Rate Control for Cardioversion?

I have been in persistent Af for almost 3 months with my cardioversion date set for April 13, eleven days from now. On Rivaroxaban as an anti-coagulant. On 120 mg of Verapamil for rate control but no rhythm control prescribed. Some in this forum have stated that a CV will not work without rhythm control such as Amiodarone. Have there been successful CV's with only rate control?

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  • Nonsense. It is actually not that common to prescribe Amiodarone but it can be given to assist the heart to maintain NSR after cardioversion. In fact I do not recall anybody making that statement you mention. Many people have CV au natural and it often works fine even if only for a short while. The whole point usually of doing CV is to see if the patient can a) be put back into NSR and b ) feels better in NSR as this can then direct future treatment pathways. How long that NSR lasts is the $64k question as it is never a cure for AF. Minutes, hours. days or weeks have all been reported and some for several years. As I said, amiodarone is sometimes prescribed in difficult cases to assist the heart but it is not a prerequisite of CV.

    Good luck on the day and try to relax.

    Bob

  • Thank you, BobD. Your answer is most encouraging and it will certainly help me to relax because I am so worked up that it is not going to work.

    Jeanjean50 may come in on this to correct me. I recall her comment as being that her hospital won't give CV unless a patient is on a heart rhythm for at least 5 weeks because they say they rarely work otherwise.

    The one -visit, CV-ordering cardiologist told me that if the CV doesn't work, then the ablation probably won't work. So, now I'm on pins and needles especially since he's probably the one who will be doing the CV. Yes, I will have to relax to counter the negative vibes.

  • The point is not now long it lasts (that is why amiodarone is sometimes given) but if or not you can be put back into NSR even for a few seconds. If they can't revert you at all then no, an ablation may not be worth the effort but so long as you can even for a very short while it is encouraging.

  • My EP never discussed CV. I have read they usually do not last. I've never heard if CV doesn't work, then ablation won't. I've never heard about using ameadarone that way either though I am not expert.

    My EP also said upfront that he found many who have ablation still need a rhythm control drug too.

    Judy

  • The one visit cardiologist stated that the electrophysiology lab would ask why I hadn't had a cardioversion first. So, here on the Canada west coast, I cannot get to an EP without first having a cardioversion. However, I have just come upon " J Am Coll Cardiol 2001 Nov 1;38(5):1498 -504" that has a chart of cardioversion success rate from a trial of 1,838 patients in persistent Af. Basically:

    <30 days

  • Sorry, I hit the wrong button. Basically:

    <30 days 84%

    30 - 90 days 78%

    90 - 180 days 77%

    >180 days 66%

    > 5 years 50%

    So, if I fall within the above statistics, at 91 days I will be in the 77% to 78% category. With the assurance of these statistics, I will now have to concentrating on relaxing.

    From what I have been reading, the duration of how long you were in AF would be a factor in needing a rhythm control drug, as well as other factors such as if all the rogue factors were ablated or if some had reconnected.

  • I can't have rythm control drugs only rate control my cvs have always worked for different amounts of time

  • That's encouraging. I now look forward to a successful CV.

  • It only takes a few minutes I usually have mine in emergency

  • I had CV in Feb. I lasted 11hrs in NSR then returned to persistant AF I only had Apixaban and 2.5mg of Bisoprosol

  • Like myself, you are on rate control and your CV was successful for 11 hours. Now I am feeling most positive that I will have some sort of success. I do note from your previous post that you went into persistent AF on March '16 and had your CV eleven months later--in FEb. '17. Are you now a candidate for ablation? The tone from my cardiologist was that if the CV will not be a success, then I won't be a candidate for an ablation.

  • I have persistent AF. I was told that taking Amiodarone for three months prior to CV and 3 months after gives a better chance of getting into NSR and staying there, but not that it was a prerequisite. 14 months on I am fine, but everyone is different.

  • Did you take the Amiodarone as stated --3 months pre and post? Since CV, are you saying you have been in NSR for 14 months? How long were you in persistent AF before CV? Your case is interesting since 14 months appears to be a long time to be in NSR from persistent compared to most.

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