Cardioversion not available on the NHS? - AF Association

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Cardioversion not available on the NHS?

honey1958 profile image
honey1958

Hello all I was diagnosed with fast AF two years ago and put on 5mg bisoprolol which seemed to control it for about a year. The episodes then got closer together and more severe and my dose was upped to 7.5 and then 10mg.

As this still did not bring the rate down Digoxin was added but seemed to make things worse. I started to have nausea breathlessness and extreme tiredness as well as the awful palpitations and after a trip to A&E was put on the list for cardioversion.

Two days later I received an email to say the NHS is not doing cardioversions for the foreseeable future due to covid. My cardiologist then stopped the digoxin and put me on amiodarone which has made me feel even worse.

As I have zero quality of life I asked about going privately for cardioversion and I will be having it in a fortnight's time.

I am disgusted that the NHS has stopped a treatment for this debilitating condition. Incidentally it could be a postcode lottery. A doctor friend in Scotland said you would be able to get it on the NHS there.

Any views? Thankyou for reading

110 Replies

Yes. I agree. pretty awful A friend has been waiting for a hip replace. for one and a half years in a major London hospital. She is is now in constant pain and using crutches. No sign of the op. taking place any time soon.

What a disgrace that is for you honey1958. A cardioversion is no big deal, so I really can't understand why it can't be carried out because of covid. So annoying that you are going to have to pay privately. Supermarket checkout workers and shelf fillers have carried on working throughout the pandemic, why not doctors!

Jean

I totally agree it’s a disgrace. It makes me so angry!Some doctors have had it pretty easy throughout this pandemic!

CDreamer profile image
CDreamer in reply to mrgwair567

And many have had it really tough.

momist profile image
momist in reply to CDreamer

And too many doctors have died!!!

Ppiman profile image
Ppiman in reply to mrgwair567

Wouldn't it be that if there were any doctors who had "it pretty easy" during this dangerous time, that it wouldn't have been of their choosing but that they were following the hospital management's instructions?

Steve

mrgwair567 profile image
mrgwair567 in reply to Ppiman

Maybe , maybe not! Don’t you find it strange though that the minute you say that you want to be seen privately, that the procedure becomes available almost immediately.!

Thomas45 profile image
Thomas45 in reply to mrgwair567

Not strange at all.

Singwell profile image
Singwell in reply to mrgwair567

My impression during two recent stays, one of which was in the 2nd wave, is that they are giving 100% and more.

Bobbo52 profile image
Bobbo52 in reply to mrgwair567

😡

I second that jeanjeanie

I never ever got a DC cardioversio at my local hospital. 3 times it was planned but twice they could not get a team, it was the anaesthatist was not available and they would not do it without one ( I did ask )! I suspect anaesthatists are in short supply!

seasider18 profile image
seasider18 in reply to KMRobbo

I've had three cardioversions with not an anaesthatist in sight. Each time they were done by nurses.

Hidden profile image
Hidden in reply to KMRobbo

My local hospital tells me that if anaesthetists are not available due to Covid they carry out cadioversions using sedation.

You are quite right Honey.

It's funny how if you pay you'll be in asap. If not you have wait.

Hmmm.

Paul

Nerja2012 profile image
Nerja2012 in reply to Paulbounce

I think this is the future Paul.

Paulbounce profile image
Paulbounce in reply to Nerja2012

I hope not Nerja ! At the moment (in the UK) we have a mix - private and NHS. Private means your in the next day - NHS means a wait (although they do a great job).

Let's see how it pan's out.

Enjoy your day.

Paul

Ppiman profile image
Ppiman in reply to Paulbounce

It's certainly not "next day" even in private hospitals. Many private hospitals were commandeered at great cost during the year - but not used it seems (according to the press...) owing to government and NHS management mix-ups and poor decision making.

hsj.co.uk/finance-and-effic...

Paulbounce profile image
Paulbounce in reply to Ppiman

Great link Ppiman - thanks for sharing.

Paul

When I considered having my aortic valve surgery privately they offered to bring a team in on Boxing Day.

Out of interest is it possible in England to pay privately for an ablation or is this procedure only covered under NHS. Asking as I am in Canada and there is limited private options for any type of private treatment. Thank you in advance

CDreamer profile image
CDreamer in reply to listerines

Yes you can pay privately, or could prior to COVID. All private consulations were interrupted by COVID as the hospital were commandeered by NHS for their elective surgeries in our area

I’ve had 2 ablations both done privately in London as, at that time, we had no local services offering the procedure and a cardiology department unwilling to refer. I have heard other Canadians say similar on this forum and one member flew to France to world class centre which I think ? invented the procedure to have ablation - cheaper option than US!

In UK ablation = £15-20K and rest of Europe similar. US I’ve heard anything from $40-250K. Of course you also need to factor in contingencies for anything going wrong, travel etc. And that you might need more than one procedure. All in all, expensive unless you have insurance.

Yes you can pay to have one privately here. When I had to see a private cardiologist because there wasn't a cardiologist at my local hospital I asked and the price was between £9,000.00 and £15,000.00 - depending on what anaesthesia used and if you spent a night or more in hospital. That was 4 years ago now so I daresay the prices are going up as I write.

CDreamer profile image
CDreamer in reply to Paulbounce

The EP’s in our area cancelled all their private consultations and the NHS commandeered the private hospital - so that NHS heart procedures could continue in a COVID free building. No private consultations here.

seasider18 profile image
seasider18 in reply to CDreamer

Our private hospital is now a fertility clinic.

CDreamer profile image
CDreamer in reply to seasider18

Well I guess some things must continue.......🙈

Kevin2331 profile image
Kevin2331 in reply to Paulbounce

That's why we don't want government run healthcare here in the USA. But Biden and the democrats are trying to ram it down our throats

Paulbounce profile image
Paulbounce in reply to Kevin2331

I won't say to much Kevin as forum rules say no politcal views should be discussed on the forum - fair enough.

