Post cardioversion advice?: Hi All, My first... - AF Association

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Post cardioversion advice?


Hi All,

My first post but I’ve found this forum so useful in recent weeks so firstly a big thank you to those who contribute such useful material and advice!

A short history - I’m 37 and have thankfully been very fit and healthy other than mild asthma up until becoming unwell with suspected COVID last March. Pneumonia triggered persistent AF for which I was DC cardioverted after a couple of months. Heart was fine for 7 months but AF returned New Years Eve. Fatigue symptoms were so much worse with this second episode despite HR not being as crazy. I was on bisoprolol 12.5 per day plus digoxin last year but this time HR could be controlled with 5mg per day. I switched to verapamil 2 x120mg a few weeks ago after struggling with breathlessness however which seemed to help and I was feeling much better than when I was when taking bisoprolol.

Delighted to be called in for cardioversion last Friday and even happier that it worked again and so I’m back in sinus rhythm once more. Im now in a long queue for ablation as cardiologist said it’s likely to return again and area is enlarged, likely caused by long distance running in a previous life.

The question I have really is how have people felt post cardioversion? I was expecting to be feeling much much better this week but I’m still pretty wiped out at times and not able to work as much I thought having to take things very very easy. I’m not sure whether this is linked to being in AF for so long and perhaps the severity of symptoms this time or the procedure or because I’m still on meds?

I was told I could reduce my verapamil to 120 once a day so not on a high dose. It almost feels like my heart isn’t enjoying being slowed down so much now that it’s back in rhythm if that makes sense. Not sure why I need to be kept on this medication but I guess my cardiologist wants to keep my HR low for a some time to reduce risk of AF returning. Presumably though, there is a point after cardioversion when it’s sensible to come off and 8 weeks as per the standard appointment wait after procedure seems a long time to wait with these symptoms.

All the reading I can find about cardioversion doesn’t suggest to expect issues afterwards so I’m thinking my symptoms are likely to be linked to meds? It might be I just need to be more patient and give things time but would appreciate views and advice.

46 Replies

Hi Dave and welcome.

I’ve not had a cardioversion but others who have should be along soon to comment but I can say that I have read posts which comment that the expectation that they would feel better after a cardioversion hasn’t been met and many say it takes a week or so to recover from the GA and the physical trauma your heart had from the CV.

Yes, controlling HR is important to prevent you from going back into AF and yes your heart needs to be slowed down so although it is a pain, you need to adjust to going slower and resting more because your heart isn’t going to be able to keep up without going into arrythmia, especially if you have an enlarged atria.

There have been a few people posting about AF following COVID but as far as I am aware, it’s pretty new territory for everyone, especially the cardiologists but I know there is a lot of research going on about just how COVID affects the heart.

Dave0 in reply to CDreamer

Thank you for the super quick reply and advice, I need to be patient I think!


I think meds are the likely cause of your fatigue Dave but remember I'm not a doctor! Yes most doctors like your heart to recover in peace without having to deal with excess rates hence the medication.

You don't mention anticoagulation which is a prerequisite prior to cardioversion but I have not heard of people claiming that any anticoagulant causes fatigue. That you have had AF (apparently not unknown side effect of covid for some people) means it can return at any time so best that your heart is protected.

To be honest most of my cardioversions have left me in NSR for some time and feeling fine in a day or so but just having the sedation often wipes people out for a few days. Take you time recovering. Let you body tell you when it feels better.

Dave0 in reply to BobD

Thank you Bob. Yes I’m on edoxaban still and for sone reason I’m not pointing the finger at that, think it’s the verapamil. Hadn’t thought about the sedation though and so will give it more time before chasing cardiologist, who has been brilliant.


Just to add a little to what the others have said, I remained on Diltiazem (a different calcium channel blocker) after my one and only cardioversion right up until I had my ablation. The side effects at 120 mg were nowhere near as difficult as Bisoprolol but it was suggested I continued with Diltiazem because it helped to keep my blood pressure under control. It’s possible that your heart enlargement is due to the arrhythmia but this may return to normal if you remain in rhythm. If your EP is indicating that AF is likely to return, they may suggest that you go on a PiP or a low maintenance dose of a rhythm drug to help keep you in rhythm until you have the ablation......good luck

Dave0 in reply to Hidden

Thank you FlapJack. Yes my cardiologist was considering putting me on a low dose of flecainide and was going to consult other specialists and get back to me. I tried high does of this as cardioversion both times but if didn’t touch the AF.

Hidden in reply to Dave0

It worked with me 😉

Dave0 in reply to Hidden

Glad to hear!

