Not sure whether to have CV

[Reena09]

I am booked in for a CV next Wednesday. My EP started me on flec at the end of August and so far I am dipping in and out of AF. This could be 4 days in sinus and then 4 days in AF as an example or sometimes as little as 2 days in sinus and 3 days in Af. I sleep better when in sinus rhythm and that is what I have noticed the most. Maybe some more energy as well. My question is, if the CV is simply a test, is there any merit having one now especially given covid as I never know when I flip in and out and can only tell from my Apple Watch. I am on 50mg x 2 and 2.5mg Bisoprolol. Or is there a chance that with the CV, I will stay in sinus rhythm rather than dipping in and out. Anyone experienced this?

[BobD Volunteer]

A DCCV will not cure AF but if you are in AF at the time it may revert you to NSR. If you are in NSR when you go for it they will have nothing to convert so will not do it.

[Reena09 in reply to BobD]

The flec is converting me to sinus, albeit it varies from 2 days to 5 days so I am dipping in and out. Just not sure whether a CV is now necessary. I was in persistent AF but the flec has changed this to PAF. I think I need to book an appt with my consultant as can’t understand the benefit of a CV now.

[jeanjeannie50]

I agree with all Bob has said. Cardioversions are only for those people who are stuck in AF.

Are you having a pre-med before the day, as the AF nurses could see what your heart is doing then. Are you positive that you're going in and out of sinus rhythm? I think I'd want someone medical to tell me that I wasn't in AF rather than trust an Apple watch. I had an episode where the pulse in my wrist said normal, but my heart was in fact racing crazily.

Do you feel well when you think you are in sinus rhythm?

Jean

[Reena09 in reply to jeanjeannie50]

It’s very obvious when I’m in sinus as my pulse floats around 50-60 bpm at rest and then when I got into AF it is much more variable and this is much more evident at night. I guess the real question is whether there is a chance that if I have the CV, if there is more of a chance that I stay in sinus for a longer period with the flec rather than 3/4 days at a time as an example. The pre assessments are all virtually now the day before. I think I need to speak to my consultant whether he thinks it is now beneficial as I was previously in persistent AF but the flec has changed this now to PAF. Hopefully that all makes sense.

[Reena09 in reply to jeanjeannie50]

Jean - I also don’t really have an idea when I change from sinus to AF and vice versa. The only difference for me is that I sleep better when in sinus rhythm and possibly can walk at a faster pace but other than that, I’m not sure it has much impact. That’s why the EP thought the CV was a good check to see if I actually feel any different.l when I was in persistent AF.

[Paulbounce]

If you are in sinus then a CV won't help. It sounds like a bit of a 'yo yo' for you.

It appears like the med's are (maybe) working - the norm seems to start on 50mg twice a a day to start then often upped to 100mg twice a day when your body as had time to adust.

You wrote

"My question is, if the CV is simply a test"

I'm not a medic so can only answer from my experince. If a CV returns you to sinus (even for a few hours) then it shows other treatments may work for you.

My suggestion is this. Go for your appointment and discuss about 'upping' your flec dose with the doctor. It's worked well for me and might for you. At least you'll have a decent ECG and decide what do from there.

Good luck with it all.

Paul

[Reena09 in reply to Paulbounce]

Thanks Paul. My only concern is that my recent liver readings were mildly elevated and this the first time this has happened. I think the GP will need to recheck the liver functions before the dosage can be increased. But in the interim, I don’t understand any merit with the CV. Does that make sense to you? The flec shows I can be converted albeit not sustaining NSR.

[Paulbounce in reply to Reena09]

Hi Reena.

Sure - I understand. Sorry sweatheart but I can't offer any help with this one - I think only your doc can help suggest the best forward.

However it's great news you are converting back to normal rythm - that's a very postive step for you.

Make a note of questions you wish to ask during your appointent - I always forget the most imortant things I want ask at the doc's. Having them written down does help and you dont forget the important stuff.

As for having the CV - again I can't answer this. If you covert anyway what's the point ? However I am not medicially qualified in anyway and only your doctor can suggust the best forward for you.

I would certainly get the liver checks done - who knows what they will be . However if they check out OK then you might (just might) have your answer. If not maybe there is another medication that could help ?

I certainly suggest having a list of questions to ask when you visit,

Do your online research but ONLY check out decent sites. There is much mis-information online.

Good luck and let us know how it pan's out.

Best,

Paul

[Reena09 in reply to Paulbounce]

Thank you so much. I am hoping to speak to him tomorrow ahead of the covid swab on Sunday! Don’t want to put myself through any of this unnecessarily.

