Considering cardioversion

[Reena09]

Hi there, I am now considering a cardioversion. Recently gone into persistent AF and if my energy levels are reduced, this may be an option. I am 72 years old. My heart beat at night seems to average 100 bpm so I may start taking a further 1.25 mg bisoprolol which is all I take with apixaban in the morning. If this helps, then will continue with rate control. Does anyone have stories / advice to share. I think cardioversions have to be carried within 3-6 months and given current situation, not sure what that means for me. Thank you.

[BobD Volunteer]

A cardioversion can be done at any time so long as a patient is anticoagulated (which you are.) If no anticoagulation there is normally a month on anticoagulants before DCCV can be done but there are exceptions for example a TOE (trans oesophageal echocardogram ) can be done to check there are not clots in the heart if there was an urgent need.

DCCV (direct current cardioversion) is not without risk so not something to rush into unless quality of life (QOL ) is poor.

[Reena09 in reply to BobD]

Thank you Bob. I agree and that is dependant on how I feel over coming weeks / months being in persistent AF. I was told that if large atria, DCCV would not likely be successful and that’s one of the risks with persistent AF which is why it is better to do sooner rather than later and before you miss the boat. Is that correct?

[BobD Volunteer in reply to Reena09]

I think the main reason for DCCV is to see if you feel better in normal sinus rhythm (NSR) as this signposts future treatment. Uncontrolled long term AF can cause enlarged atrium but getting rid of teh AF often allows a return to normal size.

By the way normal rhythm is considered to be between 60 and 100 so you are not far out if at all. My local cariolgist told me that under 100 and sinus they do not treat.

[Reena09 in reply to BobD]

Thank you. My rate is 100 bpm on average when in AF at night. Does this make a difference to the above?

[BobD Volunteer in reply to Reena09]

very low rate for AF imho.

[Reena09 in reply to BobD]

Sorry bob. What do you mean imho?

[WhitstableWanderer in reply to Reena09]

imho - in my humble opinion!

[Paulbounce]

I can only speak from my personal experience - not from a medic's point of view.

I've had 3 CV's so far. The first 2 lasted for a short while and the last one is well over a year now. However (IMO) that is due to taking Flecainide daily.

It's your choice how to proceed of course. Even if you're only in sinus for a few minutes it shows other treatments could work.

As a suggestion maybe you could talk to your doctor about starting a med (such as flec) before having your CV - if you decide to go down that route.

As BobD say's there is a risk - as there is with any medicial procedure. Maybe a CV will work for a while - maybe not - who knows. It's a lottery in many ways.

As for the time frame for a CV being successful - I'm pretty sure I was in afib for a few years before it was picked up. The last one worked (for now) so I'm not sure having a 3 - 6 months 'time limit' is necessarily correct.

Good luck whatever you decide. As stated above I'm not a medic - this post is just my personal experience.

Paul

[Reena09 in reply to Paulbounce]

Thanks Paul. I’m just not sure on the side effects of flec. I know for some time it’s fine but I am concerned starting a new drug incase it makes me more symptomatic.

[Paulbounce in reply to Reena09]

Sure Reena - I understand. However it really works for many people. It's worth a mention to your doc even if you decide against it. No harm in asking

Have a great day

Paul

[Reena09 in reply to Paulbounce]

Thanks Paul. My resting pulse is 50 with 1.25mg bisoprolol. Do you think still possible to take flec?

[Paulbounce in reply to Reena09]

I'm not sure Reena. I have a low HR at rest and no problems. I would check with the doc to be sure - they can only say no

Paul

[Reena09 in reply to Paulbounce]

Thank you Paul

[Reena09 in reply to Reena09]

Hi Paul, did you start taking flec straight after the CV? I think this could be the best option for me on the basis that the CV works and I get back in sinus rhythm. Do you take the flec twice a day?

[Desanthony]

Due to the fact that our hospital didn't have a cardiologist when I was first diagnosed I didn't have my cardioversion until 14 months and a house move and new hospital after initial diagnosis with persistent AF. I was put on apixaban and bisoprolol - bisop didn't agree with me and tried all other sorts of similar medication which didn't work. My first cardioversion worked for just short of a year my second for about 4 months and third on 3rd Feb 2020 is still working. I would say go for it if you feel you are better in NSR. I definitely am and am on the list for an ablation.

[Reena09 in reply to Desanthony]

Hi there, were you put on the flec after the CV?