I can say though (no politcal view intended) the UK is sort of half way between the two - leaning more to the NHS. Private health care here costs quite a bit - BUPA for instance. For a guy with a heart condition and my age it would cost a lot a month.

I always have paid to see a consultant privately and then asked to be referred to the NHS - explaining I don't have private health insurance. I see the same person but it takes a little longer.

Before covid I spent much of my time abroad on business (Bulgaria). It was great there and so cheap. They also have the mix but seeing some one privately cost pennies (compared to the UK). From memory I paid to see a cardio (100 lev - about £45) at a private clinc in Varna. He did ECG's and all sorts for that - I called up and he said come now. It was that quick.

I wouldn't want to go to a public hospital there though ! However you don't make an appointment - you just walk in and a doctor sees you then and there. Perfect in some ways but not so good on other things.

It's the same with dentists - just walk in and have a scale and polish - no appointment needed. Also cheap compared to the UK.

Good and bad in all of it I guess.

Paul

I think you should also get your medication reviewed so you are on the right drugs to help keep you in sinus rhythm after the cardio version I think procedures were stopped to prevent patients getting Covid as well as staff being reallocated to Covid wards but agree you should be able to have it done now

BobD profile image
BobDVolunteer

Cardioversion (DCCV) is not a treatment for anything. It is a useful tool to see if you can be reverted to NSR in which case some other treatments such as ablation may be offered. Since AF is not generally life threatening all and any treatment for AF is only really for quality of life so one should understand that in the current climate it comes very low on priority. Life isn't fair I agree but it is what we have.

By the way DCCV involves at least four trained medical staff including an anaesthetist and a doctor and is far from risk free as I discovered when my heart stopped and I needed CPR for some time to bring me back . Too many people think it is nothing but read the consent form!

Mrverycross profile image
Mrverycross in reply to BobD

I had a nurse, anaesthetist and the Arrythmia Nurse who i believe has extra training but is not a doctor. I was kept in the ward for several hours afterwards not forgetting the hour beforehand. Mind, the procedure is similar to defibrillation (only seen this in training though). And NSR only lasted 4 weeks. But the meds control my AFib which is mainly irregular heart rate with occasional fast.

BobD profile image
BobDVolunteer in reply to Mrverycross

Arrhythmia nurse is trained to MA level.

pottypete1 profile image
pottypete1 in reply to BobD

My experience differs from your description Bob.

Over a period of about 25 years I had over 20 cardioversions.

Each time I enjoyed many subsequent months AF free and it improved my QOL immeasurably. I was only cardioverted if my PIP did not work and I left it for the optimum amount of time before seeking help.

I was never told they were only giving me a cardioversion because they wanted to see if I could be returned to NSR with a view to having a later ablation. The first 10 or so cardioversions were over a period of about 10 years at Royal Surrey Guildford and the word ablation never passed any doctor's lips.

It was not until I moved house near one of the Cardiac Centres of Excellence ( by default I had no idea that this was the case) that I was referred to a Professor of Arrhythmia medicine and I was first offered one of many ablations that I have had.

I know you had a very bad occasion when you needed CPR that must have been very frightening and highlights that nothing is 100% without risk, but I would suggest that your experience was the exception rather than the rule.

Anyway each experience adds to the overall complexities of experiences endured by those that read this forum.

Take care

Pete

BobD profile image
BobDVolunteer in reply to pottypete1

Pete not a worry to me as I wasn't there at the time. It was somebody else's OH S--T! moment. lol Seriously people should not think of it as routine. It isn't!

pottypete1 profile image
pottypete1 in reply to BobD

I probably mean frightening for others.

Lets be honest how ever difficult a procedure is it is much easier in my mind for the patient than the nearest and dearest.

Ask my wife about the time I went down to the Cath lab for an ablation at 08:30 and didn't surface until 17.30.😀

Pete

qp3usavk profile image
qp3usavk in reply to pottypete1

Well said! Cardioversion IS a treatment for atrial fibrillation. If it does not succeed, then other treatments are considered. Otherwise, it would be an extremely expensive and time-consuming diagnostic procedure!!!!

Have you considered having a face to face private consultation before cardioversion, which may not be sustained anyway? Your way forward doesn’t seem very clear.

BobD wrote.

"Cardioversion (DCCV) is not a treatment for anything. It is a useful tool to see if you can be reverted to NSR in which case some other treatments such as ablation may be offered"

That's dead right Honey. Without med's you can soon go back in to afib. I have been on a fairly highly dose of flec since my last one, Two years later I'm still in sinus. 200mg a day and one other as a PIP should I have afib return. I've had a few blips but nothing to really worry about.

I'm going to take a punt that you will pay around £1800 to have it done privately in the UK. I wonder if you think it's worth think embarking on this course before having a med ie flec. I can't tell you what to do.

My first CV lasted for about 3 months - a few days for the second one and the last one 2 years (so far). I'm 100% sure though this is down to flec. Maybe it's worth talking to your cardio about this ?

My opinoin is this. A CV will help - even if it only last's a few minutes. However it's worth having a Google. (Edit - only decent sites such as medical journals. Not FB etc).

Just to be totally clear - I am not a doctor and can't tell you what med's to take. However digoxin is more likely to help you stay in sinus than bisoprolol (after your CV).

I wish you the best of luck with it. I'm sure it will help you.

Best,

Paul

Thankyou for all the replies.

I had a lengthy conversation with the cardiologist who said that the amiodarone will help maintain correct rhythm if continued after the CV. He does not want to change my meds prior to the procedure.

I'm getting really concerned now as the CV was recommended as the best next step but there is a good chance it won't work? It's paid for as it had to be in advance and you're right Paul £1.7k.

I accept I will most likely still need meds afterwards. Would love to reduce or stop bisoprol though as I'm sure it makes me feel even worse.

Cardiologist did mention ablation but as next possible step. Dread to think of the wait time though that's if they're doing it at all here in Derby

Bob I understand that AF is possibly low priority at the moment as it's not usually life threatening but I'm shocked by how bad the symptoms are. I have no life at all and can't imagine carrying on like this indefinitely.

