Cardioversion for AF

[Rebec16]

I’ve know I’ve been in AF for nearly two years although I’ve never had a symptom. I’m scheduled for a cardioversion in a couple of weeks and I feel really anxious. Since I’ve never had a symptom I’m struggling to reconcile the risks verses the benefits. Does anyone have any words of wisdom?

[PlanetaryKim]

Have you been in AF continuously for 2 years? If so, that is permanent AF, and I was under the impression that cardioversion is not used for permanent AF, only for paroxysmal and persistent AF. Or do you mean you have had AF episodes on and off for 2 years?

[jondeanp in reply to PlanetaryKim]

Rebec16 could be in persistent AF. I've certainly experienced persistent AF for at least an 18 month period. It would only revert with intervention.

@Rebec16, I had a similar concern when I was due an ablation. I did have two cardioversions prior which I wasn't so worried about. My first cardioversion put me into normal rhythm for approx 2 years

After much deliberation I decided to go through with the ablation procedure so I could get off the medication and also to be able to return to exercise. Although I didn't suffer many symptoms when in AF, I wasn't able to exercise.

[Rebec16 in reply to PlanetaryKim]

Hi

Yes permanent AF for at least 2 years. Since I didn’t have a symptom could have been years before that.

They say they want be in sinus rhythm so will cardiovert me to try and achieve that

[Buffafly in reply to Rebec16]

I’m a bit puzzled why they’ve left it this long if you’ve been diagnosed for two years. Normally they would try to get you in NSR ASAP. Very strange 🤔

[Rebec16 in reply to Buffafly]

Took a while before they referred me to a cardiologist then a while before the referral to the rhythm team went through and then covid

[Buffafly in reply to Rebec16]

🙄 O dear

[Buffafly]

Hi, what risks are you worried about?

[Rebec16 in reply to Buffafly]

Being cardioverted into asytole and have a big stroke

[Buffafly in reply to Rebec16]

If you have been taking an anticoagulant for the required length of time that should protect you against a stroke. It is very rare for a cardioversion to stop your heart instead of resetting it. But honestly there are risks with all procedures. I was wondering why you were having it at all but I see that’s been answered.

[Rebec16 in reply to Buffafly]

I’ve been anticoagulated for about 18 months so I know the risk is low but I still worry

[Physmeister]

I have had 2 cardioversions and it really is nothing to worry about. Trust me. Sleep and wake that’s about it. They tend to try this first before any alternative. Not to upset you but both mine didn’t work and so I had an ablation. Again a pretty straight forward procedure so nothing to worry about. Incidentally I was unaware of my AF unless taking my pulse or pushing myself when running. Let us know how it goes or if you have more questions.

[Rebec16 in reply to Physmeister]

I’ve been told less than 50% chance of success and they won’t do an ablation because i’m asymptomatic

[beardy_chris]

I describe cardioversion as them spending a couple of hours testing you and scaring you with all the (very unlikely) risks. Then they leave you alone for 5 minutes and you have a nap and then they tell you it's all done and spend a couple of hours testing you and send you home.

I'm not a medic but I understand the main reason for doing it is to find out whether your heart can still operate in normal rhythm and whether it makes you feel any different. This then helps to inform whether an ablation (which is a more serious procedure) might be worthwhile.

My personal view is that a cardioversion is less trouble than having a tooth filled but your mileage may vary.

[RoyM]

I understand the difference between persistent AF and permenent AF is one of agreement with your EP. Persistent AF is indeed just that, continually out of NSR. Permenant AF is a result of a decision by yourself and your EP in that no further attempts to return you to NSR will be attempted. I have been in Permenant AF since May 2016. I had a cardiversion which returned me to NSR for 11 hrs. After I returned to AF it was a decision made between myself and the EP that no further attempts to return me to NSR would be tried. The cardiversion caused me no difficulties at all. I am now taking Apixiban and 1.25 g Bisoporol and have now stopped chasing the holy grail of NSR.

[jossikins]

Hi! I have had no less than 4 cardioversions in the recent past. I would rather have that than a filling any day! I have persistent AF and it was finally decided to insert a pacemaker, which I have now had for about 4 years. These are all fairly uncomplicated procedures and nothing to worry about, rest assured. Go for it with confidence!

[Catlady56]

I've had one cardioversion, which only lasted for a few days unfortunately as being in NSR is so much better than being in afib 24/7, so you will notice a difference. Procedure itself is over in a few minutes and you wont know anything about it. I was left six months before they attempted it, so that maybe why it failed - it's not a "cure" for afib, more of a sticking plaster, but well worth a try.

[cuore in reply to Catlady56]

So, what is your treatment now? Early in my research-- three years ago -- I found a study that gave the percentage of being able to return to NRS relative to the time spent in AF. Unfortunately,I have lost the study.