I felt great after my first cardioversion.... I’d been in AF constant for 6 months prior. My first one lasted 13 months. I had an Ablation in Oct 2020 and feel great again. I take Ramipril, Bisoprolol and Apixaban.

No sign of stopping those but I don’t mind.

I take 2.5 Bisoprolol each day so maybe not as much as you? I’ve never felt any affects from the drugs tbh.

Safc1983 in reply to LordGabriel

Is that standard to continue with medication? I’m due an ablation soon and the main reason that was recommended to me was because it would stop me being on meds long term.

Dave0 in reply to LordGabriel

Thanks for replying and pleased to hear procedures worked and all is going well for you

After reading the comments and your initial post, I am not sure how much this will help. I have had 7 cardioversions and none have left me feeling any worse off, I suspect its a reaction to the meds (which I have had too). Consider taking a magnesium supplement and Co-enzyme Q10 - if they work then great, if they don't then stop taking them. But taking them won't do any harm.

Hello Jonathan How much Co- enzyme Q10? I am on Flecainide and Bisoprolol and take magnesium and vit C every day and Vit D once a month ( glass phial). What are the benefits of Q10 and are there any interactions with what I'm currently taking?Take care

Hi - i don't know why Q10 works, but it does. and its helped other on this forum. For me it has made the side effects of flecainide literally go away. The few times I have taken it when not on flecainide it has given me a huge energy boost - so i recommend taking it in the morning.

Thanks for your reply. I thought boy tiredness was faus by Bisoprolol. So maybe it's the Flec? Do you just take one tablet in the mornings ?

Bloomin spell checker! * My tiredness was...

In fact no one has answered my question about what dose to take yet...🤔😊

I asked my pharmacist about it and was recommended a type and dose - I can't remember what dose it was. Initially i took one tablet every day and then starting taking it every second day. If it works, you will know it works within 2 or 3 days.

Dave0 in reply to Jonathan_C

Thanks you, I’ll look into Q10 as not heard about that. I’m taking magnesium and multivitamin and definitely think the magnesium helps, certainly when I was in AF anyway and will continue taking.

Hello Dave,

My situation is similar to yours. 37 (now 38🙁), caught covid last April leading to heart failure and AF. I was cardioverted in autumn but I actually felt great for the four days I stayed in sinus rhythm. I have had side effects to the four drugs they put me on, though the cardiologist says they aren’t linked, so I’d tend to agree with Bob on that front. I’m no expert at all but I’d advise you not to be afraid of pestering your GP / cardiologist / EP whoever’s ultimately in charge of the care of your heart in the search for answers or alternatives. I wish you luck with your ablation in the future Dave.

Dave0 in reply to Safc1983

Thank you and I’m soon to be 38 so catching you up! Good advice and I think I’m lucky that my cardiologist is so helpful and approachable. Think I need to pester after a another week or so once I’ve given my heart a chance to recover a bit more. Sorry to hear you’ve experienced similar Covid issues and hope you’re continuing on the road to recovery!

I had 2 cardioinversions as I waited for a second ablation in the summer autumn of last year. And I had just the same “ my heart is in sinus why don’t I feel better?” Feelings as you do . For me it was a combination of the beta blocker making me quite torpid and ( aged 60) 3 weeks of rapid 140-160 bpm had made me have a sort of temporary heart failure . So it toook nearly 2 weeks for the inversion to make me feel better as I reduced the beta blocker and my heart recovered from its marathon(S) Literally one week after I was just starting to feel good my afib came back and I wAs very grumpy!

But it was better controlled so I was feeling 90% normal as I had my second ablation in November . That has set me in happy sinus ever since and 3 months on I really do dare to dream that I will have prolonged respite

You will get this sorted and you will be fine good luck



Dave0 in reply to Sfhmgusa

Thank you Steve for the positive encouragement and you’ve summed up my thoughts about not feeling better perfectly. Glad to hear you’re feeling better and long may that continue - dare to dream!

I've had almost a dozen cardioversions. Since I had progressive, aggressive AFIB ... only the early ones gave me some lengthy time between attacks. As time went on, the cardioversions didn't last for long. So I sought out and received several ablations. Currently AFIB free 100+ days post 4th ablation.

I was around 55 and no meds during early CV's. None of the cardioversions affected me with tiredness. I felt great. It's probably the meds .... slowing down the heart rate will wipe out some people. It's a well known affect of blood pressure meds.

Thanks, yes meds seem to be the consensus and my HR is pretty low now, which at least will give my heart a break! Pleased ablation finally did the trick for you 👍

After three months in very symptomatic Afib took me three months to get back to full fitness ie running and cycling again...

Dave0 in reply to Jajarunner

Thanks, useful to know, hope you’re doing well now.

