Alcohol after Cardioversion. They su... - Atrial Fibrillati...

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Alcohol after Cardioversion. They suspect there's a risk but don't tell you.

Ivan_the_Terrible profile image

I posted here last month that I considered I wasn't warned of the dangers of consuming alcohol after cardioversion. I asked the hospital under the Freedom of Information Act on this and the following forms part of the reply. In other words although they appear to accept there is some evidence to suggest that you are better off cutting alcohol consumption to near zero, they don't think this is strong enough and don't bother telling you. I find that extraordinary. Why not tell the patients there may be a risk and let them make up their own mind? Thanks in advance for any comments.

•The Trust follows the European Society of Cardiology (ESC) guidelines for management of patients with Atrial Fibrillation (AF). If alcohol is felt to be an important contributor in any individual case, this will be addressed prior to cardioversion. The requestor may be aware of data presented at the American College of Cardiology (ACC) meeting last year (and published in the New England Journal of Medicine in January this year) that suggests that moderate consumers of alcohol may benefit from near-abstinence of alcohol if they have AF. This was a study of 140 patients with widely heterogeneous forms of AF. The data is not considered strong enough to be incorporated into ESC guidelines. This is because the data from 140 patients is considered too small a study population to be automatically applied to the more than 7 million people in Europe who have AF.

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Ivan_the_Terrible
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pottypete1 profile image
pottypete1

Take it from me regardless of what ‘they’ tell you, if you suffer from AF or have suffered from AF you are far better off to resist alcohol.

I stopped drinking alcohol 3 ½ years ago and now my QOL is so much better and I rarely get an episode of AF now after previously suffering for nearly 30 years.

Pete

sotolol profile image
sotolol in reply to pottypete1

Yay. 👌🏻

Ivan_the_Terrible profile image
Ivan_the_Terrible in reply to pottypete1

Pete, I know, having learned the hard way. (I have persistent AFib BTW) I'm interested in getting them to give me another Cardioversion asap. and making sure that in the future nobody else has to learn the hard way.

Lucymoo profile image
Lucymoo in reply to pottypete1

Think everyone has an opinion regarding alcohol and their intake mines maybe a glass of pimms (in this hot weather) or white wine once every 2-3 months which suits me and I’ve never been a big drinker........for some alcohol is part of their life and as said you can only advise and people have to make their own decisions but shouldn’t blame the medics who are trying their best.

Ivan_the_Terrible profile image
Ivan_the_Terrible in reply to Lucymoo

The medics should provide information. It's up to us if we follow it.

The hospital agree they should provide information, They need to have rigorous procedures in place to make sure this happens. The majority of patients are not going to join this forum or do their own research, and even someone like me who does ask lots of questions may fail to pick up some vital information.

Personally I do not think all medics do their best, and it's dangerous to think they do. In this case the hospital serm to be hiding behind European Society of Cardiology guidelines so their strap line should be 'the bare minimum' rather than 'pursuing excellence'.

Same here, I stopped some years back, much better without it.

BobD profile image
BobDVolunteer

Even a casual glance through this forum should show that most of us avoid alcohol but you can lead a horse to water etc etc.

Ivan_the_Terrible profile image
Ivan_the_Terrible in reply to BobD

That's as maybe but what I am really interested in is the reasoning of the professionals in not warning everyone as a matter of course. I wonder if anyone has comments on that. Surely if there's any suspicion that alcohol may trigger recurrence of Afib they should be telling people.

in reply to Ivan_the_Terrible

I suspect the reason is that studies have not securely established that avoiding alcohol after cardioversion is of benefit. NICE guidelines, which most doctors adhere to, are supposed to be evidence -based. One way to establish this would be to look up the papers which deal with alcohol post-cardioversion to see exactly how strong the evidence is.

