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AF Association
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Cardioversion

Hello there, my wife has a/f and her body doesn’t tolerate it too good as she gets short of breath on exertion and stairs can be an issue, she is 50 years of age.

She had a successful cardioversion 10 months ago which lasted for approx 7 months in which time she felt fantastic, she went in for a second cardioversion last week but after 3 shocks it failed and they sent her back home.

We went to see the cardiologist this week and he has suggested maybe 1 more try at cardioversion and if that still doesn’t work maybe ablation or just to live with a/f.

Just wondered what peoples thoughts were on failed cardioversions and ablation, she is scared to death of hospitals and the thought of ablation sends her into panic mode.

Any thoughts or advice anyone can give us would be amazing.

Thanks in advance.

UPDATE :- my wife’s medications are rivaroxaban, bisoprolol, amiodarone, furosemide and amlodipine

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There are lots of people here who have been through ablation (I've had 4) and several fact sheets/people's experiences to sift through so she isn't on her own there.

They do say the more you have a cardioversion the more they are likely to fail - I've had 22 and they plus meds only seem to keep me in NSR for a few months.

Is she on any medications? Have they tried changing medications or doing chemical cardioversion to revert her?

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Hi there, yes she is on the riveroscopan (forgive me i cant remember how to spell the name without going into the kitchen to look at the meds) then a recent introduction of amioderone plus a couple of high bp meds and frusimide.

Thanks for your help and advice on this, we are both quite new to this subject so all the help and advice is greatly accepted, Richard.

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Not sure what chemical cardioversion is. I assume they use medication bit isn't that what her amiderone is supposed to do? Curious?

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IV Flecanide usually, infused over an hour.

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yes, I was offered IV Amiodorone as a chemical cardioversion, refused it though

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I was given Adenosine very effective and quick though does make you feel like you’re dying (because I believe it works by temporarily stopping the heart).

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Hello Richard, it is generally recognised that a CV rarely provides a long term solution to treating AF but if it has worked well for 7 months, that would normally suggest that your wife is more likely to respond well to an ablation. I'm not medically qualified therefore cannot comment on why the second was not successful and whether or not that will have any impact on the success of an ablation so that may well be a question you can ask her EP (Electrophysiologist - a cardiologist who performs ablations).

There are many forum members who share your wife's fear of hospitals and having an ablation but from the posts we receive, almost all that have taken the plunge do not regret it.

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To be honest one has to question if a cardioversion failed then would ablation be any more successful ? I am a great fan of ablation but one does need to have realistic expectations. Maybe a third attempt assisted by drugs such as amiodarone would help sign-post future treatment.

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Hi bob the cardiologist put her on amiderone a couple of months ago after she reverted back to a/f, thanks for your advice i am after as much help and advice as possible on this so thanks very much for taking the time to reply to me, Richard.

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I agree with BobD BUT PLEASE do research, talk to your cardiologist and/or doctor and understand what the effects of amiodarone can be. I know not everyone is the same but this is real nasty drug. Please just be aware.

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I am really worried about this drug now, until being on this site I didn’t realise how dangerous the drug actually is.

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amiodarone can be a help very short term, may be between cardioversion and ablation. I was on it for 5 months and it did me no good for the afib and I now have tablet each day for hypothyroidism. Caused by amiodarone.

Please check with your doctor and/or cardiologist and also if you search amiodarone in the box at top right it will give loads of information.

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There is a Facebook group on this

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Don't panic. I've also been on it, short term (a few months) and I am fine.

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When my cardioversions failed I was on amiodarone. My EP kept me on it until the ablation. My ablation has been successful and was from the moment he did it although to be fair he took his time over it - more than five hours. I even joked afterwards that he would not let me out of theatre until I was in NSR. So far I have been very lucky and not even had any ectopics.

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Hi Richard, if you can, I think I would ask your wife if she would consider seeking the opinion of an EP = Electrophysiologists treat heart arrhythmia's and other heart rhythm disorders. These can include irregular heartbeats, including instances where the heart beats too quickly (tachycardia), and when the heart beats too slowly (bradycardia).

As you probably know taking a medication like Amiodarone is not a long term solution and as your wife is quite young this may help give your wife more choices.

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Thanks Micky that’s what the cardiologist suggested yesterday so that’s the plan b if the next cardio version doesn’t work, I am really hoping that the next cardio version may work for her

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It might be worth a private appointment with an EP to speed things up as it is not good to be on amioderone for more than a few months.

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Does anyone know the effects of being on amiderone for more that a few months you got me worried now.

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Hello Richard and welcome to this forum where you will receive a lot of good advice from people who have lived with AF for some time.

We are all different in the way that we respond to treatments and medicines and can only base our responses on personal knowledge rather than medical know how.

I'm sorry the aversion didn't last. Unfortunately they don't always succeed and some people will have dozens to help them through their journey.

With regards to ablation, again there are no guarantees but I had mine in June last year and 7 months on I am still in NSR. My problems are a lot more complex as I also have heart disease so I take a plethora of meds too.

