CV v PiP.......

I’ve often wondered but never thought to ask......apart from the process itself, is there any difference between being reverted back to sinus rhythm by taking a PiP such as Flecainide or having a Cardioversion and is one likely to last longer than the other?

[Frances123]

Good question. I guess, as long as it’s successful, then cardioversion is more immediate(once awake) where as pip can take a couple of hours. I have no idea but wonder is being shocked has a stronger effect on heart and may last longer. Would be interesting to know. xxx

[Hidden in reply to Frances123]

Yep...my thinking too....

[BobD Volunteer]

Both count as cardioversion but one is chemical and the other electrical. Also with DCCV you can increase the number of joules given if the first bang doesn't do it. I have cardioverted with a very large dose of drugs but not flecainide apart from after my last ablation when in my EPs words I had " a shed load".

[Frances123 in reply to BobD]

Hmm, that has reminded me Bob, when I started my Afib journey 15 years ago I was seen in MAU by a cardiologist who prescribed Flecainide by IV. Bed had to be next to nurses station so they could keep an eye. Thought they were just being nice and had no idea it was because of IV flec and possible side effects 😬. I was back in NSR in about 10 minutes before drip finished. Remember munching on sandwich at same time. As I tolerated it I was discharged next day and been on tablet form (lowest dose) since. xxx

[pottypete1]

I have experienced both FJ but cannot recall any difference in the time scale afterwards.

Pete

[heartmatters1]

When I had my first episode 5 years ago, & went to A& E, they scheduled me in for a cardioversion later in the day, but they tried Flec as intravenous first. Fortunately, it worked straight away & cardioversion was cancelled. I was discharged next day, & have had Flec as PIP ever since. They both have their place.

[Buffafly]

Is digoxin also used for chemical CV? I was given a big dose of digoxin but not told if it was to reduce rate or restore rhythm or both.

[Bagrat in reply to Buffafly]

I have had 3 visits to A and E. My first ever AF episode I think I got bisoprolol and the dreaded amiodarone with no effect. There was discussion round a second dose of amiodarone but I would have had to have a central line in according to protocol so I was cardioverted later that day.

Second time I think they tried amiodarone again no immediate effect and sent to CCU to wait for cardioversion but reverted spontaneously. 3rd time reg on duty chest physician didnt like amiodarone so had digoxin. No effect. Reverted spontaneously a couple of hours later on CCU. When I saw consultant he said all the drugs used help keep you in sinus rhythm for various reasons but rarely convert you back which is why I was classed as spontaneously reverting.

[Buffafly in reply to Bagrat]

Interesting, I was told the Digoxin would have an effect after 2 - 6 hours so if I reverted before that it was nothing to do with the Digoxin, not sure if after that window applied as well. It was clear they didn't expect Digoxin to do anything dramatic as I was immediately booked to be admitted but there was no bed available 🙁

[irene75359]

I use flecainide as a PIP and that works just fine, normally within a couple of hours. I am assuming that drugs have failed for those needing an electrical cardioversion. It always concerns me when I hear how long some people have to wait.

[Hidden]

No difference in my opinion.

However, for me DCCV has always worked first shock at the lowest setting. Chemical has about a 50% chance of working for me.

In A+E I think they prefer to try chemical first, I'm not sure if the risk of stroke is lower or it's just easier as no anaesthetist required, they can just put the flec/amiodorone/whatever in IV and get on to the next patient

[Enjoy]

I told the A&E doc last friday that digoxin converted me last time and she gave me 2 tablets (not sure of the strength) and in about half an hour I bumped back into sinus rhythm. I am going to ask if I can have this as pip.

[Buffafly in reply to Enjoy]

I was told digoxin wouldn't have any effect before two hours so it sounds as though that was a coincidence?

[Enjoy in reply to Buffafly]

Could be but a happy release... although the blood pressure has still remained astronomic.

[Buffafly in reply to Enjoy]

😮

[DevonHubby1]

On my wifes last trip into A&E they tried a magnesium drip first. When that didn't work they tried shocking her but after one attempt which put her into a rhythm that worried them they gave up. 7 days of playing around with different doses of Bisoprolol and Digoxin and they declared AF was permanent. Heart self reverted shortly after and she was discharged and continues to take Bisoprolol and Digoxin. At no time was a PiP suggested.

[jeanjeannie50]

What a thought provoking post Flapjack!

With a cardioversion, there's evidence that it converts us back to normal sinus rhythm as there's an instant result. With pills which can take hours or days to work, well the person taking them may well have reverted even if they hadn't taken the pills. I personally think pills are often given far more credit than they deserve.

Jean

[Hidden]

Should I take that as a compliment 😉 Just had a 24 hr holter fitted in advance of next months review. Trust all is well and that you will soon be packing your designer bikini for the Adriatic...😜

[cuore]

I have had three electric cardioversions for persistent AF and flutter: before 1st ablation, after first ablation, after 2nd ablation lasting 3, 4, and 5 days respectively.

After 3rd electric cardioversion, I was placed ( by Canadian EP) on a daily regime of 100 x 2 Flecainide plus 120 mg Ditiazem with the result that my heart had many episodes of sinus rhythm lasting longer than the 5 days of electrical cardioversion.

I then had my third ablation in Bordeaux on May 27, 2019 and am still in sinus rhythm 4 1/2 months later.

In my case, for the first chemical cardioversion episode, it took 1 1/2 days to convert relative to the immediate electric.

So, on May 27, 2019 I had my third ablation in Bordeadux by Dr. Jais resulting in my being in sinus rhythm still for 4 1/2 months even though I was one of the worst cases at the six months persistent (defined by the first ablation) .

Furthermore, if I had not had my first ablation at the six months persistent, I would not have been able to revert to sinus rhythm.

For me, chemical cardioversion had more longevity than electric. However, neither electric not chemical cardioversion kept me in sinus rhythm for any respectful time.

In fact, had I remained beyond six months persistent AF at the first ablation stage, I would never have been able to return to sinus.

At 4 1/2 months and counting, I am now enjoying consistent sinus rhythm .

[Hidden]

Thank you for your comprehensive and helpful reply cuore. As I understand it, Bordeaux has an excellent record of excellence and that has helped other centres around the world, to benefit from their expertise. Hopefully, you will remain in sinus rhythm for a very long time.....