Sorry to moan!

Honey1958

CDreamer profile image
CDreamer in reply to honey1958

All the CV will do is indicate whether or not an ablation would possible. It works sometimes, for some people, for a length of time which could be hours/weeks/months/years. Ditto ablation - which are continuing here - see my post above. It’s not a one time fix, it often is considered a series of treatments - unless you are young and fit and have a world class EP.

My husband at 85 had a CV - he converted for 7 seconds so ablation was not an option. He was prescribed Amiodarone - he was back in NSR within 3 months. He still takes a maintenance dose. He is lucky in that he has no side effects and is very well monitored by the GPs. He had other heart problems so for us now, it is the quality of his life which is most important. From not being able to function, he is now pretty well. He will never be able to do what he was able 5 years ago - play golf, travel etc - but he enjoys life and is able to do normal everyday activities but requires more rest.

I do hope that something works for you.

Tapanac profile image
Tapanac in reply to honey1958

Ps to my last reply. If your symptoms are really so awful they are ruining your life (which we all completely understand) perhaps call an ambulance and paramedics will take you into hospital as they usually do with anything to do with the heart. Then they might give you a cardioversion then and thereGood luck

cuore profile image
cuore in reply to honey1958

You are medically in good hands; I am not a doctor, and I have no intention in contradicting what you have been told. But, let me give you my prospective as a seasoned afibber.

When placed on Amiodarone, I would be concerned for how long because one of the side effects is that it can destroy your thyroid whereby you would have to be on thyroid medication for life.

Try not to be wound up that your cardioversion will not work. The cardioversion working is relative to how long you were persistent. The arrogant cardiologist, I was sent to, put this huge fear in me that I would not be cardioverted which was nonsense because I went to see him at day 54 persistent and the cardioversion was day 91 persistent. Not enough time had passed for me not to get back to sinus. Unfortunately that cardioversion lasted only three days. It was still termed successful because the heart did return to sinus meaning I could have an ablation ( I went on to have three).

Once you've been persistent and especially if for a long time, do be careful about stopping your antiarrhythmic meds. At one year and ten months post third ablation, I have recently tried to stop Propafenone because everything was most normal for four months. Bang! AF returned and would not be stopped by taking Propafenone. I now have a cardioversion scheduled in the next five days whereby I will have been persistent 34 days. I can only hope that I remain in sinus rhythm.

My position is that AF should not be taken lightly simply because it is labelled as non-life threatening. It is life-debilitating even without severe symptoms due to all the other things that go on in your body because of it. Recent clinical trials have concluded that it is better to place a patient on anti-arrhythmic drugs to try and keep a patient in sinus rather than a rate control drug merely to keep the heart rate down and let a patient remain in arrhythmia.

Good luck. I am cheering for you that you will have a very successful cardioversion.

I’ve been in PAF for 2 years now, at least the 2 years I know about ... thankfully I suffer minimal effect from it. I’ve had 2 DCCV neither of each worked. I’m on 240mg of Verapamil daily which generally keeps my very erratic average heart rate at around 80bpm with a BP of 110/70. I think the point I’m trying to make is a DCCV is not a miracle cure.

I realise it’s too late for you to change things now as you have paid but if you do go down the ablation route then you could try this. I paid privately (£250) to see an EP in Warrington for initial consultation. He said I was prime candidate for ablation and transferred me to his NHS list at Liverpool Heart and Chest Hospital. I think the wait was only 3 months but that was just before covid. I then had an RF ablation last October and was told wait could be 6/12 months but had it within 2.5 months from appointment. I’m in West Yorkshire but was willing to travel to get a good EP, hence me going to Liverpool. I had also said I would accept a cancellation at short notice which is what I think happened the second time. I was also able to have echo, ecg and covid test done locally and results emailed to save me travelling to Liverpool. I hope everything goes well for you. x

Being willing to accept a cancellation is a really good way to shorten your waiting time. My second ablation was scheduled for March 2017 but I rang the booking clerk late November 2016 and said people would probably decline the offer of an ablation in December coming up to Christmas. I was asked to come in for my preop 10 days later and offered my ablation for December 15th. My slot had been offered to THREE other people before me, all of whom declined because it was pre Christmas. Crazy.

That’s very good advice!

I noticed NHS had it's shortcomings ... as I repeatedly read about less than satisfactory treatment in AFIB patients' posts. However, some forum members said it was a brilliant program and was more equitable for patients than in America.

Now ....... here we go again.

I think some patients have been in the obviously mediocre program for so long ... they don't know what competent treatment is. USA medical has it's shortcomings, at times; but, it's not to the degree I've read here about NHS.

I truly wish you didn't have the 'wait lists', postponements, and outright cancellation of procedures. Especially with AFIB.

I recently read in the book The AFIB Cure by EP John Day that fibrosis in the heart develops in an little as a few weeks of treatment delay. And ... this observation was confirmed by several forum patients who were made to wait and suffered the consequences.

I really think this post is unhelpful and not comparing like with like. We too can go privately in uK. But we also have the NHS. And it is not “mediocre” but under strain, and Covid is a major strain. Those medics not offering this cardioversion are not on the golf course they will be redeployed under pandemic. I had an ablation during the pandemic from a world class unit. Most cities have teaching hospitals which are top class for research. Some will be inadequate. That is true in USA too! But having lived in the USA and having friends bankrupted by chronic illness, you cannot compare. My daughter paid 3,000 dollars for an ambulance drive of half a mile after an accident! Yes, reimbursed, but so stressful.

Cardioversion is a quick but probably resource intensive procedure requiring close contact in a pandemic. Would I seek it privately? In the OP situation I might but it may not be the wisest way forward. I hope it works for the OP.

CDreamer profile image
CDreamer in reply to FaberM

Very well said. Everyone is treated here, not just those with the means to pay & jump on a flight.