Hey Dave I to am 37. Contracted suspected covid in march last year. Felt incredibly rough. Had sudden onset of fast af in October and was Cardioverted. Medicated with 2.5 bisoprolol. I was still having runs of af and Christmas night tipped into a fast af again. This time brought down with flecanide IV. Dose upped to 5mg bisoprolol. Still have some episodes of af but reverts itself so far. I think you may be on a beta blocker for a while, due to trying to keep a rate and rhythm in good parameters. I have a telephone consult with my cardiologist soon for my first referral. I think I to will be awaiting an ablation

Dave0 in reply to jd_fatboy

Sounds strangely familiar! Fingers crossed ablation does the trick for you.

I had a cardioversion. Nobody warned me about consuming alcohol post cardioversion. I maintained NSR for four days until I shared a bottle of wine with a friend. Of course every case is different, that's just my experience.

Thanks for sharing, yes so many triggers it seems! I’m currently off alcohol and caffeine for a while. Dry January was easy this year!

Windlepoons in reply to Dave0

I've been a lot better since I gave up alcohol a couple of years ago. Keep it up Dave! As an aside, I love your avatar pic. Very cute.😊

Dave0 in reply to Windlepoons

Thanks but I take no credit for the automated pic!

Windlepoons in reply to Dave0

I thought it was your pet hamster lol. You did better than me as I ended up with a fly! Have managed to change it to my cat today. Hope you feel much improved soon.


Welcome to the Forum - The A F Association is happy to provide you with any advice or information. Please do not hesitate to contact us on

Dave0 in reply to TracyAdmin

Thank you Tracy! So much great information on here!

Personally, I felt better as soon as I came round from the cardioversion. However, I started on bisoporol and came off that a few weeks after as it made me feel awful (this was all pre-cardioversion). I was swapped to metoporol which I can tolerate much better (apologies, if I've spelt the medicines incorrectly). Neil

Dave0 in reply to Neilor73

Good to hear Neil and thanks. Yes I felt similar to you first time around but not so on this occasion.

Hi I have had one cardioversion it lasted a day I am taking bisoprolol and riveroxaban I can’t get out of chair or bed in morning without a struggle iv also got a pacemaker that don’t seem to be benificial was due for another cardioversion in jan but was cancelled I can’t walk far and can’t stand for more than ten min as pain in my back is unbearable I take co codamil for pain have a call next fri with clinical nurse but am at a loss with what to do with my life all I do is sit as that’s the only way I am pain free and of cause then the weight goes on over a stone since xmas not been out for 12 months unless for bloods so I need the cardioversion ASAP then it’s not 💯 percent it will work no way to turn at moment thank you for these posts they are interesting and helpful

Hi Geraldmilton I can relate to your back pain. I was taking rivaroxaban for 5 yrs and could not stand for more than 5 minutes without being in excruciating pain. I kept telling my cardiologist that I felt it was the anticoagulant but he didn’t think it was. I had no life I went to work and came home that was my life for many years. I finally convince my doctor to change my medication and my back pain went from a 10 to about a 4 which was a significant difference. My pain did not go completely away but at least I got my life back. The reason I still have back pain is because I had back pain before I was on any anticoagulant and the rivaroxaban just exacerbated it.

Dave0 in reply to Geraldmilton

Sorry to hear you’re feeling that way, that sounds really tough, hope your call leads to a way forward real soon.

Hi Dave,

I was cardioverted a couple times in the past with no bad reaction afterwards, only a general feeling of relief I was back in sinus rhythm. As a past history, I too was on Verapamil which turned me into a walking zombie, and my meds were finally changed. I had Covid in December, that unfortunately has now ramped up my a-fib episodes; I'm getting a second opinion soon as to a second ablation -- my first was in 2019. Good luck in finding a solution. I hope you get back to normal soon.

Dave0 in reply to Snowgirl65

Thank you and glad you felt good after cardioversion, I was much the same first time around but not this time so it’s likely to be the verapamil causing me issues now that I’m out of AF I think. Hope things settle down for you as you recover from the effects of Covid.

Hi. I've had 3 cardioversions and felt pretty much instantly better after each of them AF wise but did feel tired for a few days after, which I was advised was probably due to the sedation. After the last one in August, I did end up in A&E a few days later as I had developed a chest infection so I was probably brewing it when I had the cardioversion. Hope you feel better soon.

Thank you! And glad you felt pretty good afterwards (chest infection aside!) all this is pointing to my medication I think.

Just an update in case helpful for others - I heard back from my Cardiologist a couple of days ago and he suggested coming off the verapamil. Very soon after doing so, I was feeling so much better 🙌Thanks for comments all!

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