well so put you back into NSR ,and no evidence to say it will make it worse .I went into persistent for 16 days until I went on Flecainiade PIP which within 1hr it stopped , which may I add felt great and now I continue to take it PRN

regards

[Dadog]

Life is an exploration; and decision taking crops up all the time. Treatment for AF varies for everybody and so CV has differing results for all. I went a year with AF (they lost my details and forgot about me!). I knew I was in AF and felt it. After my CV I felt so much better and it lasted 13 months. The second CV has currently lasted 22 months and still going strong. I would think, in your case - and as Bob suggests - if a CV doesn't last long, there's no reason why your return to AF should be any worse. There's every reason why your decision should be to go ahead and see what happens! Good luck in your exploration of AF!!

[Stucoo]

Roy,

I was diagnosed with persistent AF in May with the only effect being a reduced exercise tolerance as well as the occasional flopping about in my chest. I work on the 4th floor of a building and walk up the stairs everyday and when in NSR it is easy, when in AF I get puffed out near the end.

I had a cardioversion in July and it was great to be in NSR, however I was on Flecainide to help keep it. I stopped Flecainide in October due to side effects and went back into persistent AF last week. I feel the same as I did in May when diagnosed.

I have considered staying in AF but I prefer NSR, but don't like the drugs. So, like you it is a worry as to what to do.

[RoyM]

Thanks to everyone who took the trouble to reply. I decided to go ahead with the cardioversion. I have an appointment for the procedure on the 20th December. Cheers Roy