I’m sure your system is great for those who can afford it but truly terrible for those who cannot. And plenty of people cannot afford it in the States. The NHS is far from mediocre and is free for everyone.

The thought if an elitist system of health care is abhorrent.

Nobody will bankrupt themeselves or their families for medical treatment in the UK. Plenty do in the US. Plenty in the US have no access to healthcare at all, not even glasses and teeth if they don't have the money for the ridiculously expensive insurance premiums.

But then it's not uncommon to hear American's supporting this completely unfair system. Rather like Stockholm syndrome. Your system is far worse for so many and on a par for the rest as our rich will pay to jump queues and see the best specialists. You have nothing to brag about.

I am so glad you call a spade a spade and place things into perspective relative to AF.

Canada has the same system, especially western Canada, as the NHS. The one good thing in these social systems is that you do not pay for the visits and procedures.

But, what good is that for the AF patient that has to wait and wait in persistent AF so that the patient is then never given a procedure at all or the waiting time has cause so much fibrosis in the heart so that regardless of the number of procedures the ablations don't last.

Also, in western Canada there is no luxury to go for private consultation and then being placed on the public NHS for a short cut. Private clinics are banned. In Canada, a huge number of patients are led to persistent AF and doomed to stay there forever. No socialistic system ever compensates for these eternal AF patients, myself being one of them. Five years after being first diagnosed and four years of persistent AF, I have seen little to no improvement in wait time.

listerines profile image
listerines in reply to cuore

Interesting cuore, am also in Canada and have been wondering about public wait times and the possible impacts on patients with persistent afib (who i believe should be prioritized for treatment). Are you connected with an afib clinic and discussed your concerns with an EP? I find that the squeaky wheel sometimes gets a bit more grease in the Canadian system (unfortunately).

cuore profile image
cuore in reply to listerines

There is a long story of the wait time for me just to get to see an EP , I was not prioritized even when I offered to pay for the ablation "because I would be unfairly jumping to the head of the line" even though at this time I was five months persistent, and had to jump hoops for that appointment to not be at 7 months persistent. Instead, I jumped on a plane for Bordeaux, France and had the ablation one month later at the six month persistent stage. ( I paid for that procedure and two more for three ablations myself -- to the underground for the free Canadian health system. )

In six months persistent , my heart became extensively remodelled that I was one of the most complicated cases at the six month stage, an honorary distinction for which I will forever pay.

I am still paying the waiting game price because now I need a cardioversion (even after three ablations) and it will be day 34 persistent to get this scheduled cardioverson. Utter nonsense, and who knows how much further damage to an already damaged heart is being done in 34 days . Yes, I did follow up to make sure I had a time because I was being yo-yoed between EP office and booking. The last scheduled cardioversion took 91 days.

Grease is needed, but not for the patient, but for the Canadian AF system. No one should ever get to persistent via a laid back waiting time attitude. Your post does not reveal if you are a patient, an AF researcher or both. Because you pose your question at arm's length I would conclude you are a researcher.

listerines profile image
listerines in reply to cuore

Hello cuore, thanks for replying. I am certainly not a researcher just a fellow afibber concerned about systemic delays in the Canadian healthcare system negatively impacting one's health. The lack of any private option for treatment can make things additionally challenging in Canada and after reading about your situation above it adds further fuel to the proverbial fire. I am wholeheartedly sorry that you have not been treated with more dignity and respect. Regarding a cardioversion though would you not have the option of heading to hospital and having this completed in a more urgent fashion (covid aside)?

cuore profile image
cuore in reply to listerines

That may be an option in the future. I do have a Canadian EP. When I phoned the office on Day 3 AF, I had to wait another week for the system to schedule (probably because he wanted to have payment evidence) which brought it to day 11. Then there was my sending him Kardia ECG which I did on same day. Day 14, was call back from office secretary whether I wanted cardioversion. I did have an email ready to send that contained question about going to emergency. Easter. Then again Day 19 via secretary whether I wanted cardioversion or drug treatment -- no address to go to emergency for cardioversion. Cardioversion booked by secretary for day 33 AF. Not given time so phoned following week. Yo-yo between secretary and booking gal. Booking gal changed to Day 34. And, I do not know who is going to do the cardioversion. It is a nightmare here when we do not have a private option and when AF patients are purposely left to get worse. I have no choice but to deal with it. There are praises for the Canadian healthcare system, but not for AF.

Commiserations. I think practice may vary depending upon where you live. I have never been offered a CV ever and that was from 2014 and also had to go privately to access treatment other than drugs for my AF. I did, in the end, receive a Pacemaker from the NHS which has resolved my issues but that was pre-COVID.

Unfortunately, I do believe that we will lose many of the services we have enjoyed for none immediately life threatening conditions.

Please do not blame the doctors. I listened to a GP friend recently for over an hour, distraught at what is happening (or not) in the NHS. If we want to retain the medical staff we have we can’t start blaming them. Yes, be angry but direct that anger where is belongs, the people who hold the purse strings and the policy makers. It’s been privatisation by stealth - as my sister who is ICU manager - has been saying for the past 5 years.

The NHS was broken before COVID - it’s now on it’s knees.

I have had 2 DCCVs during lockdown, an elective one in August last year (3 month wait from when AF kicked off again) and another one, a couple of weeks ago on admission through A&E so may be it depends on which hospital and how many more urgent patients they have. You have the choice of where to have treatment within the NHS so may be worth checking with other areas regarding their lists (I'm in Coventry). Amiodarone has kept me in NSR following DCCVs so with me, it has been a necessary evil. Having my first ablation next week so hopefully, that will get me off meds at some point soon. I had been on the list for ablation for 10 months, though they said they had expedited this due to the issues I've had in the past month.

Ask your GP to refer you to an electrocardiologist ASAP. They take afib and quality of life a bit more seriously. Plus you need to sort out your meds for after the cv.