Ivan_the_Terrible profile image
Ivan_the_Terrible in reply to

At last, someone has got the point I was trying to make. There is the paper which I cite and Bob D has said that most people here avoid alcohol. Okay you may need strong evidence to approve a drug but how strong does the evidence need to be to tell people that alcohol may trigger a recurrence? Are there dangers in avoiding alcohol which may outweigh the potential benefits.?

in reply to Ivan_the_Terrible

A statistical hypothesis test -will have a statistically significant result when it is unlikely to have occurred given the null hypothesis. Usually, the significance level is set at 5% or less (usually less in medical studies). If it doesn’t meet that standard, then it’s unlikely that doctors will base a recommendation to patients on it. I don’t know of any study that shows that avoiding alcohol is dangerous. As is well known, it has been claimed that drinking small amounts of red wine has a protective effect on the heart, but that result is outweighed in relation to AF patients by the likelihood that it wpuld trigger an arrhythmia.

Ivan_the_Terrible profile image
Ivan_the_Terrible in reply to

You are the only person here who has got my point, and seem more knowledgeable about statistics than me. I'm grateful for any help you can give. Are you saying that the evidence that alcohol can trigger AFib 'doesn't meet' a certain 'standard' or that it is 'well known' ?

Should you be interested the article in question is at

nejm.org/doi/full/10.1056/N...

I'd be particularly interested if you have any comments on this sentence from the response to my FOI request.

"This is because the data from 140 patients is considered too small a study population to be automatically applied to the more than 7 million people in Europe who have AF. "

I can't see what bearing the second figure has on the first, how could it make a difference if the number in Europe was any smaller? Surely the key questions are the size of the 'population' from which the sample was taken and the how far the sample is representative of the population.

Thanks for any further reply.

in reply to Ivan_the_Terrible

“Are you saying that the evidence that alcohol can trigger AFib 'doesn't meet' a certain 'standard' or that it is 'well known' ?”

My point was that there doesn’t seem to any hard statistical evidence that abstention from alcohol after a cardioversion is likely to prevent recurrence of AF following the cardioversion. There is quite a lot of evidence , however, that even moderate drinking is bad for AF and makes progression from PAF to persistent or permanent AF more likely. Therefore, doctors are likely to tell patients that abstention from alcohol, or a low level of alcohol consumption, is advisable for those with AF. However, they are *unlikely* to say that avoidance of alcohol following cardioversion will make it less likely that they will need another cardioversion because the evidence for that specific claim just isn’t there.

The exact impact of alcohol will vary from individual to individual. For myself, I have found that if an alcoholic drink is sugary or cold it might prompt ectopics or even AF, but the occasional drink doesn’t usually have any obvious effect (although as the article makes clear, alcohol can have effects on the heart even 36 hours after consumption).

On the question of the sample of 140, it is rather small in relation to the population . Also there might be issues about whether it was random- were the sample members all from a particular country or area of Europe for example.

Ivan_the_Terrible profile image
Ivan_the_Terrible in reply to

Thanks, see my reply to DesAnthony below.

Desanthony profile image
Desanthony in reply to Ivan_the_Terrible

I can remember being told when having to do statistics in college (many years ago) that any study of this sort should be of at least 1000 people and over a period (if necessary) of at least 5 years.

Ivan_the_Terrible profile image
Ivan_the_Terrible in reply to Desanthony

Surely it depends on what you do with the results of the study. For testing a drug you would need a very high level of confidence that the advantages outweigh any side effects, but for warning patients to avoid something, when there is no great disadvantage in doing so, then you might not need such a high level of confidence.

Desanthony profile image
Desanthony in reply to Ivan_the_Terrible

Its a very fine line. I was initially appalled at being told not to drink alcohol at all when diagnosed but then slowly got back after a new nurse said it wouldn't make much difference to have "the odd drink" It didn't make any difference. To be honest I didn't even take things easy after my first CV - which so far is the one that lasted the longest for me. That's just the way it is with this thing.

