AF after cardioversion

[cuore]

Wednesday, day 34 in AF , I will be having a cardioversion. I am aware that cardioversion is a band-aid, but I have had three ablations already.

One year 10 months post third ablation, I was doing very well, especially the last four months in a beautiful normal b.p.m. range, aided by Propafenone. Due to kidney issues, I tried to wean off the drug. Bang! Back in AF.

A few questions are crossing my mind for those that have had more than one ablation:

1. Did you have to have a second cardioverson soon after?

2. How long was the time span before AF reoccurred?

3, Was there something specific that triggered your AF? (Mine was eating a third consecutive donut in stale oil that a friend gave me. )

4. What was the next treatment, i.e. another cardioversion, another ablation, road to permanent AF?

5. Could these waiting for cardioversion 34 days AF cause further remodelling and fibrosis to an extensively fibrotic remodelled heart?

6. With so many ablations (mine 3), were you ever able to stop an anti-arrhythmic drug?

After so much effort, I feel as if I am doomed to fast-paced permanent AF. I am totally aware that those in that club are doing very well, but thank you, I do not want to join it. I am also aware that any treatment is for quality of life , continuously expressed, but thank you, I do not hold that viewpoint.

I am grateful for anyone answering this post to give me further enlightenment. I feel that I am at a crossroads in this disease that I never will be able to live in sinus rhythm.

[Kaz747]

I’ll answer question number 6 - I have had 4 ablations for various arrhythmias. My last was two years ago and I haven’t had any known AF since but occasionally I get a bit of tachycardia. My EP has left me in 25mg of Atenolol each night. Because of all the dramas I had I think it’s a bit of an insurance policy.

[cuore in reply to Kaz747]

Thank you for your reply. When I get back to sinus, I will make sure that I take the anti-arrhythmic drug prescribed. I tried to get off of it once before. I was able to get back to sinus rhythm within 4 hour of taking Propafenone. This time, to my shock, it didn't work. I stayed persistent. I get both AF and tachycardia, but more and more AF now. Can hardly wait for the cardioversion because I am paranoid that more damage is being done.

I am going to conclude that if you have had 3 or 4 ablations, you'd better take the anti-arrhythmic drug or suffer the consequences. (Granted you are taking a beta blocker.) Congratulations on two years.

[Hidden]

Q. 1. Offered but refused. I asked the chance of being in SR at 6 months. 50%. Pointless

Q. 2/3. 4 weeks. Major stress

Q. 4. Settled for permanent AF, ok with beta blocker

Q. 5. Need to know your degree of atrial myopathy (MRI). Not helpful to generalise

Widen your DCCV net. Ring around for cancellation slot listing. Consider private depending on predicted chance of success (and cost of course)

[cuore in reply to Hidden]

Thank you so much Bill64. You made some thoughtful choices. AF returning in 2/3 weeks is so disappointing. You were offered another cardioversion, but were you not also offered another ablation?

After watching Dr. Sanjay Gupta's video, I am now going to read up on atrial myopathy. Fascinating topic. What a beautiful age we are in as there is more and more research on the heart.

I live in western Canada. There are no private AF clinics; they are forbidden. We do not have the luxury of seeing an EP privately and then going onto the public system to gain precious time. The comment of my EP was that I would be jumping the line. Disgusted with the waiting time in persistent here, I did go to Bordeaux, France for three ablations for which I paid myself.

So pleased to hear that you are doing fine in permanent AF.

[Hidden in reply to cuore]

The experienced EP who did the second advised that a third wouldn’t work. At further follow up, a new inexperienced EP suggested he try again. I felt (and understood) that he needed to develop his expertise, but not by practising on me.

[cuore in reply to Hidden]

That's interesting because many have had three ablation including myself. I do see your point in having an experienced EP though.

[Coco51]

I think maybe as it's Wednesday you may have had your cardioversion. Even so I will reply to your post because you may find it helpful. 1. My first cardioversion was before my first ablation. It lasted around 12 weeks up to the week before the procedure.