In my humble opinion, it is the Bisoprolol that slows you down I started on 2.5 mg and felt like a portable lump, I am now on 1.25 mg and it controls my af very well in fact better than on 2.5 mg. With respect to Doctors, the NHS top brass and doctors have become lazy, self-esteem driven, and overpaid. ( yes I run my own business in the private sector in the UK ) I recently needed an op and I booked in with the Nuffield first class service and an excellent job I got in three weeks after booking after I was told I would have to wait a year by the NHS. However here is the good news, in the end, I did not have to pay as they noticed I had been referred by my docs so the NHS picked up the bill as they have not spent any money, Now the Nuffield when I got there was 80% empty - and guess what that was because no one in the NHS had booked in any operations when they reopened. So my advice is to yell and scream and play the system. And if anyone winges about my NHS comments, my staff have worked flat out had no holidays either and do their job, if the NHS don't like their jobs leave and see if they can get the same pay elsewhere, their job is what it is covid or no covid - caring for people. It does not matter if it is covid or ulcers Sorry for the rant.

This is deeply unpleasant. The staff at Nuffield will mostly have been trained by NHS and work there the rest of the time. Working flat out is common in many jobs, life and death after 7 years training and close personal care is not. I have been part of a group of retired NHS staff offering support to NHS staff traumatised by what they have seen during Covid. The strongest feeling they felt is guilt, that they weren’t able to do more / felt overwhelmed / weren’t as personal as they wished. Humbling. No self pity.

Nothing humble about your opinion

I read a few of these replies and wanted to say I sympathise with how you must be feeling. It can be a very distressing condition. My understanding of Cardioversion is that it's not a Treatment as such - more an emergency intervention. At least in the UK. Reading your post I wonder how good your cardiologist is and if you might do well to send money in a private appointment with an excellent Electrophysiologist, who might come up with some solutions for you.As for the NHS, I can only say that from my experience of being hospitalised twice in 4 months - one of which was in the 2nd wave of the pandemic - that they are doing their 100% best and more. They're underfunded and that's a different matter. 🙏🙏🙏 For you

I think it may very well be a postcode lottery as I had a cardioversion done in December in Yorkshire. They were stacked out and said there were delays because of COVID but were trying to keep going. I have also noticed people mention wait times for procedures on here that are different for things like ablation etc that also relate to different parts of the country. I’m sorry you have felt so unwell and had to go down the private route. The amiodarone is meant to increase the success of the cardioversion. Good luck and I hope all goes well for you so that you feel so much better after.

I knew that would provoke a reaction, I pay thousands of pounds a year in tax and NI six figures worth and I expect a service covid or no covid, you should be able to give criticism to something you all pay for. We all work hard Covid has been very difficult for me and my staff but no one winges anywhere like the NHS. I go round empty doctors surgeries, empty hospitals it is not right for the poor people on this site that have to wait.

Well aren’t you the big man . My daughter is an intensive care consultant in a department that was short staffed before the pandemic . She has worked unconscionable hours many unpaid. She did not sign up to deal with a life threatening disease without adequate PPE and did in fact catch Covid as a result and gave it to her seven year old son . And that is true of many nhs staff . I don’t expect you are expected to risk death as part of your job . If you are going to give criticism you should at least know what you are talking about . Unfortunately what I would like to say to you is not allowed on this site

here we go don't dare comment about the NHS there is no difference between caring for people in a hospital or in a care home or the public at home looking after relatives. welcome to the new china the NHS . make a comment and get shouted down. if you are so good, why are all these people on this site not getting treated now let me tell you something? UK gov figures 2632 in 1257 hospitals in the UK that is an average of 2 per hospital speaks volumes. Even if it were 10 times that number that would only be 10 per hospital. The staff in the NHS are great, the people running it could not find their way out of a paper bag.

Comments about the NHS are fine if they are accurate, fair and measured and the entirety of the NHS is not lumped in together . So there’s no difference between looking after a patient in a care home or at home, and a coronary care unit, an ICU or an operating theatre ??? Seriously ???? You are “shouting down” the NHS I am pointing out the inaccuracies and unfairness in your tirade . I can’t imagine anyone having much luck in shouting you down

No there is not I am a consultant and they all need the same care on a human and skills basis wherever you are. However, I tire looking at empty doctors' surgeries, empty private hospitals, and resources not getting used. The government is just as bad Covid covers up a number of sins so they are happy too. The Labour party has been wet fish and done nothing either.

A consultant in what ?

Infectious diseases

Says you . And yet you have all this time to run your own business ? Are you one of the slackers you are criticising ? I would have thought a consultant in infectious diseases would have been a tad busy just now

I am very, but I still have time to stick up for Jo average who is not getting any treatment. How dare we preach how good we are with the waiting lists we have. I will speak out. What are you going to say to all the people on this forum with no appointments ? I will not comment anymore as this is not the place for it

I notice you have gone from “they”to “we” re NHS . Happy to call a halt to this

Thank god arrogance isn't infectious! The NHS has been stretched like never before in history with covid , staff overworked and at breaking point, some losing family to the same pandemic caring for us without hesitation , some souls lost due to idiots that "know best" and their holier than thou preaching. So letting us know that it's all a charade and "things should run as normal" really sounds ideal! What it's like to be enlightened, this world is officially broken 🤷‍♂️

You are clearly on a roll and have a very simplistic analysis, and a deeply entitled attitude. Of course there are bad managers and some bad practice but the worst nursing I ever had was at a private hospital and the NHS has been trying for years to fix the private op done inexpertly. My mother was disabled in a Nuffield hospital and the surgeon did not return to see her, she was taken by ambulance to the local NHS to take over her care. She had very expensive cardiac surgery privately against the caution advised by NHS cardiologist and died. There are good and bad everywhere. But working with no eye on profit is an ethical good and less likely to skew clinic decisions. Bye, I don’t think this is best for this forum and I don’t want to encourage you! I hope the OP gets help though.

It is good to provoke a reaction. In any field, not just medical, the public sector generally has no idea how hard the private sector has to work to merely survive in contrast to the public sector where the government can just print more money. You hit the target that poor people should not have to wait.