Desanthony profile image
Desanthony in reply to Ivan_the_Terrible

Some people can drink alcohol and do not go into AF whereas some drink one cup of caffeinated coffee and go into AF. I am waiting for an ablation and back in Feb this year we were given a series of lectures on AF and ablation - I am sorry to say only 3 people attended. One person had already had one ablation and was waiting another and the other guy and I were waiting for one. Other than being grossly overweight (and he had already lost 3 stones in preparation) the guy waiting for an ablation like me had brought his risk right down to the fact that he used to treat himself in work to a big cappuccino on a Friday break time and that sent him into AF before the end of the afternoon - however he could go out and drink and nothing would happen. The guy on his second ablation knew that he could drink anything but wine which would send him into AF. For me there doesn't seem to be any trigger other than strenuous exertion so at 76 am trying to take it easy and not over do things by picking up heavy loads I think I ought to be able to pick up just because I could 20 years ago LOL. That is what sent me back into AF after my first CV which had lasted just short of a year. If alcohol was a trigger before CV then it will be after. Some of us never find what triggers our AF and it can be a mix of things. A dear friend of mine who died recently never drank alcohol in her life, never drank tea or coffee, was never overweight, and was the sweetest calm little lady we knew still had AF which came back after countless CVs and other procedures she had had.

Ivan_the_Terrible profile image
Ivan_the_Terrible in reply to Desanthony

I have asked the question, is it worth going through all these procedures? The case of your friend makes me ask it again.

Desanthony profile image
Desanthony in reply to Ivan_the_Terrible

As you probably already know any treatment for AF is just that, a treatment not a cure. The treatments only help with quality of life. If, like me, you are hardly able to function when in AF - breathlessness etc and no medication works then yes CV and ablation, if they work will help. A CV shows that your heart will go back into NSR - even if it is for minutes or hours so other treatments such as ablation are also likely to work and help with quality of life. Some people get on very well with medication and don't bother with a CV. Those in Permanent AF will not go back into NSR with either medication or CV. Unfortunately I couldn't cope with the medication so was absolutely delighted when my first CV worked so well and now hope that my forthcoming ablation will work as well.

Ivan_the_Terrible profile image
Ivan_the_Terrible in reply to Desanthony

I didn't do anything after AF was diagnosed as my quality of life was good. This year I felt I was becoming more tired and requested a CV. It's reassuring to know I can go back to NSR, just disappointing that I didn't have a better chance of staying longer in NSR. I am much less worried by the prospect of an ablation than by the side effects of drugs, but NICE guidelines state I should undergo a second CV with drugs, it's a question of funding. If I have to gave CV with drugs I would be happy if and when I reverted to NSR.

Desanthony profile image
Desanthony in reply to Ivan_the_Terrible

Funnily enough I had the second CV with drugs and it lasted less than 4 months where my first one lasted just short of a year and this last one has lasted 5 months. Here's hoping it lasts longer I feel so good I don't want the ablation but know its the best chance of staying longer in NSR

Ivan_the_Terrible profile image
Ivan_the_Terrible in reply to Desanthony

So you've had three? Presumably the third is with drugs and thryvfon'g make you feel bad. I was under the impression that an ablation, if it works, is for keeps.

Desanthony profile image
Desanthony in reply to Ivan_the_Terrible

No the second was with amiodorone for 6 weeks (I think) the only side effect I had with amiodorone was it did affect my thyroid count, though side effects can be awful and numerous. I had 3 blood tests while on amiodorone and although I was told I would finish after 6 weeks they would have taken me off anyway because of the thyroid. It took about 3 months for the thyroid reading to come down. It must have been at the same time that I went back into AF. As that CV only lasted abut 4 months. I had another CV in Feb and that is still keeping me in NSR as the first one without drugs did I am hoping it will last up to a year.

Ivan_the_Terrible profile image
Ivan_the_Terrible in reply to Desanthony

And this is on the NHS? I can get a private CV in Russia for about £600. I'd be very happy if I got by with one of these per year and no alcohol, no drugs. The annoying thing about not being warned about alcohol is that I am deprived of the chance to see how long I'd stay in NSR without drugs.