In your case, you did return to NSR. The objective of a cardioversion is to see if you can return to NSR, so by that definition your cardioversion was a success. But, it didn't last long -- a few days.

I had a cardioversion at almost 4 months persistent, and like you, mine lasted three days. As a result of my being left in persistent for so long, I have had to have three ablations. Plus had I not had my first ablation at the six month stage, I never would have been able to return to sinus. (I had to leave my country and go to France due to waiting time)

AF begets AF, especially so if one is persistent, and then there is the real begetting- more damage is done than when one is paroxysmal . It boggles my mind when one is persistent that the medical system just sits back and allows one to get worse.

In my case, the lousy cardiologist whom I saw at 54 days persistent even lied when he said I would not get worse waiting 6 weeks for a cardioversion which turned out to be nine weeks beyond waiting to see him. A lot of GPs and cardiologists hoard patients instead of immediately referring them to an EP even when one is persistent. Sad.

[Catlady56 in reply to cuore]

My treatment is meds only. I don't want ablation(s) as the idea of burning away parts of the heart from the inside is too risky for my liking. If it doesn't work then you are left with an even more damaged heart than you began with. Many people will tell you it's a great treatment and will set you up for NSR, but my alarm bells are ringing so I wont have it, but that's my personal choice. I don't have an EP. I live in rural Wales with small hospital, so lucky to have a cardiology deprtment. I asked if I would be monitored there regularly and was told no. I get on with life as best I can and make the most of what I've got. Have been told by various sources that Afib doesn't kill anybody - for me the jury is out on that one!

[cuore in reply to Catlady56]

An interesting perspective on atrial fibrillation treatment when one becomes persistent. Do keep us informed how you are getting along, especially with your meds only treatment.

There are two rhythm control methods. One is an electrical cardioversion which you have had and which lasted a few days. The second is chemical cardioversion whereby you are placed on on rhythm control meds in the hope of returning to sinus rhythm and staying there.

My understanding of treatment of permanent AF, although I may be wrong, is that one still takes the anti-coagulant, but either no meds beyond that or a rate control med, not a rhythm control one. It would be informative to know your journey, especially for the ones that take the same path. Good luck to you.

[thinkingaloud]

I was diagnosed with persistent AF last year after attending a clinical trial unrelated to AF. Had not experienced any obvious symptoms. Had a cardioversion last autumn which put me into NSR for 2 weeks during which time the only difference I sensed was feeling generally more calm. After talking with the consultant I decided not to have an ablation as my symptoms appeared so minor and to control it via medication. I was very anxious before the cardioversion but it was so straightforward and over before I knew it.

[cuore in reply to thinkingaloud]

Are you on drug rhythm control then?

[cuore in reply to cuore]

Actually, you must be on rate control drugs since the objective becomes to keep the heart rate down rather than to get you back to sinus rhythm and keep you in sinus.

[northernsoul1]

Best ten minutes kip you'll ever have. I've had two and they don't last particularly if you've been in AF for that long but it's a trip out.

[Jalia]

I was first diagnosed with AF over 27 years ago. During that time I've had 20 dc cardioversions . If i recall correctly 2 of them have lasted 3/5 years and many 6/ 12 + months. My last one was in February this year.

I understand your anxiety. I was quite petrified at the idea for the first few I had but they were really necessary as I was highly symptomatic.

There is in reality nothing to worry about. However given that you have no symptoms I can see why you are questioning the wisdom of the procedure as of course there is always the possibility of something going wrong, remote though it may be.

Can you arrange to speak to one of the cardiologists even if it means delaying the procedure?

[Rebec16 in reply to Jalia]

I have been for preassessment again this week. (I was cancelled in March becasue on covid). My anxiety has been increasing since they phones me to say they wanted to do it. I spoke to the specialist nurse who tried to reassure me. The odds just don’t seem good enough

[cuore in reply to Jalia]

I would disagree with your suggestion to delay because AF begets AF-- the more you have the more you will get, which is especially true if you are persistent. Two years is a long time to be in persistent which is the reason for the 50% chance given to @Rebec16 to return to NRS.

[starry-eyes]

I have had two cardioversions and they were both a piece of cake. Just make sure you ask for a steroid cream afterwards if you look a bit red from the pads as this ensures it does not irritate. After the first time, I was not put on any drugs which I think was a mistake. Now on meds and free of symptoms for 2+ years.

[Reena09 in reply to starry-eyes]

Can I ask what meds you were put on?

[Ducky2003]

I've had 3 (last one was 2.5 weeks ago) and now on list for ablation. It's natural to worry but it was fine. You may not be symptomatic but I'm sure you will feel the difference once you are in NSR. You may be lucky and stay in NSR for a good while after so it's worth a shot. Best wishes.😊

[cuore in reply to Ducky2003]

Good point, Ducky2003. Some get so used to arrhythmia that for them , it becomes normal.