Please research Amiodarone very carefully. It did not agree with me and caused problems with my thyroid, liver and kidneys. I will take thyroid tablets for the rest of my life, the side effects of these have caused my hair to thin and break. Amiodarone is no longer the drug of choice as others which have fewer side effects are being prescribed.

As suggested a private visit to an EP may help to put your wife's mind at rest re the ablation.

It may also be worth asking for a blood test to check potassium and iron levels. From personal experience if I am deficient in either of these, my breathlessness and fatigue increases.

I hope that your wife's quality of life gets better; she is very fortunate to have the support of a good man.

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Thank you so much for your kind words, I am now extremely worried about this amiderone drug, we are going for one last cardioversion then we will do the ablation i think and maybe see the consultant private, i really need to ask about this drug as i am worried now and do not want my wife having any more long term problems as she has enough on her plate with the a/f, thank you so much for your help and advice it’s very helpful to us.

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There are loads of threads on this subject here. The middle path seems to be

1/ Get your baselines for lung function and thyroid measured before you start

2/ Act quickly to do with lungs if you suspect anything.

3/ Check thyroid regularly. Some say every 6 months, I prefer more often.

4/ Check drug interactions, especially if you take warfarin.

Side effects such as easily sunburnt, and thyroid problems tend to kick in after about 30 grammes, so this is your rough guideline when to ask to stop it. But thyroid can kick in earlier.

There is plenty of evidence that a CV done while on amiodarone is more likely to succeed, and amiodarone is good at keeping the lid on things in subsequent weeks, bearing in mind that the longer you stay in NSR the more likely you are to stay in NSR. ie, failure tends to happen early on, hence the use of amiodarone as a lid on it.

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Thank you so much for your help, we are due to go to India next month so will have to watch the sun with her, but i will keep a close eye on things with this amioderone drug, its a good site this is with so much help and advice.

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Can you sort me out a caravan before you go? I did ask last year for availability ;)

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Hi. After failed cardioversions I had an ablation under GA. I too was nervous but so pleased I had it as so far so good. It is a decision only she can make but it might be worth looking into whether she would have it under sedation or GA. Good luck.

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Hi I'm a failed cardiovetsion a d ablation patient. I opted for medication instead and got rid of the amiodorone as I felt it was very toxic. 9 years later I'm still going strong lol I struggle with hills but I get there I swim I work full time and am a gym goer. I'm a similar age to your wife. Lots of choices but feel sure she will make the correct one for her

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Glad to hear you are doing well and i have a feeling my wife will go the same way, was it your choice to ditch the amiderone or did the doctor say enough was enough with it ?

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It was my choice to come off it. I did my reading and looked at my lifestyle and it was a no brainer for me. I love being outdoors in the sunshine to start with lol . No One argued with me, they changed one of my other meds and it has been like this ever since. I get tired but everyone gets tired I just plan my days accordingly.

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Hi Richard, I'm 55 and have had 2 cardioversions now. The first lasted about 6 months I went back into AF because of my own stupidity I believe. I decided against an ablation and had another CV which has now lasted 9 months and counting.

My preference will always be the minimally invasive/extreme procedure if possible, and on that score the CV wins hands down. However if they don't work then clearly you have to look at ablation or some other treatment recommended by your doc.

Finally, I think it's important to understand triggers for AF and specifically your wife's. They are not the same for everyone. No treatment will help long term unless you make the necessary lifestyle changes and respect the condition.

Is it an option to try another CV, having possibly made some lifestyle mods and see if it works?

Finally, the usual disclaimer, none of us are doctors and can only give you our views and experiences. Your EP is the expert.

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Hi there i am really interested to hear about the triggers, could you maybe list a few as I know alcohol is one but not sure about the others, my wife swears that hers flipped back into a/f after i startled her one night when she was asleep in bed i came in and turned the tv on which it came on at full volume, she almost jumped out of her skin and she is adamant it was that causing her to flip back into a/f, what do you think ?

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Common triggers (bit late) are stress/shock, alcohol, too much caffeine, stimulants in cold meds etc, NSAIDs eg ibuprofen, dehydration. Lifestyle changes to stay in NSR - don't smoke or drink alcohol, lose weight if necessary and follow a mainly plant based diet, try to avoid stress and get enough sleep........ remove telly from bedroom ?

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Hi Richard.

All I can say is that I have had two Cv’s and <touch wood> the second has been very successful, 8 months of NSR no AF at the moment.

What I would question is your wife is only on an anticoagulant? Or is she on amiodorone (which is a horrible drug) too?

I take Apixaban and Bisoprolol and get by ok but feel sluggish all the time.

If so I would really recommend seeing her doctor and changing the amiodorone.

My Consultant is insistent on my having an Ablation even tho at the moment I’m fairly stable.

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Hi there yes she has recently been put on amiderone which i am learning from this site that its such a dangerous risky drug so i am panicking now as i really dont want to cause her any more problems as she has enough to deal with, thanks for your advice its really helpful and i am so glad you are ok.