Desanthony profile image
Desanthony in reply to Ivan_the_Terrible

Yes this was on the NHS. Private CV here is about £1400 and ablation somewhere in the region of £9,000. Depending on whether you stay in of course. These are figures from 3 years ago when I thought I would have to go private due to there being no cardiologist in my area and I had to pay to see a cardiologist 3 hours drive away. I have thought about a CV every time I need one but NHS in this area only do 3 ( so have already had my share and a friend of mine in Peterborough can only have 3 too so some health areas have this rule but not all. Therefore, ablation is the way to go if staying with NHS and the EP I would see for whether NHS or private is the same person who has suggested ablation as I get on so well with CV but not drugs.

BRHow profile image
BRHow

I love getting drunk. I love booze. With that being said, booze and AF is a Given. If you want to be AF free, don’t drink.

Lucymoo profile image
Lucymoo

Different people respond in different ways to alcohol and some foods. It’s easier to identify what foods including alcohol is a trigger for you. I find coffee and particularly chocolate triggers for me. Alcohol occasionally isn’t a problem and I keep away from drinks with caffeine in them too.

Find what works for you and keep well

Ivan_the_Terrible profile image
Ivan_the_Terrible in reply to Lucymoo

Thanks, that's okay for people suffering paroxysmal AFib, but not persistent AFib. I can't afford to learn from experience if I need a fresh cardioversion every time I make a mistake.

Desanthony profile image
Desanthony in reply to Ivan_the_Terrible

I have persistent AF too. Don't forget CVs generally don't last forever. This is why I am waiting for an ablation I have had 3 cardioversions all of which worked for varying lengths of time. at present I am in NSR since my 3rd CV in February.

in reply to Lucymoo

Unfortunately, the recent study referred to in this article indicates that even drinking modest amounts of alcohol may be problematic if you have AF, and that the effects of a drink can continue for around 36 hours afterwards: medpagetoday.org/cardiology...

Ivan_the_Terrible profile image
Ivan_the_Terrible in reply to

Thank you very much for this link.

CDreamer profile image
CDreamer

I’m sorry but I don’t believe it is a doctor’s responsibility to warn you of every single risk factor unless it is known to be life threatening.

Maybe instead of looking to load responsibility onto the hospital you might approach the breweries and ask any drink containing alcohol should have a long list of warnings of the consequences of imbibing, similar to warnings on tobacco and most other things these day, but IMHO our overstretched medical services are not responsible for your life choices.

Ivan_the_Terrible profile image
Ivan_the_Terrible in reply to CDreamer

The hospital appear to think it is their responsibility and so do I. Fir one thing it's a total waste if NHS money to give someone a cardioversion and not to take the simple step of warning them against things which may negate the effect.

Desanthony profile image
Desanthony in reply to CDreamer

You should have seen the list of risks on a packet of chewing gum I bought for my son in the states when I first visited back in the 70's It was longer than the wrapper! I don't know if they still do this over there. It is up to us to be proactive and educate and inform ourselves of everything we can but I do understand that quite often we don't know the right questins to ask which is where these forums and associations like the AFA come into their own.

Ivan_the_Terrible profile image
Ivan_the_Terrible in reply to Desanthony

It's fine, we can all take advanced driving courses but the authorities still need to erect road signs. If I'd been warned I might still be in NSR. If everyone was warned, which should be standard practice and doesn't consume much resources, then the average time patients spend in NSR after CV might increase. It would be cost-effective for the NHS to give such warnings.

Desanthony profile image
Desanthony in reply to Ivan_the_Terrible

Fact is you might have gone into AF for another reason unless you have already found that alcohol is definitely your trigger and sometimes it is not the alcohol but something like the sulphites in wine.

in reply to CDreamer

To be fair, I think it’s not unreasonable to expect to be given at least some basic medical advice following a cardioversion. To take an analogy, following some recent root canal work, my dentist advised me to “brush and floss carefully around the crown to minimise the chance of re-infection and to “try not to chew too much on one side of the mouth.” Although abstention from alcohol following a cardioversion isn’t known to prevent the need for a subsequent one, it might have been reasonable to offer at least some general advice to avoid alcohol as this is known to trigger AF in many people (including, by implication, following a cardioversion).

