My husband is due to have his first cardeoversion next month. We have been waiting many many months to get his thyroid under control and then the covid delays it will be close to a year before diagnosis before we get to go in.
He has no issues with his constant AF and takes no medication other than Apixaban. When the nurse called last week she seemed quite intent on saying that it may or may not work at all or it works it is very likely to return to Afib.
It seems strange to us they are basically saying it’s unlikely to work but let’s do it anyway and see what happens with low risk of permanent success. Why put yourself through it or is it the first step to many options?
He has good BP and HR.
Any advise or experience would be helpful
Thank you
Written by
Spudly22
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Hi Spudly, it’s best to look at a cardioversion as an important part of a treatment plan, particularly for those in persistent AF. Whilst there are risks, they are deemed as very small on the basis it’s almost the same as being defibrillated and that’s done to save lives! If it doesn’t work, then nothing is lost because it’s extremely unlikely to have any impact on your hubby’s condition. However, if it does work, even for a very short period and he feels significantly better being in normal sinus rhythm, then it means there is a good chance he will respond well to further treatment such as an ablation. So yes, it is an important step to other options!
Cardioversion is not a treatment in my view but a diagnostic tool. It can signpost future treatments if the person is put back into NSR even for a short time.
I beg to differ on this! It is the first line of treatment for many. If it is unsuccessful, then other, more invasive, treatments and meds are explored.
Why do an invasive procedure if DCCV fails to return nsr.? If a first fails, then a second may be tried using amiodarone for a period before and after.
The stated aim of DCCV is to discover a) if a patient can obtain such and b) if they feel better in this state. If yes to both them ablation or rhythm control drugs may be tried but if the answer is no then the risks far outweigh any possible benefit and rate control and anticoagulation would be the likely treatments.
I presume you are agreeing with me here, as I don't really understand your response, otherwise. Cardioversion isn't a test to see if you can achieve nsr, it is a treatment to achieve it!!! If it doesn't work, and sometimes patients will have many, then other treatments are considered. Meds are usually used, of course, in conjunction with these treatments. I had my first cardioversion last September for unexplained and sudden onset afib. I was hospitalised and put on a raft of meds whilst waiting only 6 weeks for the procedure. It was successful in returning me to nsr and now I'm off all meds, including anti-coagulants, apart from Bisoprolol, which primarily controls my bp. Fingers crossed I will not need any more treatment, but it is a treatment for afib, and not a test!!!!
For sure you are lucky and whilst one may hope your AF will not return this is more likely as I am sure you will have been told. The rest depends on whether you look at it from the patient's or doctor's point of view.
Thanks for the positivity! (ironic comment here!!) You sure are, in my late mother's words, a "Job's comforter". I still beg to differ, however, as an English teacher, as to your definition of the meaning of the words test versus treatment. Any treatment might not be successful, long or short term. But a test is a diagnostic procedure, of which cardioversion is not. Cardioversion treats the sinus rhythm, whether that is a lasting treatment or not. I had many tests prior to my treatment, to determine whether the treatment might be more successful. Then I had the cardioversion, which was the treatment. I hope that clears everything up. I think maybe there is a language barrier going on here!!! Please let this be the last word now!!!! And no more negativity either: we all need to give positivity with regard to medical conditions on these sites, and with regard to patient outcomes. Everyone is an individual, with differing medical needs.
Not sure where you were medically trained, as is commonly known here, I’m not, but like a few here, I have been fortunate enough to have heard countless AF related presentations from many experts in their field. Cardioversions are only performed on people who have AF so by definition, that means they are either in persistent or permanent AF. We are told that a CV is only likely to bring a long term solution to patients who are in their early 20’s or younger, provided they are treated within weeks of diagnosis. This accounts for a tiny proportion of AF patients and certainly does not apply to the vast majority of forum members.