Thank you so much, I am not Stupid, or arrogant I simply would like to put Jo averages view across about the real world, not the public sector world - where yes they do an excellent job no one disputes that - but the stories of waiting times and lack of consultation do not bode well with Jo average who does not have the benefit I have or many of the people calling me stupid. My staff work incredibly hard and long hours, they don't ask for medals they get on with it. We must get to the stage where we can criticize a service we all pay for. If not we may as well live in China. Thank you for your comment it is appreciated.

This sounds familiar, and I sympathise with you. My local hospital (Watford General) told me that my A&E admission at Christmas does not meet their threshold for a follow up consultation, nor even an ECG, in spite of their own A&E consultant requesting both!The NHS has just about coped with COVID-19 (so far), but all other parts of the service have broken down as a result - yesterday's waiting-list news shows that.

It would seem that minor ailments such as AF now have to be dealt with in the private sector. Becoming infected with COVID-19 would appear to be the only way to access secondary health care.

I had a cardioversion in January 2021, only had to wait a couple of weeks, so its not all NHSTrusts. Unfortunately it didn't work

cuore profile image
cuore in reply to Vrouse

Do you recall how many days persistent you were, if you had not had an ablation? The time spent persistent is when the heart remodels.

Oh goodness.

I had 3 cardioversions (2 with the pads and one chemical) during December and January all on nhs. I was taken in by ambulance twice and third time a telephone call to go in.

Unfortunately they didn’t work for more than a few days, but now on flecainide with bisoprolol. I’m sorry you can’t get a cardioversion where you are but with my experience this should not be the case. I also know a friend had a cardioversion 2 weeks ago also nhs. I hope you feel better soon and manage to get your treatment

cuore profile image
cuore in reply to Tapanac

Your treatment is interesting because you are on an anti-arrhythmic drug and a beta blocker. Are you going for an ablation?

Tapanac profile image
Tapanac in reply to cuore

Yes I am down for a left side atrial fibrillation/complex tachycardia ablation going to the harefield hospital as my local hospital is not equipped for that sort of ablation. I’ve been waiting about 10 months for this hence all the cardioversions, but since being on flecainide although I feel sluggish because I have put on weight either through this or lockdown and baking etc, I feel better touch wood

It took me a long time to recover from my first ablation in 2018 and obviously it couldn’t have been so successful if I still had problems

Apart from

flecainide 50mgs x 2

Bisoprolol 1.25mgs

Apixaban 50mgs x 2

I am on low dose thyroid pills and low dose diuretics

All the best

Pat

cuore profile image
cuore in reply to Tapanac

From January to now is about is about four months persistent, plus you were at least six months persistent to that despite 3 cardioversions, for the total 10 months as you say. You don't have your date for your second ablation. Is you EP at all concerned that you are spending so much time in persistent?

Tapanac profile image
Tapanac in reply to cuore

Morning. No EP doesn’t say anything as touch wood since being on the flecainide it seems to have settled for a while, but never know when the beast will strike again. He will be phoning at the end of this month or the arrhythmia doctor will. I gather Harefield heart hospital is tremendously busy and also I’m a bit worried about this particular ablation because it is a specialised one hence the reason St. George’s hospital or my local hospital couldn’t do it. The arrhythmia nurse says it is about 6 hours general anaesthetic but don’t know for sure.

I say things are ok but I do have bouts of feeling the acrobats doing their act in my chest but whether it’s persistent af or weird tachycardia I don’t know. I do know that when it starts I say ooohh nooooo.

It is my friends birthday today and for the first time in a year we are meeting outside for a meal and we always have one of their special gin and tonics but as I haven’t had any alcohol for a year I’m a bit dubious whether I should.

I’ve never drunk much as I’ve got older anyway although when we were younger (maybe 30-40s) I did have a fair bit at parties like most people.

Well I’m babbling so will stop.

All the best to you

Pat x

cuore profile image
cuore in reply to Tapanac

That sounds good because I appear to be reading that you are in sinus rhythm now. I have not heard of a complex atrial tachycardia ablation in the left atrium. I had an ablation for pari-mitral atrial flutter in the left atrium. For it, I had an alcohol infusion of the vein of Marshall. It was one hour for the procedure and two hours total in the lab. So, if you were to go in persistent AF again before your ablation, would you be getting another cardioversion?

Tapanac profile image
Tapanac in reply to cuore

The hospital said that I couldn’t have another cardioversion as the three I had in December/January weren’t successful. I guess that doesn’t mean anytime in the future, but I don’t know. I must say if I thought (which I know is not possible) I would rather cardioversion than ablation. As I’m 77 I just hope that the flecainide is ok and lasts. I suppose they will do more tests at Harefield before they proceed with anything.Take care

Why would anyone expect that the very necessary treatment of people with Covid 19 wouldn't mean that all other procedures would be delayed?I am sorry that honey1958 feels she has no quality of life, but she is much better than the 350 people still on ventilation becaue of Covid 19.

Sorry, my comments may seem harsh but we really do need to keep things in perspective. To honey1958 I hope you feel better soon. I've had AF for 27 years, first paroxysmal, then persistent and now permanent. During those years I've had scary times but it's never affected my quality of life to the extent that yours appears to have had.

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Ah yes that would be because while you are debilitated and uncomfortable you could be so for many years. whereas someone with covid needs immediate attention. Because of that a knock on effect has meant small surgeries are being put off. But its not disgraceful ...it is the reality of what happens when any extra unexpected event happens. Like a car crash...you'll find your routine caefioversion reschedules if thousands of people just crashed their cars too... Extra pressure on the NHS means people like you and I get fobbed off. It sucks but at least we aren't digging graves for our neighbours like our grandparents or great grandparents would have had too. So ya know things are pretty good considering the possibilities.