Ivan_the_Terrible profile image
Ivan_the_Terrible in reply to

Thank you for your support. I did in fact specifically ask what I should avoid doing in order to give myself the best chance of prolonging my time in NSR.

I'd say that the effects of alcohol take a long time to wear off. I'd honestly say weeks or months. You get rid of the physical effects that are measured by the medical profession, but it's deeper than that, it's a mind-thing, a yearning, maybe sort of a minor addiction even, and until that goes from your head, you don't really settle down properly. I suppose that this was a stress. That was my experience anyhow.

doodle68 profile image
doodle68

Hi Ivan :-) I have Paroxismal AF and didn't need anyone to tell me that for me drinking alcohol is not a good thing to do for me a number of reason, I will give you a couple of examples firstly my episides are highly symptomatic and if I went into P-AF having had a couple of drinks I would almost certainly cope less well with the breathlesness and feeling of being lighteded. Secondly I take anticoagulation so if I have a fall and hit my head it could be dangerous and drinking alcohol could contribute to a fall.

Apologies if I sound as though I am lecturing but you say ''Why not tell the patients there may be a risk and let them make up their own mind? and I get irritated by the suggestion that we all need to be 'advised' on every little detail of our own welfare these days when we all have a brain we can use to apply common sense .

Ivan_the_Terrible profile image
Ivan_the_Terrible in reply to doodle68

It's widely known that drinking more than a certain amount of alcohol per week or per month is not good for you, but the safe drinking limits for those with AFib are much tighter than that and I would not describe them as 'common sense' or 'common knowkedge'. I did specifically ask the CV nurse what I should avoid to remain as long as possible in NSR.

Ducky2003 profile image
Ducky2003

I only drank a glass of wine now and again, on birthdays or Christmas or an occasional meal out but I havent had a drop for 4 years since the AF started. As soon as I was diagnosed, I made it my business to make myself aware of the condition and its triggers so I read up on things and asked questions rather than just relying on what I was told.

I think we all have a degree of responsibility for doing our own research as it's our own health on the line at the end of the day.

Pretty much the first thing I discovered was that alcohol could be a trigger so its surprising you hadn't come across that information yourself, unless you've done no research of your own.

Ivan_the_Terrible profile image
Ivan_the_Terrible in reply to Ducky2003

I did a degree of my own research but directed my questions towards the medical professionals. IMO it's their job to give you the information needed. There isn't time to give it to everyone verbally but they can give it in writing. If it's vital they have to check that patients know it. There was a time when my GP would printed things off from the internet and gave them to me. For the medical profession to rely on patients getting vital information from other sources is very risky, they might miss something.

Ducky2003 profile image
Ducky2003 in reply to Ducky2003

I went back and read your previous post and now, I think, you are querying why you weren't told to abstain after the cardioversion? As you mentioned that you had cut back your drinking when you were diagnosed, you were obviously aware of alcohol being a trigger so I'm a bit lost as to why you thought that changed after the cardioversion? I'm not trying to be "censorious" but curious as to why you thought cardioversion meant you didnt have to continue with any lifestyle changes you had made, as that to me, would be more the issue to question the NHS about rather than the alcohol in isolation.

Ivan_the_Terrible profile image
Ivan_the_Terrible in reply to Ducky2003

Thank you Ducky. I have persistent, not paroxysmal, AF. I cut my drinking prior to CV because I thought that would be generally good for me, but I had the occasional celebration. There was no question of a celebration sending me into AF because I was already there. However the situation after CV is different and that's what I didn't realise. A celebration won't send you into AFib when you're already there but it may cause you to revert if you've had a cardioversion.

