Hi everyone, I'm new around here but hoping you can give me some insights into my dilemma over cardioconversion. I was diagnosed with AF about 18months ago and was put on Bisoprolol and Warfarin and within days, I was suffering significant side effects. I have found that the medical community around me isn't interested so I've had to live with the problems. At my first AF clinic, I was told by the cardiologist that I could have cardioconversion but I would have to stay on the meds because I had no symptoms prior to diagnosis. His fear was that, even if cardioconversion was successful, my heart could revert to AF at anytime so it was best to stay on the meds. I thought that if I had to stay on the meds, what was the point in having cardioconversion. I've since talked to another cardiologist who has offered me this treatment as a way of coming of the meds and so relieving the side effects. Frankly, who do I believe? I was wondering if anyone else has found themselves in a similar situation and what was their outcome. I'd also be interested to hear from anyone who's had conversion and how it went. Does it actually work?
To cardioconvert or not to cardioconvert - Atrial Fibrillati...
To cardioconvert or not to cardioconvert
Direct Current Cardioversion or DCCV to give it the correct name is not a cure for anything. What it may do if you are in AF is to return you to normal sinus rhythm (NSR). There is no guarantee how long this may last BUT it is a useful test to see if you feel better in NSR. If you do then it can signpost different treatments such as rhythm control drugs or even ablation as a way to reduce symptoms. Any and all reatment for AF by gthe way is mainly for quality of life ( QOL) as there is currently no 100% cure.
Of course before any such treatment is done it will be necesary for you to be anticoagulated for at least a month to reduce the chances of any clots being thrown off and causing a stroke.
I have had 3 Cardioversions and all have been successful. I could not cope with bisoprolol or any other similar types of medication, I think I tried about 4 different ones - they made all my symptoms worse - I was better off without them. After trying different doses, different mixes and different types of medication we did find that digoxin was OK for me at the lowest dose - cardiologist started me of on a higher dose but I found I was still poorly and when talking to a friend found that there was a lower dose - thought I had been started on the lowest dose but mistaken and GP took my doseage down but was only on this dose for about 4/5 weeks before my first successful cardioversion. Because of my age after cardioversion I still had to stay on anticoagulants but that's all - not digoxin. The anticoagulant I am on is Eliquis aka Apixaban which I believe is much simpler to use than warfarin as only one blood test a year needed when on them. When I went back into AF after that first cardioversion they didn't put me back on any such medication as bisoprolol. My first cardioversion kept me in Normal Sinus Rhythm (NSR) for 11 months and then I put myself back into Af by picking up and moving a heavy box of books. Had another Cardioversion and kept in NSR for about 6 months and then had another last February and am still in NSR.
Really if you are having problems with your medication - especially after you have been on it this long its my opinion that either a different dose or different medication should be tried. Are you seeing an Electrophysiologist? If not ask to be referred to see one. AF is an electrical problem and a cardiologist deals with the "plumbing" of the heart whereas an Electrophysiologist deals with the electrical part.
I had a cardioversion three weeks ago today and I’m still in sinus rhythm. I stoped my bisoprolol before the procedure and haven’t needed it since. I’m on Apixaban not warfarin and will need to stay on because I like you had no symptoms prior to diagnosis.
I’ve had 2 cardioversions. I was in AF for 6 months prior to my first one.
It was like night and day, the difference. It lasted 13 months. My second has lasted 8 months, so far but I’m going for an Ablation now.
So yes have one, I didn’t realise how ill I’d felt before ....
Ive been in both positions having symptoms by not having a cardioversion and later on not needing a cardioversion as I am now asymptomatic.
My last cardioversion lasted four and a half years but when I went back into AFIB I didnt have any symptoms where as before every time AFIB struck I felt quite lethargic .
My cardiologist recommended that I have a cardioversion only if it will improve my quality of life (QOL ) he basically left it up to me to decide if its necessary.
I dont have any side effects from Rivaroxaban or Diltiazem which is all I am on now.
IMO if you are having side effects get a cardioversion and a change of medication , I found the change of medication was the greatest improvement in QOL.
Wife suffers from Paroxymal AF. After a bout lasting over a week she was told to go to A&E where they attempted to cardiovert her. Only one attempt was done as it put her heart in a dangerous flutter. A week in hospital and she eventually self reverted.
I'm told she's a rarity and most times it does work.
No 1- Afib begets AFib. The more you are in it, the more you will be in it. If you can get out of it that is a good thing. Never managed to get an electric cardioversion myself so no experience ( I wanted one on several occasions but I either self reverted (fine) or my hospital would not do it (very aggravating)).