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Good Morning, sorry to hear about your wife. I would try another cardio version but perhaps try some deep breathing exercises to calm down a bit. I have had five and one ablation. Found amiodarone very good but they took me off them after ablation in 2013. I think that anxiety cause a lot of AF. I lost my hubby and went back into AF in 2016. They put me on it as a pill in the pocket but it did not work then I was in and out of hospital and they put me on flecanide 100 mg twice a day plus my bisoprol and obviously blood thinners. I could not walk far at first, cant lose any weight (flecanide) but now 12months or more later I swear by it. I am really well. What I,am trying to say is give tablets time to work albeit a few months she is quite young, she may be able to nip it in the bud by changing her lifestyle. Bit more exercise change her diet cut down on alcohol. If you ask any of us old timers we all think something triggers AF off. Write down everything that she eats, then when she has a turn she might be able,to see what has caused it. Spicy food, too much chocolate, definitely caffeine. Sorry to have gone on so much. You look after her, all the best Gilly Bean.

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Hi there thank you so much for your advice that information is so helpful especially the triggers as we do have a lot of spicy foods, we have chocolate and alcohol but not that much, we have recently started slimming world so we are trying to loose weight but as for excerise my wife struggles as she gets easily short of breath so can not face exercise at all.

I am hoping that with the slimming world and the healthier life style that will go a long way to improving things.

Sorry to hear about your husband life can be so cruel at times but hope you are managing ok.

Thanks again so much for your advice, this site is fantastic and so friendly and helpful.

Richard.

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Hi there, I started slimming world 1st April 2013 Straight after ablation. I had been on amiodarone for about six months. But they stopped all my medication. Anyway Iost three and a half stone. But two years later due to hubby I had a very bad year. So have put it back on. I still do slimming world it is a way of life to me. But I just can’t lose,any weight, I swear it is the tablets. Still i am well. I have three dogs which keep.me going the one is telling me now,she wants her walk. Let us know how she gets on. Gill

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Thank you i will do

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Hi Richard

Just read all the replies to your post, only one thing to add, I too became very breathless while on several drugs, in the end figured the worst affects were from Bisoprolol, changed to Nebivolol and pronto things became a whole load better.

These drugs are all powerful and different ones suit different people so worth trying to change, but do give them time to work.

Since feeling better I have also returned to the gym, carefully goes, walk everyday and eat a very healthy diet , lots of fish and managed to lose a bit of weight, all helps.

I am still a bit breathless but nothing like before and now at least have a lot more energy. Hope this helps and good luck, she is a lucky lady having a husband who is involved and helping with the research, there is a lot to learn and knowledge is power.

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I had an ablation to get off the drugs, 11 months without AFIB so far , No drugs since the 15th May.

The ablation was not a big deal. No need to panic over that, I would have another tomorrow to keep off the drugs. I am 58, i do not want to spend any more time breathless or with drug side effects.

I have never had an electro cardioversion, but have been cardioverted by flecainide infusion in my local hospital CCU. Perhaps that is another short term option your wife could discuss with herr medics?

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Cardioversions are usually a temporary fix. Ablations are quite routine & no big deal, as they are the specialty of the electrophysiologist, who has done hundreds, maybe thousands of them. They are usually a permanent fix, but sometimes require a 2nd one. I needed a follow-up one 15 months after the 1st. They gave me odds of AF coming back after the 2nd one at 20%.

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Hi Richard you mentioned your wife’s cardiologist but I did not see mention of an Electrophysiologist. My cardio conversion didn’t work with my cardiologist but whenI went to see my EP he did put me on heavy dose amiodarone and heavy dose magnesium, hit me once and I went into steady sinus rhythm and have been in rhythm for almost 2 yrs. If you are in the US and need the name of this wonderful and caring doctor let me know and I will post it. He works out of NY and NJ. Much luck to your wife this is a horrible thing to go through and I hope she finds a happy ending

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Hello there we are in the uk I am afraid !! Our cardiologist says our next step after the 3rd attempt of CV is to book in and see an EP.

Thanks for all your advice I am really hoping this 3rd attempt does the trick, glad you are ok and still in SR

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Richard I forgot to mention that amiodarone is a wonderful drug for treating afib but side effects are terrible. I now have hypothyroidism thinning hair and neuropathy and cardio conversion is not a temporary fix. My Electrophysiologist is the he’d of 2 prestigious medical centers in the US and never gave me a hint of this procedure being temporary so all my best to you and your lovely wife

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Try taking magnesium (research on here for details) eg magnesium taurate or citrate, but not magnesium oxide, providing you do not have problems with your kidneys. Take it for at least 6 months. People with AF (and many others) tend to be short of it, and putting that right may well help the other treatments to work better.

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Don't now why your wife is on amioderone as it used to stop going back into at so it hasn't worked so I would stop taking it. it is a dangerous drug that wrecks your thyroid so be careful.

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I meant Af

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