Ducky2003 profile image
Ducky2003 in reply to Ivan_the_Terrible

Mine is persistent too and after a couple of years of it behaving with meds, it's back with a vengeance but I think the key is anything can put you out of NSR whether before or after any intervention so irrespective of what puts you back in NSR, be it meds, cardioversion or tripping up the stairs (yes, that did happen 😁) if your heart is particularly sensitive, it wont take much to send it doolally again. Hopefully, you get sorted again soon.

Ivan_the_Terrible profile image
Ivan_the_Terrible in reply to Ducky2003

Thanks.

Steve101 profile image
Steve101

When you point a finger at someone else (in this case the health service), there are three fingers pointing at you. Bottom line WE have a responsibility to do the right things. IMHO there are too many people always looking to point the fingers at others instead of saying ‘what can I do?’ You see this with Covid, the government should do this, the government should have done that, the same people that ignore social distancing.

In the case of AF, if you improve Your health life style, you will have a better outcome.

I will now step off my soapbox.

Steve

Ivan_the_Terrible profile image
Ivan_the_Terrible in reply to Steve101

Gosh, what a lot of censorious people here.

Desanthony profile image
Desanthony

I was told at my very first meeting with the anticoag nurse after being diagnosed with Persistent AF that I should not drink. I hardly did drink then and drink even less now but still can and do drink for me it is not the trigger that put me into persistent AF - It was taking down kitchen cabinets and dismantling them that did that

Ivan_the_Terrible profile image
Ivan_the_Terrible in reply to Desanthony

According to the procedures of the hospital the CV nurse should have raised questions of alcohol consumption and lifestyle when she first saw me over a year ago. She never did any of this. I also found her incredibly rude. One reason for pursuing a complaint is to flag this up.

Desanthony profile image
Desanthony in reply to Ivan_the_Terrible

Well that's fine. As I said it was flagged up to me right at the beginning. Really you should also take it easy for a week after a CV I am not sure that I ever really did to be honest. I think i may have "throttled back" but probably only when my wife told me to. Incidentally, when I first went into AF she was out and I decided to remove the cabinets from our utility room. When I went back into AF after my first CV I was attempting to move things in the garage of our new house and she had said she just needed to grt some shoes on (as she was in Flip Flops) and would help me. I decided I could do it on my own rather than wait and there you are back in persistent AF again. I just saw something on Face Ache yesterday saying that most accidents old men have are caused by them doing the things they think they can do because they did them when they were young men.

CDreamer profile image
CDreamer in reply to Ivan_the_Terrible

If the nurse who attended you broke Hospital protocol - that’s an entirely different matter to the one outlined in your post and when protocol is broken, then of course you have grounds for a complaint

Personally I was not being censorious, I think we all have the ability to self-regulate and make choices and long may it remain that way. Yes, we sometimes need direction and rules to abide by but the case around alcohol and AF per se is not proven.

I don’t know enough about cardioversion and the recommendations because I have never been offered one but had I been, I would have taken the trouble to do my own research mainly because I am cynical about individual medical advice which in my experience has been varied, based upon opinion as much as evidence, often contradictory and biased and is constantly changing as we learn more.

As a matter of interest - have you approached the AFA about this subject?

As another of today’s posts highlights, protocols and procedures differ from hospital to hospital - the NHS is not one body - it an enormous conglomerate of QUANGOs. Our local hospital is an NHS Trust and therefore sets it’s own protocols and is not ruled by the NHS.

The only body I know of which advises on protocols is NICE - maybe also worth checking on their website.

Ivan_the_Terrible profile image
Ivan_the_Terrible in reply to CDreamer

The nurse is in clear breach if the protocols in not giving me general lifestyle advice, which didn't matter so much as I was able to provide this myself. Whether she should have warned me on this specific question of alcohol AFTER (excuse caps) CV is another question. And the wider question is should warnings be issued if it is thought that something may be a danger but it is 'not' proven? I'd say yes and am interested in why the European Cardiology Society appear to think otherwise. I may contact the AFA on that.