[Desanthony in reply to Reena09]

Not on Flec. Never been on it just had amiodorone before and after second CV - 3 weeks before and 3 weeks afterwards. At all other times just kept on apixaban as anything like bisoprolol and other types of rate drugs didn't agree with me - in fact made me feel worse.

[Ducky2003]

My first cardioversion lasted 4 days. I was then put onto Amiodarone and had a second one 4 months later which kept me in NSR for 3 years. They then took me off Amiodarone and we hoped that the heart would have got used to NSR and would stay that way but unfortunately, AF returned in June after 8 months. So, I'm back on Amiodarone and awaiting cardioversion number 3 and on the list for ablation. I personally felt instantly better after my cardioversions so for me, quality of life was massively improved as I now regularly wake up during the night with a pulse of 150. My experience so far has been positive but only you know how badly the AF is affecting you. I'm only early 50s so I want to do anything to get back to as normal as I can.

[Sean_C]

Hi Reena, I am a little younger than you (I'm 57) but I had a similar experience with AF. I was in persistent AF and my pulse rate hovered around the 90-100bpm mostly. It was definitely AF though, as several ECG's showed the erratic beats and the missing P wave. I also had a Echo scan which showed my ejection fraction to be 37%, and probably the reason why I felt so bad and had no strength or energy. After the 2nd CV they did an MRI to check and my ejection fraction was up in the 50's.

Anyway, I have now had 3 cardioversions, which made me feel so much better. The first lasted about 5 months before reverting. The second lasted one week short of a year (went back into AF on April Fool's Day - go figure) and normal rhythm since the last cardioversion is 14 months and counting.

I may be unusual in that the CV makes me feel normal (and after many months of AF while on the waiting list) often like the 6 million dollar man. To the point that I declined an ablation, even though the EP said it would probably come back. One CV a year is a bargain in my opinion.

So I have had only good experiences. However as Bob and others have stated, everyone has different circumstances and levels of health, I only want to give another experience.

Good luck!

Sean

[Sean_C in reply to Sean_C]

I should add that when in normal rhythm I can stop the Bisoprolol and only take 1.25mg of Ramipril as well as the usual anti-cogulant (Rivaroxaban in my case). When in AF I also need to take a low dose of Bisoprolol. (also 1.25mg, reduced from 2.5 which caused my HR to drop too low).

[Reena09 in reply to Sean_C]

That’s really helpful. Do you take any supplements?

[Sean_C in reply to Reena09]

ah, good question, i forgot about that. Yes I do. I take Magnesium Taurate 2 per day (morning and night, based on the recommendation of the York Cardiology guy) and a vitamin D tablet in the morning, that's all. I'll occasionally take Vit C if I have a sniffle or sore throat but only for a day or two.

I also still enjoy a drink, which is taboo to many (most) on this forum who find that alcohol is a massive trigger for AF. Again, don't take this as a recommendation please

[Reena09 in reply to Sean_C]

Thank you . Have you tried flec after the cardioversion?

[Sean_C in reply to Reena09]

No I haven't. Never been needed / prescribed.

[Reena09 in reply to Sean_C]

I was under the impression it keeps one in sinus rhythm for longer but maybe that’s not the case!

[Sean_C in reply to Reena09]

I am in no way an expert but my understanding is that Flec is used for when the heart rate is at dangerous levels, to slow it down and hopefully prevent it from going that fast again. I suppose that also covers possibly (hopefully) preventing your heart from going back into AFib?

That is not the case for me, even in persistent AFib my HR is anywhere between 80 and 100 (usually at the lower end of that range, bear in mind that in NSR my resting HR is around 56-58) so in no way at the dangerous levels you see with the more severe types you can get with paroxysmal afib.

[Golfer60UK]

Go for it, the Apixiban is a blood thinner, Bisoprolol a beta blocker

[pablojack]

I had a cardioversion for atrial flutter 2 /3 years ago. My heart rate was 150 with multiple ectopics. The procedure was immediately successful but it did drop my resting HR to c 46 but with no ectopics.

I was on apixaban before and after as per the recommendations. I have had no recurrence and no symptoms. I was told that in the event of a recurrence I should go straight for an ablation, because of the first time success of the cardioversion.

My experience is flutter and not fibrillation so this is not a recommendation. I also never had physical symptoms apart from acute awareness of ectopics. My electro cardiologist told me it always comes back but so far so good. Meanwhile I take magnesium, cq10 and a host of other things. Maybe they help, maybe they don't.

Everyone is different but I hope you can tiptoe through all these experiences and find a way forward with your own cardiologist.