[Ducky2003 in reply to cuore]

I've had friends with absolutely no symptoms whatsoever, who have only discovered they have AF upon a pre-op check and are doing fine on just a small dose of beta blockers, so its difficult to explain to them how debilitating it can be.

[Mrverycross]

Hi. I'm in permanent AF and asymptomatic. Diagnosed last November. Probably had AF for years, the only symptoms being some nights /days I had a very high heart rate which I couldn't bring down by relaxation techniques. I had bad depression/anxiety for many years and I put the symptoms down to that. But last year I started to get some different symptoms which affected my mood mainly- couldn't cope with work and started to really feel the cold, also got a huge, then podiatrist discovered erratic heartbeat cos my feet were cold and white! Cardiologist put me on meds-rivaroxaban- then gp on bisoprolol. Cardio wanted to try cardioversion which I eventually had in July although she said it probably wouldn't work and if it did wouldn't last long but wanted to see how I felt if I got nsr. I was undecided really - what good would it do etc just like you. It worked for 4weeks. Back in perm AF now. I did feel more alert and could walk uphill better without serious heavy breathing. A cardioversion is no big thing - just seems it. More risk walking the streets to the shops. There is no harm to give it a go. No one knows if it will work for you or for how long. I can understand the is it worth it feeling cos it does seem pointless if it isn't going to work. But it doesn't hurt and I know I was at much more risk of a stroke for a long time before officially diagnosed so any risk through a cardioversion is nothing.

[cuore in reply to Mrverycross]

Asymptomatic appears to be interpreted differently by different people even though they may have the same symptoms. I am really interested in your post, and wonder how you came to the conclusion that you were asymptomatic since you do list these symptoms:

-depression - palpitations - cold feet - less alert - slower walking uphill ( you do not include stopping when walking up stairs) - serious heavy breathing walking uphill

It seems to me that some have more tolerance for symptoms than others and/or some have a greater degree of symptoms than others.

[Reena09]

I completely understand. I was previously in PAF and recently gone into persistent AF. My only symptoms seems to be shortness of breath on exertion. I’m booked in for a CV in two weeks as well. EP has suggested I try flecainide 50mg x2 but im dipping in and out of AF. Have you tried any rhythm control drugs? I’m also worried especially with covid around but I think benefitS outweigh potential risks.

[Rebec16 in reply to Reena09]

I’ve been on amiodarone since the new year in preparation for the cardioversion

[Ducky2003 in reply to Rebec16]

Then you have a good chance of staying in NSR after the cardioversion. I stayed in NSR for 4 days after my 1st, without rhythm control. 2nd time, I had been on Amiodarone leading up to it and stayed in NSR for 2.5 years. Then cardiologist took me off Amiodarone to see if I stayed in rhythm without meds and I did for another 8 months. Back on Amiodarone prior to this 3rd cardioversion and still in NSR after 2.5 weeks, thankfully. Hope it works for you too.

[Desanthony]

You are like me in Persistent AF. Permanent AF is when you cannot come out of AF even for a short while after a cardioversion. I have had 3 successful cardioversions and waiting for an ablation. You can be cardioverted once you have been on anticoagulants for a month. Unfortunately, like you for various reasons I couldn't get to see a cardiologist (there wasn't one at my local hospital) for months then they tried all sorts of medication which didn't work - infact it made me feel worse - I was better off with none of it only the anticoagulants in the end. thankfully when I moved house I was referred to a fantastic cardio - about 14 months after first being diagnosed and had my first cardioversion just a couple of months later. This lasted for just short of a year. the second CV lasted 5 months but I had a total knee replacement at the time and I am sure it was the gruelling physio and unbelievable pain that put me back into AF. I had my 3rd CV in February and am still in Normal Sinus Rhythm. Sat here wondering do I really want the ablation but you get complacent thinking how well you are and as I am getting older really want something that will last a bit longer than a year. Am hoping in the next few months my ablation will come up - It should have been last April but C19 reared its ugly head and now after being unable to keep as fit as I wanted as our gym was closed I want to get back to the fitness I had before so that I can go into the ablation as fit as possible.

[pablojack]

As many have reported, cardioversion is a simple procedure that should be of no concern. What is more concerning is the assumption that being asymptomatic and remaining in permanent AF has no consequences.

[Reena09]

I’m scheduled for one in under two weeks as well. A question, have you had your flu vaccine? I’m wondering whether it makes sense to have before Cardioversion as my fear is that the flu jab can bring on AF and we should then have before cardioversion.

[Rebec16 in reply to Reena09]

I’m not keen on needles so I’ve never had a flu jab. I would suggest you speak to your doctors about what the options are