No 2 - IMO Never accept meds that cause you problems if you have not tried the alternatives. Its your life being ruined. Bisoprolol causes a lot of issues for a lot of people. I was on it but stopped after 7 days. The side effects were too bad. My GP swapped it for atenolol, another beta blocker. This was much better but still bad. After 2 weeks I had had enough of that and went back to my GP who then said I may not tolerate Beta blockers so switched me to Verapamil , a Calcium channel blocker, which had no side effects for me. Note We are all different with drugs - many people on this forum get on fine with bisoprolol or even swear by it.
Please note there are many other beta blockers than the two I tried, I understand asthmatics have a big issue with Bisop (again from the forum) , and people have had problems with Bisop but found other beta blockers that work with no/minor issues.
Also please be aware that Bisoprol does not necessarily keep you out of AFIB and in NSR . It is a RATE control drug for AFib (it is actually a blood pressure medicine - it lowers blood pressure which causes some side effect issues in some people - BP TOO low).
What is does for AFIB is to stop your heart going to a dangerously high rate (like mine always did 165BPM + resting in AFib).
If your AFIB gets worse then you can be put onto a RHYTHM Control drug , such as flecainide which can only be prescribed by a cardiologist or EP and needs to be monitored.. These drugs keep you in Normal Sinus Rhythm. Often with flecainide, you also take a rate control drug as you could be in SR but still in a very high heart rate. ( I did when my AFIB progressed past just taking Verapamil)
Note NOT MEDICALLY TRAINED, just my 5 years personal experience.
Best wishes
Are you in persistent or paroxysmal AF?
18 months is a long time to be in AF, the longer you are in AF the more intractable it becomes as structural changes can occur in the heart.
Cardioversion is safe and simple, I would definitely recommend trying it if you are in permanent AF, but it may not last very long because of the time you have been in AF....but it's your choice.
Good luck
To be honest I didn't know that there were different types of AF and none of the medics I've spoken to have mentioned what type it is either so I'm at a loss to answer you.
If it comes and goes then it is Paroxysmal = occasional. If it is persistent then it is there all of the time. When it changes to Permanent = you and your medical team agree that there is no further treatment available or required.
Many people live very well in persistent and permanent AF as they do not respond to any treatments but it does sound as though you are not being well served by your medical team so may I suggest you contact the AFA - go to the website - inform yourself and then go back to your GP and ask to be referred to an Electrophysiologist for a consultation as to the best course of treatment for you. Tests should include ECG, Echocardiogram, BP monitoring and Bloods. I could not tolerate any of the drugs other than anticoagulants - I found the AF preferable to the drugs as at least when I wasn’t in AF I felt human - on the drugs I felt terrible all of the time but they do help some people.
And receptionists may request you ask what you want to talk to the GP about but you are not obliged to disclose details but in these times they are obliged to operate some sort of triage and find out whether or not it is urgent and consultation for AF as a chronic condition would not be considered urgent, although that is not an excuse for not offering an none urgent appointment!
In these times you need to be Polite but Persistent to get through the extra layer of triage most GP surgeries have put up.
The three main types of atrial fibrillation are paroxysmal, persistent, and long-term persistent.
Hopefully you only have paroxysmal AF, i.e. it comes and goes, but it could progress to the next level.
You can live with AF for many years without knowing it, but it can cause problems if left untreated, and can rob you of energy.
I would find out more about what type you have and then discuss the treatment options in detail with your doctor,
Good luck
Thanks guys for the info on the different types of AF. The short answer is that I don't know what type I have since non of the medics I've been involved with have said anything other than "you've got AF". I've only had two ECG's in connection with this and the last was about 18 months ago so no help there. I've tried too check my own pulse but find it very difficult and, to be honest, I wouldn't know what I was looking for. However, perhaps I can get some answers to these questions at my assessment tomorrow?
On the subject of receptionists making clinical judgements; that system has been in place for several years at my GP's surgery so it doesn't relate to CV19. the only change they've made for CV19 is to make as many appointments as possible telephone rather than F2F.
Thanks again, let's see what tomorrow brings.
Hello, just had my second ablation which so far after 4 weeks is holding in normal sinus rhythm. I am on Bisoprolol and Apixaban and agree that the bisoprolol can have certain effects on individuals, such as breathless and low energy levels. Personally I quite accept these issues since they are doing the job the Cardiologist wanted.
The best person to discuss any issues you have or questions, is your Cardiologist
Dave J
AF or not ?
To ablate or not!
Ablation or not ?
AF or not AF
Stuck in limbo (not a good feeling !!)