BobD has clearly explained the importance of having a CV as a significant part of the process of treating someone with persistent/permanent AF. It is not negative to tell people the truth as to why a CV is offered. I have never heard a Cardiologist or EP say anything other than a CV is an important part of the treatment process to see if a return to NSR is possible and it is very unlikely that it will provide a long term solution to AF. If a patient goes into a treatment plan for AF, they need to understand that during the journey, they will encounter a number of highs and lows along the way. If we are over optimistic about the success of a CV, imagine the impact on the patient when the almost inevitable happens. However, if we are honest in our comments and the patient is made aware of what is likely to happen but it’s the fact that it worked which is crucial, the patient is more like to appreciate and understand that why the CV is part of the plan and not a treatment in its own right.......
Accusing someone of negativity who spends so much of their time helping others by being honest with their advice will probably not be well received by this group.
I agree with you. I also feel that failure to achieve even very transient sinus rhythm with direct current cardioversion (DCCV) would not necessarily preclude attempts at subsequent chemical cardio version or pulmonary vein isolation (PVI)
I think one also has to consider the context. It’s hard to imagine a healthy 30 year old being refused PVI because DCCV has not interrupted atrial fibrillation.
The monogram below appears to support your point of view.
My post is inevitably an oversimplification. In my experience, even electrophysiolgists (EPs) don’t always agree.
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I’m sure you are right however because a CV is effectively a “re-booting” of the heart and does not do anything to treat the elements within the heart which cause AF, this is probably why at some stage, the AF may return. If a patients expectations are that the CV will provide a long term “cure” then naturally they will be extremely disappointed if or when it eventually fails. If they are made aware that at some stage this is likely to happen but that the CV will have successfully indicated that other treatments are open to them then this is more likely to help overcome their disappointment. Many here choose not to research using Dr Google like others might, instead they prefer to seek help and advice from people in a similar situation to their own and as I’m sure you will appreciate, this why BobD and others need to offer advice in an honest and more generalised way....
I couldn't fine the date of the post, but the more current literature (confirmed via tests) advocates to start with rhythm control rather than rate for better outcomes. The above presents rate as step 1.
Thank you for your support on this matter. I was a relatively young recipient of a planned cardioversion last September. But my cardiologists assured me that if it did not work, or did not sustain nsr, then they would explore other treatments for me, not just medication. I have had brilliant support from the team at my hospital and am glad that there are some positive and productive commentators on this site, as that really helps too.
Hi Spudly.I was diagnosed with AF in March 2020. I had to wait until October to have my first cardioversion.
Despite hits of 75, 100 and 150 Joules it was unsuccessful.
I did not feel any better or worse as a consequence though.
I underwent C/V again last week, (21st Jan. 2021) and it worked this time.
The difference was that I was put on Amiodarone after the first failure and that seemed to make the difference.
It's 5 days on now and I feel fit as a flea!
However, I am well aware that I could revert to AF again... in 1 week, 1 month or 4 years as happened to a friend of mine.
He went in for C/V again this year at the age of 68 and it worked first time.
Thank you Very helpful - he feels completely normal now but maybe he doesn’t know what normal is now and will feel even better!
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I’ve just read your profile, are you saying you had a cardioversion on the 21 Jan 2021 and then ran a kilometre 3 days later followed by a mile yesterday at the age of 60 whilst on Amiodarone because your 1st CV last year failed after 3 jolts....
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Yes. I used to run previously, so apart from the 15lbs I've put on over the 10 months since I was first diagnosed, I'm in pretty good nick. Doctor and 'specialist' don't seem to have a problem with it.
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Of course it’s your decision but sometimes we know passionate athletes might ask if it’s OK to continue with their exercise regime without necessarily defining what the regime actually is. Some might say that’s so the patient gets a response they would prefer to hear, but I couldn’t possibly comment. Amiodarone is, without doubt the most powerful drug available to control rhythm. It is commonly known as the drug of last resort and carries with it a very unpleasant range of side effects. It is only used to support cardioversions and ablations when it is known that remaining in rhythm is extremely fragile. Most people in your situation would wrap themselves in cotton wool to give their heart at least half a chance of benefitting from the procedure.
What you do is, of course entirely up to you, but maybe you could spare a thought for the team of NHS staff who are probably totally exhausted, but gave you this chance of attaining a degree of normality before you decide to put more stress on an already fragile muscle.......and wreck the chance they have given you.
