Hi all, I'm new to AF and this forum so apologies if anything I ask has already been covered but I'm after some advice about what to realistically expect post cardioversion please?
I'm 38 and been diagnosed with AF in April. Prior to this, I was very fit and active having participated in sports of some kind for years, approx 5 times a week including running, cycling and judo. The symptoms first became evident during a run and I have been in constant AF since. I have been prescribed Bisoprolol 3.75mg and Apixaban 2x5mg in preparation for CV and am on a waiting list.
Since being in AF I have suffered from shortness of breath, fatigue and dizziness which have improved slightly over time but some days are better than others. At its worst climbing a flight of stairs leaves me out of breath at the top. Having stopped all exercise too, I realise how much time I spent doing some sort of sporting activity!
I work for the emergency services and my breathlessness issues combined with the meds has meant I am unable to perform frontline duties. I'm currently office based and on reduced hours while I await the CV.
I appreciate these questions are very bespoke to me but any advice is gratefully received!
Is CV therapy likely to improve my breathlessness issues and general feeling of fatigue? I've been told I need to take the anticoagulant for a month post procedure but am I likely to continue taking this for the foreseeable future? I have read of people's experiences of exercise triggering AF, but does anyone exercise in any way whilst in constant AF? Has anyone experienced breathlessness on a similar level and have any success in changing it?
As you can imagine I'm feeling quite frustrated and a little lost going from being an active person to one who struggles with fatigue after a walk! Not only has this affected my day to day activities, but it's also having an impact on work too. Thanks for reading!
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Noxof
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Hi Noxof, you seem to have had a similar experience to myself. I’m 34 now and in hindsight probably had my first AF experience in my late 20’s. At the time I played football 5 days a week and would consider myself generally active and fit. The first time I was officially diagnosed was just over a year ago when I went in to permanent AF. Like you I was on thinners for a month prior to CV. After the CV I switched to 50mg flecanide twice a day and 1.25mg bisoprolol. I made some minor lifestyle changes I.e cutting out caffeine but that’s about it. I returned to exactly the same active lifestyle shortly after and didn’t really notice much difference in my performance. Then back in January this year my AF came back. I took an extra flecanide and went back into a normal rhythm. Maintaining the same medication all was good until early last week when the same happened again. I’m now taking an extra flecanide tablet in the morning and I would say this seems to have slowed me down a little on the playing field although it’s early days yet. Everyone is different but from what I’ve read for most AF seems to be progressive. I’ll see how long I get on an increased dosage and if that doesn’t work then I’ll investigate down the ablation route. I would say that pre cardio version you will probably feel crap despite any medication. I worked the month leading up to my op and like you climbing each set of stairs was a personal triumph 😂 afterwards will be much better. I would caution that even when back to supposedly normal another challenge that you may face like myself is the mental impact. I don’t think I’ve gone a day since my diagnosis without checking my pulse and it’s never far from my thoughts. Best of luck for your procedure 🤞🏻
Thanks Ross, really appreciate your reply. I think you're right, the mental side of things and change of lifestyle, as a result, will have an impact. I often pushed myself hard when training and may have to accept that I won't be able to in the future.
DCCV should put you back into NSR even for a short while and if so you should feel better. It is not a cure for AF but can sign post other treatment if your quality of life is improved.
Are you in the UK or the states? Drugs are available in the U.S. that can convert afib by themselves or make it more likely that a CV will result in prolonged NSR. In any case an anticoagulant would be prudent because of the risk of stroke. Different combinations of drugs can be used to increase the chance of staying in NSR after CV.Hopefully you are able to see an Electrophysiologist who would have the specialized knowledge to help you on your journey. Best of luck.....🙂
Hi Etheral, I'm in the UK. I've been told my risk of stroke is low at my age even with AF as I don't have other contributing risk factors such as age, weight or other health/ lifestyle conditions. Thanks....
Neither persistent nor permanent AF are necessarily a bar to cardio training. Guidelines are vague about maximum rates during exercise. The dose of rate control meds like beta blockers and calcium channel antagonists are adjusted for rates at rest and during exercise.
I have permanent atrial flutter with 4:1 conduction and have to be careful not to push too hard and induce 2:1 conduction [140 vs 70 bpm] which can then continue for several hours.
In your current situation, you need to talk to your GP for advice about what would be safe levels of exercise specifically for you, while waiting for the cardioversion. Any idea when you are likely to have this?
If you have not seen a cardiologist, consider a one off private consultation with an electrophysiologist who may suggest that at 38, an ablation is your best way forward.
Should get an appointment in 2 weeks, will cost around £200. Revert to NHS for further investigation (private tests are very expensive). Ask the secretary to get your NHS notes.
Maybe you could ask your GP to get your DCCV date brought forward, once the regulation 4 weeks on anticoagulants is up, so you can get back on the front line.
Unfortunately, my hospital has temporarily suspended CV procedures while they move locations. Should take another 2 or 3 weeks before they restart. I have also found out that I'm 18th on the waiting list with the hospital conducting 4 a week, hence a rough guess of 8 - 10 weeks.
I will look into the electrophysiologist idea, thank you.
I went through the same as you last year from a similar background situation. Will try to answer each of your questions in turn. Don't worry about the feeling of breathlessness and fatigue, they will disappear after the CV when you will feel much better almost straight away. Post procedure I was kept on the same meds as you for a month until I saw the cardiologist who then stopped them and I have been fine ever since and been able to make a phased return to previous levels of exercise. I too would get out of breath prior to the CV from just climbing stairs and the bisoprolol exacerbates the feeling of fatigue also. I would not do any exercise whilst in AF and the reduced hours is a good plan.
As Ross mentioned the mental effect must not be underestimated both now in terms of the despairing feeling of having lost all fitness and then the constant pulse checking when you return to exercise but stay positive; you can make a full recovery.
Best of luck for the CV and hope you haven't got too long a wait.
Thanks Marathonrunner, that's really encouraging to hear. Do you still have to make adjustments in exercise intensity and duration? I'm thinking that my expectations of what I can achieve compared to previously will have to be changed - no more going for a PB just be happy to take part perhaps!?
One step at a time but a year on I'm back to same duration and intensity and back to racing. Have made other adjustments along the way but hopefully PB's still to be had.
Hello Noxof. I’ve had AF for 9 years and it is now classified as persistent. I was taking Bisoprolol for several years until the dosage was increased to 5mg per day. I don’t get side effects from medicine but I had to come off Bisoprolol because of tiredness and lack of energy. I feel much better for it but, of course, the AF remains so I take apixaban and will have to take it for the rest of my life. I also now take a statin to reduce my cholesterol level. I really hope the cardioversion works for you but be mentally prepared also for it not working. In your favour , the AF has been picked up early so that will improve your chances of success
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