Cardioversion didn’t work…: I was so... - AF Association

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Cardioversion didn’t work…

CTblood profile image

I was so surprised! I had my 2nd cardioversion on Friday, they had 3 attempts but said it didn’t work. I’ve had persistent af since at least October 19 (apart from 5 months in NSR after my 1st cardioversion in Oct 20) . I’m now on the waiting list for an ablation at St Thomas’ hospital but do have a concern whether it will work as my understanding is that the longer I’ve been in af the harder it will be to convert. The EP said they wouldn’t attempt an ablation if they didn’t think it would help so I will trust him. I’ve also ordered a copy of The Afib Cure and hope to get some tips and advice. Thanks for any advice and support.

23 Replies

Sorry to hear this. I think you’re right that an EP won’t attempt ablation if they weren’t hopeful. Sometimes takes a couple of goes as you know. Let us know how you get on

CTblood profile image
CTblood in reply to rosyG

Thanks RosyG, fingers crossed I don’t have to wait too long.

PS. On my discharge letter it showed the plan is to wait for an ablation but if my symptoms worsen then Amiodarone and a repeat cardioversion during ablation waiting period.

rosyG profile image
rosyG in reply to CTblood

I’ve heard a lot of people were put on amiodarone during lock down as couldn’t have ablation. If you have made decision I would push for ablation. Make sure they know you’re willing to take cancellation slot etc

CTblood profile image
CTblood in reply to rosyG

Thanks, I have made it very clear to the cardiac team that I am available for an ablation at any time!

Just checking, have you been put on the ablation waiting list since your failed CV or were you on it before the CV and it has just been confirmed that they are keeping you on it. I’m no medic, but it is not unusual to have another CV supported by a course of Amiodarone either side of the procedure especially as its not that long since you were in regular sinus rhythm. I think you should see this as a positive outcome because given the current pressures on the NHS, they are unlikely to offer an ablation unless they felt there was a good chance it would work. Just hope everything goes well for you.......

EP John Day in his book you ordered THE AFIB CURE ... discusses how to determine the severity of your cardiac fibrosis. I guess .... the longer you wait for an ablation that might cure you ... the worse the fibrosis gets and detrimental to ablation success.

I had 12 cardioversion. Never could stay in sinus for very long. My first AFIB ablation failed at 9 months; however, my 2nd gave me 10 glorious years of peace and normalcy.

I think if you source a top EP ... they can pretty much do miracles no matter how bad your case seems. I always sourced the best ... and flew there, if needed.

There's some people on this forum you would never think would be a candidate for ablation ... and they came out of it relatively cured. So, you never know.

Good Luck! whichever way you choose. The book is a wealth of info for AFIB sufferers. I'm certain you will enjoy it.

Thanks Lord, I’m looking forward to reading it.

Thanks Flapjack, I was put on the waiting list when I spoke to the EP in May and he agreed the plan was for a cardioversion and go on the waiting list for ablation. I was disappointed the cardioversion didn’t work as it had worked in Oct and I’d read the success rate was quite high. I’m over it now and hoping the wait won’t be too long…

FlapJack profile image
FlapJack in reply to CTblood

I may have got the wrong end of the stick but I think it’s important to clarify your situation regarding having an ablation. As has been said by others, it is unlikely that they will carry out an ablation after a failed cardioversion. What often happens when someone has a failed CV after a successful one is to have a third CV, but this time to be prescribed amiodarone for a limited period before and after the third CV. If that works then an ablation is more likely to be offered. If appropriate, a maintenance dose of Flecainide might be prescribed to help the heart remain in rhythm if there is a delay in having the ablation. Side effects of Flecainide tend to be less severe than those associated with amiodarone.

Just for your own peace of mind, I think you should clarify with your EP what the treatment plan is. It would be interesting for us to know if St Thomas’s confirm that you are still on the waiting list for an ablation despite last Friday’s CV failing, that said, if that is what was said in your recent discharge letter then I guess that is what is going to happen. One things for sure, St Thomas’s has an excellent reputation and I am NOT medically trained!

CTblood profile image
CTblood in reply to FlapJack

Thanks again for your reply, I was told after my failed cardioversion the next step is an ablation but if my symptoms get too bad then Amiodarone and another cardioversion until the ablation can be done.

That's interesting. When I was first in A&E for an episode of AF, I too was given cardiversion treatment. They tried it 3 times, and it didn't work. I was told that further attempts would cause trauma, so I was admitted to the ward for a week and pumped full of bisoprol. I was also told that if cardioversioning didn't work then an ablation would also not work. I wonder what is the thinking behind that?

I was treated at Barts & The Royal London NHS Trust who have a good reputation in cardiovascular medicine.

CTblood profile image
CTblood in reply to JK5AEO

Thanks for your reply, I also thought an ablation wouldn’t work but EP said they wouldn’t do one unless they thought it would work so I’m happy to give it a try.

Well ... it seems 'cv doesn't work' needs to be defined: I had nearly 12. At first med would have success after 30 min at emergency. Then, meds didn't work .... so they went with paddle shock. That put me in sinus everytime. Then, playing around ... I discovered a half tab of pill-in-pocket Flecainide would convert me back to sinus, at home, within 30 min. That was great, since I didn't have to waste time, money, and inconvenience going to emergency.

However, I could always come out of arrhythmia with some form of cardoversion, but they never stuck for more than a week in the end ...... sometimes less.

Are they categorized as success or failure?

In any case, the CV's never gave me much respite, but went on to successful ablations. Seems to indicate that failed CV's didn't correlate with my ablation success.

cuore profile image
cuore in reply to JK5AEO

The success rate of a cardioversion is related to how many months you have been persistent. The longer you are persistent the less the success. Did your chemical cardioversion work?

JK5AEO profile image
JK5AEO in reply to cuore

A week of intravenous medication worked.

cuore profile image
cuore in reply to JK5AEO

Have you remained in sinus long post your cardioversion?

JK5AEO profile image
JK5AEO in reply to cuore

Well, the CV didn't work, but bisoprolol did. Until 6 months ago when I had a fast AF, then back into sinus 12 hours later with more bisoprolol. Normally I'm fine.

My first cardioversion lasted 4 days, unmedicated but being put on Amiodarone prior to subsequent ones, held me in NSR.

CTblood profile image
CTblood in reply to Ducky2003

I hope you’re recovering well from your ablation, your posts have made me chuckle. 🤣

Ducky2003 profile image
Ducky2003 in reply to CTblood

Thank you. Good days and not so good days but having to still make sure I take things steady...... not easy on a good day. Still hoping all settles in the next 5 weeks.😊.

I think each case must be different - my 2nd cardioversion kept me in sinus rhythm and I was well for 12 glorious months. Then I had my 1st ablation - as it didn’t have an impact my EP advised a CV to shock my heart into behaving. As that didn’t work I had a repeat ablation 8 weeks ago and am now firmly back out of rhythm and back on previous meds (ie beta blockers). Waiting to speak to my EP to see what options exist now. I’m also at St Thomas’s. Good luck!

CTblood profile image
CTblood in reply to Louloumay9

How frustrating for you.! I’m on Bisoprolol too, it just makes me feel exhausted. Good luck to you too, hope you don’t have to wait too long to speak with your EP.

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