Discharged by EP, but puzzled.

Dear All,

3 weeks ago, I had a DC cardioversion (first time). I was fine for about 3 hours - sinus rhythm - and was allowed to go home. However, in the taxi, my heart began jumping all over the place, and I had a bad night. Things settled back to my normal AF, but I didn't contact the arrhythmia nurse as I was due to see my EP. To my surprise, he said there would not be much point in having an ablation, as "they are only about 50% successful, and have some risks". He didn't suggest trying another CV, either. I wonder if my age (76) has anything to do with it? I assume the fact that I said, apart from bouts of lethargy, my current quality of life is fine, probably helped.

I was absolutely delighted, as I hate the thought of any 'interventions', but I'm puzzled, as I thought of the many friends here who write of having had several CVs and ablations. I'm still on a Beta-blocker (Atenolol), and an anti-coagulant ((Rivaroxaban). (By the way, I feel so much better on the latter, especially as I don't need those horrible Warfarin blood tests!)

I should just trust the expert's judgement and be grateful, but I wondered if anyone has had a similar experience, and how it's been for you.

Love to all,

Pat

[BobD Volunteer]

Hi Pat, the important thing to remember is that any and all treatment for AF is only ever about improving quality of life (QOL). That your DCCV failed so quickly would suggest that ablation may not be successful and since however safe there is always some risk in such procedures one must question the wisdom of going that route for what purpose? If your QOL is not unduly disturbed by your AF it becomes a risk benefit equation heavily weighted on the risk.

If you are badly affected by your AF events then the equation is vastly different. And this please note from a great advocate and fan of ablation.

[Bahman]

Hi Pat , I too have just seen my EP . I have now been in AF for two month . Some eight month ago my EP had offered me a cyroblation which I delayed partly because I was not sure of having one and also had to have double hernia operation ( by the way I am 72 years old) , a good excuse for delaying the ablation . However in the mean time I have gone into persistent/permanent AF. The EP thought that there would be no benefit in having a cardioversion as most people revert back to AF very soon at the out most within two years. As for ablation my choice is now only via catheter ablation and the chance of success on the first round is only 50% and operation time much longer. Also , as Bob has pointed out , he did not think that the risk in my case is worth taking since I am asymptomatic and have had other heart issues in the past. His only suggestion is for me to change my Metoprolol to Bisoprolol as the latter is once a day table and has a better heart rate control ( I only hope that I don't have adverse reaction by changing medication !! ) . Further more he wants me to have a 24 hour monitor once I have been on the latter beta blocker for a week or so , and then see me with result in hand .

ps my resting hr now is 70-80 , it was 50-55. During gym excersise it fluctuates between 130-160 hbm.

[Hidden in reply to Bahman]

Hi Bahman,

Sounds as though your EP thinks like mine. Why not try the Bisoprolol and the monitor, and see what happens. If you are managing to do gym exercises, you are doing well. Good luck!

Pat.

[cuore]

I am 74 years old, and had an ablation in Bordeaux, France on July 3, 2017 -- a little over two weeks ago. Although I had been in persistent AF for almost six months, age was not a factor. I did have in Vancouver, B.C. Canada, a cardioversion which lasted half a day on April 13, 2017, but the purpose was to see if my heart would return to normal sinus rhythm. Yours has also, albeit for three hours.

My medical report reads, "She had no complications." I attribute this outcome to the excellent skills of Dr. Pierre Jais who performed the procedure.

[Hidden]

Hello Cuore, I'm assuming that your ablation has been successful so far. Hope it continues! My EP was uncertain about the success of a CV, but just wanted to know whether being in Sinus for even a short time improved my QoL sufficiently to move on to having the ablation. I'm not sure whether I was able to judge, as I'm sure I was still recovering from the 'knock-out' gas. I returned to AF in under 3 hours. Nevertheless, I don't feel my normal QoL (in AF) is too bad, so I'd rather not try the ablation. Many thanks for writing to compare your experience. All the best,

Pat xx

PS I'd be interested to know if anyone else had a similar event to me during their CV - I had gas, (like the old dentists used), and felt nothing, but I vividly remember jerking upright and then lying back again whilst I was 'unconscious'. I had 2 shocks but only remember doing this once. It caused no pain.