I have been free of unstoppable AF for two years, since an electrical cardioversion. I had not heeded the warning signs: several incidents in the last few weeks of Classical Tachycardia. Usually when relaxing in the early evening, perhaps tense, irregularities build up, and the heart suddenly starts racing. I have learned to take prompt action, well known on this forum, the tricks, + Flecainide. The target is the irregularities, deal with that, and rate goes suddenly to normal. So, I should have been taking Flecainide as prophylaxis.
Well, Friday, the real big one hit me, 5pm right on time. Nothing worked. Started at i130. Bisoprolol got it down (good news). The fast rate became irregular. Tried various combinations of Flec and Biso on Saturday till Sunday morning. Then decided, no medicine was best, so the doctor would have a clean start.
Sure enough, during the night, I noticed the rate suddenly went back to normal. I heard the irregularities (one advantage of having a mechanical heart valve) increase again, whereas usually after a tachycardia, it is quite regular and weak. So, you guessed it, Mr tachycardia restarted, this time at 155. Well, at least my theory of how this happens was confirmed in my case.
I saw my Cardiologist 4pm Monday. He then suggested something I have never heard of, and never read about: try conversion with tablets of Amiodarone. Hit it hard, with a bolus of 1200mg, taken orally. All the medical stuff talks about intravenous which is risky. He said I could do it at home, but better in the 'Clinic' so that if something happened, emergency help was at hand. I am glad I opted for the clinic. During the night I observed, made my own notes. It took around 6 hours for the rate to come down, and being night time, it went to the normal low rate of <60. Then, irregs fought back. Slowly I saw the rate increase so that by 10am it was 130.
Doctor saw me. Evidently there was a battle on, and Amiodarone had had some success. He proposed one more attempt. This time 800mg in one go, and, since I obviously survived low blood pressure etc I could go home. I also thought that movement would help instead of being tied to a machine.
Went fasting Wednesday, 830am, for a full 12 lead ECG, prepared for electrical cardioversion. At 930am the doctor asked me: are you ready for the shocks? Then he smiled, and gave me the shock news, I did not need the electrical shock. But, the situation is still very fragile. I had to stay on Amiodarone for a month. 400mg Monday to Friday, then the weekend off. I reasoned back: I had the evidence in my bag: Flecainide is the best for post-op treatment. He said, loads of people are on Amiodarone, the side effects kick in after 6-9 months. I reminded him my Thyroid was getting bad after only 3 months last time, (and I knew that because of my diligence in getting a test earlier than usual). He said, you know you can last 3 months on it, so what is the risk of 1 month? Also, if I have to come back for the electical cardioversion, Amiodarone is in my system as a help. Powerful arguments.
He explained, he preferred Chemical methods to the shocks. He preferred to try these first. Eventually, no method will work, but right now the chances of significant delay are high.
Today, I am glad I followed his advice. I hesitated, took meds at 2pm, went for a siesta. I noticed at 4pm the irregs were fighting back, then had that sudden 'click' like the end of tachcardia.
Curiously, despite resting, right on time, 6pm suddenly felt the warning signs again, so, back for another short siesta. Maybe tomorrow I should be busy in the garden, or busy doing some manual work, since mild exercise helps maintain sinus rhythm.
In conclusion. Maybe this is a French way of doing things (I am in Tunis). I provide this, so that others can negotiate with their doctors. It was certainly new to me.