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I think that both my doctor and cardiologist are far better qualified to comment on what I should and should not do when it comes to exercise than you. The heart is a muscle and accordingly needs exercise, which over many years it has had. I've continued to work throughout my A/F and despite doing between 16,000 and 20,000 steps per day I've have suffer no ill effects. For that I am more fortunate than most. The amazing staff at West Suffolk Hospital took the time to put my life back to normal, and I will be eternally grateful to them for doing that. My normal is working and trying to generally keep fit. So please carry on doing whatever you want to do with your life and stop pontificating over mine.
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Your absolutely right, I wish you nothing but well which is why I was advocating caution. It’s only reasonable to make people aware of the risks they might be taking and it’s also important that they are discouraged from encouraging others to do something which could do them potential harm. I’m not suggesting that that is something you were trying to do but I’m sure you will understand the point I am making.
I’m not sure if that comes in the category of pontificating because frankly I couldn’t care less what you do. All I have tried to do is make you aware of what I have heard many EP’s/Cardiologist say in terms of recovering from a Amiodarone assisted cardioversion or ablation, after all, it was you that asked if anyone had any comments at the end of your profile.
I've been through it all. Four ablations. 6 to 8 cardioversions. Atrial flutter .... Lone Afib ... paroxysmal Afib. Never let it get as persistent as yours appears to be though.
On cardoversions, none of them every gave me that much normalcy. I was back having Afib attacks in pretty short order. Maybe the most successful one ... was early in my journey 12 years ago at age 55 when I wasn't having Atrial flutter that much. Might have went a month before it returned.
Your best bet ... is to move beyond cardoversion to something that keeps you off AFIB. The longer you are in persistent AFIB ... the more the heart negatively remodels itself. Therefore, (when you finally decide) ablations and possibly medications will not work as well.
I don't know your age, but you do say that 'you have no issues with being in PAfib.' Some people are content to live out their lives in persistent Afib. If that's you, then maybe try one cardioversion and see if you get an extreme miracle. But I doubt it will take you permanently out of AFIB for any appreciable length of time.
Lots of folks do anti-arrhythmic drugs to stave off AFIB for years. I've taken Flecainide and it has worked as a pill-in-the-pocket to take me out of Afib (in fact, I discovered it cardioverted me so well, I never went into Emergency again for conversion.)
Get some Flecainide or similar from your doctor and give it a try. It's much more convenient to convert yourself at home in 20 minutes than scheduling ... traveling ... exposing to C-19, at the hospital.
Now, onto ablation. My Electrophysiologist ablates people from 16 to 95. Many of the patients I saw that were ablated that week didn't look all that healthy to me. Overweight ... taking half a dozen meds ... comorbidities ... diabetes ... high blood pressure. So, you don't have to be that healthy to qualify for one.
It's not a very taxing procedure. Under general anesthesia ... done in 2 hours or so ... into recovery room overnight for observation ... and out!
If you can find a good EP who specializes in AFIB ... then, that would be my recommendation for best chance of getting back to somewhat normal heart rate. My brother had AFIB ... and had one ablation 10 years ago by a so, so EP. He's doing pretty well with few episodes. Has good quality of Life.
I had 10 years of normalcy after my 2nd AFIB ablation. Then, it returned AUG 2020. I contacted a world-class EP (without hesitation) and had the procedure done OCT 23. I'm a more complex case. It's well known that some people need a follow-up 2nd ablation to do some touchup to get close to a 'cure' from AFIB.
Whatever you decide: Good Luck! One of those options should set you on a path of normalcy.
After my 1st CV i stayed in NSR for over 6 years,Its quite possible he may have success, on the other hand he won’t know until he gets the procedure. All the best.
Generally speaking, the longer your husband stays in persistent AF, the greater will be the remodelling of his heart, and probably the shorter will be the time period that your husband will stay in NSR, especially if your husband has a genetic component to his AF. AF begets AF, the more you have the more you will get. Thus, the nurse's comment.
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Persistent afib treatment options, can't tolerate Amiodarone - so many questions...
Let me tell you a story....
AF episodes starting again!
Enlarged left atrium 
black outs