In the US, you can go into ER and get a cardioversion, depending on symptoms, rate, length of time after drugs are tried. Might be the next day or while still in ER. My first one lasted 20 months. I convert easily each time....17 in 7 years I have had. I also had one when I went to my EP office and he sent me to ER to wait for him to arrive after office hours. Currently have not had one in almost a year. I am just “ill/sick” in afib, my rate goes insane and metoprolol does not phase it, even at high doses. With different drugs and dosages altered I am much more stable. Bless you, I hope you get some results.

cuore profile image
cuore in reply to Spoiler

So, you've not had an ablation but have been able to stay in sinus for seven years via cardioversion? Granted you went to ER, were you persistent for any length of time before your cardioversions. What drug are you on now to keep you in sinus.

Spoiler profile image
Spoiler in reply to cuore

Yes, persistent. In the beginning I was in complete persistent afib for 3 months, rate 135-160. Unable to do anything. I was going to a cardiologist, not EP!!! He tried one drug after another, each drug for 30 days, then unsuccessful cardioversions( would convert for a few seconds, but my rate was in the 20’s due to beta blocker) I have always had bradycardia normal rate was 44-52. I finally converted with a cardioversion and propafenone. My primary care physician suggested a second opinion and sent me to a EP. I ended up with a pacemaker after a cardiac arrest on the second pill of Tikosyn, which by the way chemically converted me in only 3 hours. I had a ablation a little over 2 years ago, it was done in 2 surgeries since I had complications, ended up in ICU for 8 days, developed cardiac tamponade during surgery(bleeding between the heart and heart sac) they could not finish, I went back 6 months later to finish without any complications. I currently take flecainide and metoprolol 50 mg every 12 hours and warfarin 5 mg daily. No other drugs of any kind! I work 5 days a week now, but would love to be off drugs. I have 2 EP Dr. , one says stay on the drugs until they do not work, the other one ( my ablation surgeon) says do another ablation. I am open to the surgery, but with covid have not done any traveling. My ablation surgeon is about 1400 miles away at the Cleveland Clinic in Ohio (US)It is the #1 heart center here. I have had 2 cardioversions since my ablation, they were 2 weeks apart due to adjusting medication dosages. I actually got worse when the flecainide was at a higher dose. I have taken anywhere from 50, 75, 100, and 150 twice daily. A roller coaster of adjustments☹️

I noticed 1 1/2 to 4 hours after taking it I was going into flutter/fib. Sometimes we have to be our own advocate. My Dr said that our hearts go through change and drug adjustments have to be made. In my case, less of a dose? Who knows?

cuore profile image
cuore in reply to Spoiler

Yes, I have heard that chemical conversions take a few hours as opposed to electrical conversions.

You were prescribed Tikosyn by an EP, but went into cardiac arrest after the second pill. If I remember, some time back a lady posted here that her husband actually died from taking Tikosyn. She was trying to get the drug banned. But, I have no intention of causing any commotion on this blog. My apologies if that sounds alarmist, and I am elated that you survived.

Having two procedures because the first is not "finished" is not uncommon. For my first, the ablation was so extensive that my heart swelled and a second was needed. Luckily, I had no complications for my first two or my third one either.

I am picking up that when your dosage was being adjusted after your second cardioversion, you went into AF, and that happened twice. So, I am concluding, also basing it on myself, that we have to be more than careful with these anti-arrhythmic drugs because they can easily cause arrhythmia when the dosage is altered in any way. In my case, I tried to wean myself off Propafenone but went into arrhythmia.

Like you, I have found less of a dose of an anti-arrhythmic drug is better for me. But, I still have to take an anti-arrhythmic drug or go into arrhythmia.

I am watching if the new treatment Pulsed Field Ablation is going to be extended for persistent patients and especially those that have had previous ablations. Currently the BEAT trial is in Europe, but it is a five year trial.

Spoiler profile image
Spoiler in reply to cuore

I survived the cardiac arrest, I was in a specialty hospital, Arkansas Heart Hospital, where each room/patient is set up as ICU room. They performed CPR, DC shock, and IV drugs. I was taken immediately into emergency surgery to implant a temporary pacemaker to speed up my heart rate to hopefully help overcome the rhythm. From what I was told, it could have recurred, I could have been on life support also. All in all, very very scary and completely unexpected by me and the EP Dr. My back was so out from all the procedures I could barely get out of bed, I suppose the CPR. I totally respect the dangerous drugs, nothing to mess around with. I do not touch any over the counter drugs, never have anyway. When did the BEAT trial begin? Very interesting.

cuore profile image
cuore in reply to Spoiler

This article below summarizes a good number or prominent EPs who are in trials involving pulsed field Ablation:mdedge.com/cardiology/artic...

The article above mentions Dr. Pierre Jais of LIRYC who has received funding for pulse field ablation in the trial called BEAT. There are numerous other on-going trials that all focus on this new technology because it is faster and tissue selective -- only the cells where the electrical signals originate are target and killed. Thus, no scaring is formed in contrast to the current system using thermal or cyro energy to create scars that electrical signals cannot jump over.

I am not sure but I think the trials began in 2019. I am still trying to find out if this technique can be used for patients who already have had ablations. In 2019, it was not possible for an already ablated patient. I do not know whether two years hence there has been an advancement so patient like you and me can also benefit.

1.25 mg of Bisoprolol put me to sleep 40 minutes ish after each of the 8 tablets I took. When I woke up I felt terrible, pain on my upper chest and arms, no exercise tolerance. If I had 5 or 10mg I dont think I would have woken up! I then tried 25mg( min dose tablet) Atenolol another beta blocker, i was only very exceedingly tired on that! So that went after 2 weeks. My GP then decided I did not tolerate beta blockers and put me on a Calcium Channel Blocker , verapamil and I had no side effect with this. I do not think CCBs are as effective in beta blockers for many, but presumably that's why they were OK for me as Bisop was obviously too effective! The ccbs act more slowly also from my ( twisted) experience.