Sunstreaker profile image
Sunstreaker

I was wondering if any health care professional at any time throughout your AF journey has asked you about your alcohol use. THe Trusts response does seem to suggest that if an individuals alcohol intake warrants attention then that would be addressed at some point. I appreciate this does not address the issue of suggested cessation from alcohol following any AF intervention. Personally I am aware that British Heart Foundation literature citing the relationship between alcohol and AF was adorning the Cardiac unit walls as I spent nervous moments reading them as I awaited appointments. I have been surprised myself that no one has to date quizzed me on my alcohol intake as part of any assessment which has included two cardiology appointments and one EP phone consultation. I know alcohol is a trigger for me and have abstained for nearly a year.

Ivan_the_Terrible profile image
Ivan_the_Terrible in reply to Sunstreaker

The only time I ever recall a professional mentioning it was over the phone, shortly after I was first diagnosed whilst abroad. I think she said I should limit myself to no more than one drink per day, that did indeed become my average. I did pick up a British Heart Foundation leaflet whilst waiting for my first hospital appointment, but didn't read it all. All my questions were directed to the consultant, and subsequently the nurse and were 'what is the value if this treatment?' And 'what happens if I don't take it?'. Alcohol was never mentioned at the hospital. It's in the protocols that it should be discussed, but it wasn't.

I did very specifically ask the nurse after cardioversion what activities I should avoid to maximise the time I spent in NSR and she said 'none'. If she had said that any alcohol increases the risk of reversion, and that I should never consume more than one unit in 24 hours I wouldn't have drunk the wine in question. The hospital don't claim so far she did tell me, sonthe questions are whether she should have, and whether the protocols should say that that she should. My instinctive view us that you don't have to prove a risk to warn of it, which at the heart of my question.

Sunstreaker profile image
Sunstreaker in reply to Ivan_the_Terrible

Often some health education literature is used to address this type of patient information, some fact sheet as it removes the onus of an individual having to give an explanation. It does seem reasonable that at some point someone should have given you some information to suggest there is a considered link between AF and alcohol. It does not appear to be the stance of the NHS to encourage complete abstinence. To me the issue of triggers seems to be something not readily discussed. If we underplay our alcohol intake when questioned, not suggesting you did, we limit the attention this issue is given with our individual health care.

Ivan_the_Terrible profile image
Ivan_the_Terrible in reply to Sunstreaker

The protocols state

"Lifestyle measures are first addressed in the pre-assessment clinic if not earlier. This is done face to face or may be done virtually as part of the standard clerical completion of the proforma. That is, we scope patients to see if they are ready for cardioversion. Alcohol is specifically addressed. This is because of the interaction of alcohol and general anaesthetic but more importantly, interaction with Warfarin causing destabilisation of International Normalised Ratio INR levels (INR is a measure of how long it takes the blood to clot.) In getting patients ready, alcohol advice is given much earlier on. And patients have a lot of questions surrounding this topic."

The pre-assessment clinic was more than a year ago. I don't recall any mention of alcohol at all, and think I would it it had been mentioned. The nurse was the rudest person I have come across in the NHS, IMO completely unsuited to be dealing with patients in such a setting. I've no interest at all in downplaying my alcohol consumption. I am glad you agree with me about triggers. I am hoping that by kicking up a fuss they will get me transferred to another hospital, but also that it will benefit other patients in the future.

Paulbounce profile image
Paulbounce

Hello Ivan.

I'm sorry to hear your CV didn't turn out as expected. These things happen and I guess it's a lession learnt.

OK - here's my take. My first two CV's lasted a short while - I was put on Flec (100 mg twice a day) for the third one and I'm still in sinus after over 12 months. I had two afib 'attacks' when travelling after just a few hours sleep. On the advice of my cardio I took an extra dose (300 mg in 24 hours a day MAX). I was soon back in sinus although my HR stayed high for a few days afterwards. Without looking back at my replies to your posts, I'm pretty sure I suggested you talk to your cardio about taking a med before / after your CV.

It's working at the moment for me - I know that could change in a heart beat though (pun intended).