2. Second cardioversion was 13 months after the first ablation . (9 months of sinus then in and out of persistent AF for 4 months). It lasted 4 hours!

3. First recurrence was when I was sitting in a beautiful pub garden in the country overlooking a peaceful valley eating a small but delicious meal. Smoked salmon starter followed by homemade pasta with wild garlic pesto with salad as it happens😋 no wine. (No doughnuts😉. I don't have a sweet tooth.)

Second recurrence was resting on the sofa 4 hrs after the cardioversion when I had a slightly tetchy phone conversation with my daughter who was bring a pain! Then was in AF for 3 months till the second ablation.

4. I have not had persistent AF since then just lone episodes though quite frequent. But much more manageable. Still on Flecainide and Bisoprolol. Trying to cut back on Flecainide was a disaster.

At the time of the second Ablation one consultant said I could need a third. Since then, I have booked a session with Sanjay Gupta online for second opinion. He thought in my case more Ablations could be the law of diminishing returns. Interesting to actually talk to him.

In the last year I have had a backup pacemaker fitted as the AF drugs make my lifelong Bradycardia worse. Once my HR was down to 36.

Doctors say if the AF is troubling then Pace and Ablate is a neat solution if I didn't mind being pacemaker dependent. But I do mind so that is on the back burner. I'd rather stop the beta blockers but that doesn't seem to be an option.

5 & 6. Cardiologists have told me that you should have a Cardioversion or Ablation within 4 months of persistent AF starting, to avoid remodelling. They have pretty much stuck to that with me.

If you have fibrosis already the AF may not make much difference according to this video.

youtu.be/l_Xc3FnPIuM(Not working as expected?)

I am fast coming to the conclusion that once we are in our 70s even people who are relatively healthy still have wear and tear in the heart, and worrying about it makes it worse. Once I was eager for a third ablation but as I am managing quite well at the moment, feeling OK, managing my fear through having learnt self-hypnosis, I might wait.

Sorry a bit of a ramble. But good luck with the cardioversion.

[cuore]

Thank you Coco51, your reply came just before my cardioversion, so it was most helpful. I would like to report that my cardioversion went really well and I am now in sinus rhythm again. This time, I will not try to wean myself off a drug.

Now for me to understand your journey. For your first cardioversion to last for 12 weeks ( about 3 months) right up until your first ablation is very good compared to me. I lasted 3 days. You had another cardioversion prior to your second ablation , and you seemed to be maintaining sinus rhythm post second ablation.

It is disheartening when we take a drug to help one problem, we create another. You take AF medication to address your AF only to develop more Bradycardia. It is a vicious circle.

I believe The AF Cure, a book I haven't yet bought, says that fibrosis starts at 5 weeks persistent. Dr.Haisaguerre in 2014 had already presented a paper at the AF annual symposium that during the first six months of persistent AF, 4 rotor areas are formed. The authors of this book are building on his initial research.

I did ask my local EP about the heart remodelling after ablations in persistent and he said yes, the heart is still remodelling. I was in day 34 when this fourth cardioversion was done.

Good luck to you that you do not need the ablate portion of your procedure. And, a special pat on the back for exploring your options.

[Coco51]

Great news about the cardioversion. I am very pleased to hear it went well and worked. Time now to enjoy the sinus rhythm and the spring weather. You have had the procedure within the best time frame, so long may it last!

You are so wise to stick with the Propafenone. Let your heart get used to a nice steady beat.

Yes it is disheartening when one drug counteracts another but in my case I suspect I am paying the price of a career in which I thrived on stress, deadlines and adrenaline! (Which I enjoyed I must add).

I am about to start reading The AF Cure, and I'm glad to see a journalist has played a part in the writing of it. At least it should be understandable. So much science writing is mired in dreadful jargon. Although I am wary of any book that talks of "Cures", I shall be keen to see what it offers.

Good luck to us both 😊