AF Association
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Failed Cardioversion -what next?

Cardioversion done on 16 Feb just short of a year since AF diagnosed as result of TIA. Unfortunately AF returned on Thursday so now feeling pretty negative about what happens next. Suggestion that might be attempted again but only if taking Amiodarone which fills me with dread. Has anyone gone on to have second cardioversion which lasted for a few months without use of anti- arrhythmic? If on Amiodarone was this only for a short period of time? I like to exercise regularly and would love to get back to doing level of walking/ cycling which I did prior to AF. Am currently on Bisoprolol which may not be as effective any more and wonder also what drugs have worked best for others as alternative to further cardioversion. It seems I may not be suitable for ablation due to level of left atrial enlargement.This forum has been an integral part of my AF journey over the past year and I’ve been helped greatly by sharing in other people’s experiences. At the moment I feel the failed cardioversion has knocked back the progress which I have made with the help of this forum over the past few months.

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I would discuss other meds if you are really unsuitable for ablation.

If you would like the scoring system we were shown at a recent support meeting, do PM me with your e mail address. It allows you to work out the chances of successor ablations for persistent AF

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Thanks Rosy would find this helpful- first time post so hopefully can work out how to PM!

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I was in persistent af for six months. After a first cardioversion that lasted a few days I had a second one a month or so later. The second time I took flecainide for a few weeks before and continued after, and that lasted for a few months before occasional episodes resumed.

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Good to know there may be alternate options to Amiodarone and that this may work- I’m also in persistent AF.

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First cardioversion lasted 6 months thanks to amiodorone, but I'll never take that again.

Second lasted 3 months, third lasted 3 weeks etc etc.

My left atrium was also enlarged because of AF. Since ablation it's gone back to normal size thanks to being in NSR

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Reassuring to hear thanks

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I have had 7 of them lasting from a few weeks to a few months have now had a cryoblation

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Thanks.Were they done quite far apart and without any additional drugs being given?

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The shortest time was 2weeks I can't have the drugs as I have LQTS

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Hi lindat, has you EP said they won't do ablation? If so I'd probably get a second opinion.I'd definitely think twice before starting Amiodarone. Especially if cardioversion is only going to last a month or two. Personally I think I'd get ablation if at all possible. Probably your best chance to get back to where you were before AF. Try to keep your chin up and not worry to much.

Best wishes, Shaun

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Suggestion was that it was borderline on wrong side of what the local guys will consider suitable for ablation. Prob due to success rate. A second opinion would do no harm. Thanks for words of encouragement Shaun

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I have had 12 DC cardioversions over the coarse of 3 1/2 years. The first 2 did not convert due to the wrong drugs used. The 3rd one worked for 22 months with propafanone. I refused amiordarone twice and finally took it a month, that will not happen again. I developed breathing issues while in NSR, never ever had those issues while in NSR. Also ears ringing and my glands in my neck felt like I had the mumps. I had a partial ablation Jan 05, am taking low dose of Flecainide 50mg every 12 hours, have taken it before and worked great, no afib. I would get second opinion about ablation, my heart had been enlarged from persistent afib and now it is normal after controlling the afib. Amiordarone was the last drug they tried me on before ablation, I was determined not to take it.

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I too am in persistent AF so helpful to hear your story . Makes me feel a little more positive -thanks

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Good news is that you can convert to SR so are suitable for ablation. L.A. enlargement is common with AF so yes get a 2nd opinion. You are on a journey with AF not a sprint so take a breath and go with it with the forum as support. Good luck.

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Yeah I did feel positive when it worked initially so good to hear this can indicate may be suitable for ablation. Patience has never been my strong point but you are right that it takes a while to get there- the forum helps keep sight of that- thanks!

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Hi there , I have never taken amiodarone , but I to had an enlarged left atrium and had the cryoablation procedure done 👍🏼 same hospital as mikee.

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Good to hear it’s working for you Sam. Which hospital and did you go private or NHS?

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Yes it was NHS and glenfeild heart and chest hospital in Leicester.

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I would be trying to find answers to

1. Does "unsuitable for ablation" relate to chance of success, or the reluctance of an EP to ablate after a previous TIA?

2. How long will I be on Amiodarone after the next DCCV, and to what purpose?

3. Why am I taking Bisoprolol, being in persistent AF? Is it limiting my ability to exercise?

4. Why is my left atrium enlarged - hypertension, endurance exercise, burden of previously unsuspected AF?

5. Is pace and (AV node) ablate an option if standard ablation is unlikely to work?

Opinions will vary between individual cardiologists, individual EPs and across the disciplines. I would pay for a one off private opinion (without any private investigations which cost a fortune if self funded) from an experienced cardiologist who will tend to give a conservative view, and separately an experienced EP at one of the top half dozen teaching hospitals across the U.K. Private simply to speed up the process, out of area NHS referrals are an alternative.

What is the enhanced quality of life you are looking for, how do you see life with AF? Generally it does not prevent normal healthy exercise, as opposed to unhealthy endurance exercise. Many live good productive lives with permanent AF as long as they take an anticoagulant.

My instinct is that you will choose at least one ablation, it's a pretty safe procedure in the hands of an experienced conservative EP, and you will regret not giving it a go. If it doesn't work, it's not the end of the world.

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Thank you for such a comprehensive response Oyster. Will help me put together points for discussion at my next appointment with possibly a second opinion via a private consultation.

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Oyster suggests asking some very pertinent questions - knowing what I now know - that’s the tack I would take.

Best wishes CD.

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Thanks - will def use the info which all of you have been happy to share

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I have had 9 cardio versions and a number of ablations but in my early years I had AF with no treatment at all due to miss information from my GP at the Time. But I was still working and teaching as a 3rd Dan Karate instructor. I was diagnosed with AF in 1992.

It was not until other conditions compounded my way of life I had to give up work though ill health in 2012. I am not just a AF sufferer, so not a benchmark to look at. Do not let it control you. Oyster has it spot on in my opinion.

Be Well

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Thanks - it’s amazing how many cardioversion/ ablation that many are able to have. Presume this was all on the NHS? I feel a lot more positive .

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Yes all NHS and have no complaints with the way I have been dealt with at all. Multi conditions are not helping my treatment and a few allergy's have not helped my case at all?

My biggest issues have been my two main conditions are my heart and lungs which act in a different way to drugs they are meant to treat. I am now waiting for an assessment for my Pulmonary Hypertension in Sheffield in March.

Be Well

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That must be really tough for you. Hope your next appointment come up with some answers and a way forward. Take care.

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