For some - one drink will trigger afib. For others a couple of beers are OK. However bingle drinking will trigger it - I can pretty much promise you that. You may be luckly - you may not as well. You know what's coming if you do !

Here's my advice to you if you decide on another CV. Discuss with your doc about starting med's before having another CV. Often they'll start you on a lower dose and increase it after a few weeks to give your body time to adust. Then you'll be good to go. It might help you stay in sinus.

DON'T binge drink afterwards. Stick with a couple of beers max - the ideal is no booze at all.

I wish you future success with any other CV's you may have. For sure though I would discuss med's (like flec) before embarking on another attempt - it might help.

Good luck.

Paul

Ivan_the_Terrible profile image
Ivan_the_Terrible in reply to Paulbounce

Paul, the thought of taking Flec is horrible, I'd rather have a cardioversion. The wine was quite strong, I may have been silly to open that bottle, but I am sure if I'd been warned at the hospital I'd have found an alternative. Now I may have lost the chance to see how long I can stay in NSR without Flec.

Paulbounce profile image
Paulbounce in reply to Ivan_the_Terrible

Hello Ivan.

Sure I understand. We all have a personal right to refuse certain med's (or all med's) if we so wish. This is your right and I respect that.

However for me Flec has worked wonders. I know this can change at any moment but being afib free is a huge bonus. There are people on this forum who have been afib free for many years and put it down to Flec. It can also work as a PIP and has done for me.

I can only speak from my own experience but I wouldn't be without it. My resting HR is in the low - mid 50's and I doubt it would be the same without Flec. I've no side effects and it 'does the job' very well.

It's unlikely a CV will last forever but I think Flec can keep the engine running much longer if you take it.

Again this is just my take on using it. However (as above) I respect yours for not wanting to take the medication.

Maybe you were 'silly' to open the bottle of wine - who knows - your afib might have come back anyway. I'm not knocking you at all - I've done plenty of 'silly' things in my lifetime. I still do ;-)

Just as a matter of interest why are you so against it ? It's your decision of course but I would be interested to know why.

Enjoy your day.

Paul

Ivan_the_Terrible profile image
Ivan_the_Terrible in reply to Paulbounce

My heart rate was in the low 50s for a few days after the CV on the lowest dose if bisosprolol. I look for natural remedies, traditional medicine and healthy lifestyle as much as possible and resist as much as possible doctors who fling pills at you. This approach has stood me in good stead thus far in life. Drugs have side effects, I react extremely badly to Ibuprofen. I take Paracetemol very sparingly. I resist them as much as I can but will consider them as a last resort. Can't say I completely like the general approach of Western medicine, the patient is not an individual but a statistic. Traditional wisdom is written off as anecdotal, unproven evidence, and there's no money to run tests on it. The profit motive of drugs companies corrupts everything. You've probably heard it all before. The thought of surgery is not so terrifying. Maybe I'm irrational, but it's a part of who I am. I'm very grateful for your advice though.

Mugster profile image
Mugster

How do you know for sure alcohol triggered your AF? It might have nothing to do with it.

I had persistent AF. My CV put me in NSR for 2 days before reverting. I did t drink any alcohol in those 2 days.

Apparently that's not uncommon.

The key thing was that I was offered an ablation,which was successful. That was 2 and half years ago, and I drink a bottle of wine a week and did so with persistent AF

Ivan_the_Terrible profile image
Ivan_the_Terrible in reply to Mugster

I can't be absolutely certain. It was four days after the cardioversion, I drank the wine in the evening and woke in the night with my heart pounding. Alcohol is a known trigger for relapse. I'd say highly probable.

Kn177yn0ra profile image
Kn177yn0ra

I must be strange then because I find that a brandy and coke kicks me back into NSR a treat!

Ivan_the_Terrible profile image
Ivan_the_Terrible in reply to Kn177yn0ra

Lucky you :-)

Kn177yn0ra profile image
Kn177yn0ra

I know!

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