Maybe worth a try for you?? I an not medically trained but it was easy for me to see it was the meds as one day j can run 6 miles at 8 minute miles pace, I have one afib attack that was stopped, I am given bisoprolol and the day after I can only run 100 yards slowly before I am completely exhausted as My max HR is only 117bpm!

I'm in the USA and first experienced atrial fibrillation in my late 70s after open heart surgery to replace the aortic valve. I also had a pacemaker implanted a week after the surgery because of a chaotic heart rate. The afib was paroxysmal and disappeared after a month or so but returned a year later and I was started on 5 mg bisoprolol by my cardiologist. Six months later the afib was still paroxysmal but occurring more often and the cardiologist upped my bisoprolol to 10 mg. Medical/insurance will not pay for the very expensive version of bisoprolol in less than 5 mg. Bisoprolol 5 mg was okay for me but taking 10 mg per day gave me many health problems and I had a big fight with my cardiologist to change me to some other medication, which he eventually did.

Today on this forum is the first time I heard that cardioversion is a trial to see if an ablation would be successful. I was under the impression that the earlier an ablation is given means the more chance there is of success. I asked for and was referred to an electrophysiologist and had an ablation almost two years ago. I don't feel any afib but I see some heart rate changes on my Fitbit Sense, and have the $100 gizmo to check for afib but haven't used it in more than a year. Within 10 ft. of my bed I have a St. Jude monitor which sends my heart information to my EP and at my last appointment I was told that my afib burden is 15%. All this detail to suggest to you, honey1958, that you look into getting an ablation as soon as you recover from the cardioversion. I do hope the cardioversion will be successful and that you'll have better quality of life very soon. I do feel for you taking that high dose of bisoprolol and hope that you'll be able to change to something easier on your body.

I'm not amongst the wealthy in the USA but my story re NHS vs the US system is that I was the first of my sisters to have lung cancer 32 years ago. I got surgery very quickly and I'm still alive. My one year older sister, also in the USA, had lung cancer about 15 years ago, had surgery, and she's still alive. My youngest sister, a police sergeant in Cheshire, had lung cancer about eight years ago, wasn't offered a chest x-ray for her cough until it was too late, and died. One sister out of the four of us didn't have lung cancer, and neither did my brother. So, for some the US health care system is good, for some the NHS is good.

Wishing you good luck, honey1958, and better health very soon.

The NHS is a lottery imo. I had a CV which lasted 5 months so then had to get an ablation but the wait was another 6 months. Now I know of a cardiologist in Delhi who used to work in Liverpool heart hospital and he does private ablation for £1500. I wish I had known of him when I was on the waiting list because several blue lights to A&E with arrythmias waiting for the op has weakened the heart irreversably.

cuore profile image
cuore in reply to sandoval22

Exactly!! The vast majority of the public and even those with AF do not understand that when a patient becomes persistent and stays persistent irreversible damage is done to the heart. There is too much concentration on that AF is not life threatening -- full stop. The fact that AF is not life threatening does NOT mean that clinicians can complacently allow the patient to become persistent. AF is NOT just about quality of life: AF is also about the damage it does to your heart, especially when one gets to persistent. EPs know this; they know about damage. Yet, for whatever reason, many patients remain in the persistent stage for far too long. Forget cardiologists. Many guide patients to persistent stage and let them stay there solely as their patient. These cardiologists do not even have the decency to refer patients.

I did go for a private ablation, Bordeaux, France, three of them in all. Unfortunately, when I finally got there , my heart was really, really damaged. So, AF is beyond a mere quality of life. Yes, there are worse qualities of life depending on diseases. But, let's compare apples to apples, not applies to limes. If you want your heart to get remodelled, stay in persistent.

There is a disclaimer here for all those affibers who got to permanent AF either by choice or by no fault of their own. My hat goes off to these permanent affibers who are handling the condition so well despite how they got there. However, I doubt there are members there that would want others to join their group.

There is also a huge waiting liist for Echcardiograms. When my annual one was cancelled last year they said that 2500 were waiting.

If you look around you can get an echo for £150 which isn't free but not alot for peace of mind imo.

I had it each time. The last time the nurse seemed concerned afterwards and asked if I'd felt anything. I said no but wondered how much I did have as when I got home I felt really tired and slept for about seven hours. Had a late dinner and slept well all night.

Hi. I am really sorry you are having such a rough time. I was diagnosed with AF last October. I too needed a cardioversion. They were stopped at my local hospital because of Covid but have recently started again. I had my cardioversion on 26th March and for the first time in months have a normal sinus rhythm. Most hospitals are starting to do cardioversion again now that Covid hospital admissions have dramatically fallen. Hope all goes well with your treatment. Such a shame you have had to pay for it.

I wonder if it is down to the health authority as I received my cardioversion appointment date yesterday of 1st May? I am relieved to get it through as I seem to be having problems with the Amiodorone, which had tesulted in a scan next week as the blood test has now shown an abnormal liver result. I really hope you get an appointment through soon as I know that you will be so anxiious to get it done

Bound to be a result of resources locally. I do hope it helps. Go to A&E if you really feel you can’t wait... they tend to be able to fill in the cracks in the system at the moment.

Exactly Prince .. people need to look into this Cov-deception more .. and (for instance) take one hour to listen to these Drs talking about the Cov pandemic manipulations. youtube.com/watch?v=WyoXR53...

jeanjeannie50 profile image
jeanjeannie50 in reply to Rhea11

Wow, interesting!

They are still doing cardioversions here I would say this is your local area that has made this decision. Out of interest how much is your Cardioversion costing you - 4 years ago it was £1,400 here.

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There seems to different reactions to Covid in cardiology departments regarding procedures such as cardioversion. Some hospitals have stopped the procedure completely. Others have reduced the numbers due to increased bed spacing etc. Others have stopped the procedure if anaesthetists are unavailable, but others will use sedation without a anaesthetist. It depends on local conditions affecting bed capacity and staff availability. Remember there were already staff, space and budget shortfalls before the pandemic which healthcare staff had been warning about for years.

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