[Buffafly]

Only a holter monitor can tell for sure whether you are really going in and out of sinus if you can’t tell by feeling your pulse. When I am in AF I have slower periods when I feel better and then feel bad when my heart speeds up but it’s all AF. If you turn up for the CV and you really are in sinus at the time then of course it will be cancelled but if in AF and you have it who knows what the effect will be? I wouldn’t cancel unless you are 100% sure you are having periods of sinus - not sure I would trust an Apple Watch. Same goes for speaking to your consultant - you need to be sure it really is sinus and not just slow AF.

[Reena09]

I am 100% sure and on the Apple watch you can see minute by minute readings so for me it’s fairly obvious to see the change in pattern. I just don’t see the point of going through a CV when I am in and out of AF unless there is a chance that I will stay in NSR for a longer period and again, there is no guarantee.

[stoneyrosed]

I too am on 2x 50 mg a day and 1.25 mg of Bisoprolol, i flit in and out of AF all the time everyday, i called cardio and he told me the medication has basically stopped working and i am now on the list for a ablation, nothing was said about a cardio version. Always best to go with what your cardio suggests though in my opinion. Good luck

[Reena09 in reply to stoneyrosed]

Thanks. Did they try and increase your dosage? How long have you been on the flecainide?

[stoneyrosed in reply to Reena09]

Yes my Bisoprolol was increased but made me feel like passing out and it was only increased to 3.5. He said i can increase the flecanide to 200mg a day x2 but he said the side effects will probably as bad as the symptoms but left it up to me which i felt was a bit odd, seems like my last resort is an ablation.

[stoneyrosed in reply to stoneyrosed]

Been on flecanide about six weeks

[starry-eyes in reply to stoneyrosed]

I was told the maximum flec dose is 150mg x2 per day. I am on 100mg which keeps me in rhythm and have no side effects.

[Reena09]

Thanks. Did they try and increase your dosage? How long have you been on the flecainide?

[mjames1]

Ask your EP their reasoning. Also confirm with them that you're going in and out of afib versus always in afib. CV seems to make sense only for the latter. Apple Watch and how you feel aside, your EP may have a different interpretation. Ask them.

[starry-eyes]

I would ring the EP's secretary and tell her the flec is getting you in rhythm some of the time so what does the consultant suggest? No point in taking a CV appointment unnecessarily and the consultant may just want to review meds to see if he can get you there more permanently.

[Cookie24 in reply to starry-eyes]

This advice sounds right. Prior to ablation, I would get long episodes 5,8,10,16 days and get on the schedule for a cardioversion. I would convert to sinus a day before the procedure and get an ekg done. Once I went to hospital, told nurses I am not in afib, ekg was done, and was let go. Propafenone worked better for me than flecanide.

[Reena09 in reply to Cookie24]

Thank you. How did the ablation go?

[Cookie24 in reply to Reena09]

I had a successful cryoablation for afib. Fourteen months later, I developed atypical aflutter which is difficult to treat. I had a radiofrequency for atypical flutter and had an episode 8 months later (under much physical and emotional stress). Resumed propafenone and converted to sinus before scheduled cardioversion.

[Physalis]

Before I got my Apple watch I could feel when my AF started but had no idea about it really. It was a game changer for me. From then on I knew exactly when it started, how long it went on for and when it stopped.

It might not be so useful for other people with different symptoms. I only got it for the fall detect feature but I haven't had to use that once.

I can't see that a CV is appropriate unless you are in AF for a long time, which you don't seem to be.

[LMCPL]

Hi, I‘be had 2 CV’s which did not work. However I was given no 3 about 8 weeks ago. Been in S.R since. So in my opinion it’s worth a try. Worked for me. But I now do keep away from Caffeine & Alcohol & plenty of exercise

[Reena09]

Thanks everyone! Spoke to the EP and he has cancelled the CV. He has now increased the flec dosage so that I take 50mg in the day and 100mg at night to see whether it will make a difference. The reason he increased the night time one is that according to my readings I am switching from NSR into AF at night. Hopefully this gets rid of the dipping in and out but let’s see. As I have a small frame, the EP said he doesn’t want to increase the dosage beyond that. Hopefully it works. Really appreciate all your help.

Need to run an ECG in 5-7 days. I presume others on the forum have done the same just to check that the flec is not causing any other Arrythmia.

[cuore in reply to Reena09]

When I stopped taking Propafenone, I was in sinus rhythm for six days then had an episode at 8 p.m. I went back on Propafenone, but like you my dosage is greater in the evening because the one episode started at night. So, 150mg in the morning and 300 mg. at night. I always wondered if someone was on the same regime when an episode starts at night.

[Reena09 in reply to cuore]

For me, I don’t even know I go into AF apart from using the toilet more at night but can tell from my Apple Watch readings and my EP has had sight of these. Last three occasions were at 2am and two at 5am. I’m hoping the extra 50mg stops the flip to AF. Fingers crossed. Good luck to you and thanks for responding