For those that had one or the other, may I ask how severe were your prior symptoms and what was your actual heart rate ?
I have mild/moderate AF but no severe symptoms other than lack of energy. HR averages in low to mid 80's (65-85). However, the Zio patch indicated my HR zoomed to 180 for about 45sec at one pont. No symptoms.
Cardiologist has offered a cardioversion but I am undecided.
Thanks !
I've had 22 cardioversions over about 27 years. I was very symptomatic before all of them , heart rate immediately before ranging from about 130 ish to 180 ish I would say. All of these were arranged as 'emergency, ' so no long waiting list !All procedures carry some risk but if your cardiologist has offered you the procedure it's worth considering, if only to restore your energy levels.
First it is important to understand that any and all treatment for AF is mainly for quality of life (QOL) as it is not considered a life threatening condition provided that rate is well controlled and that patients are anticoagulated for stroke prevention where appropriate.
It sounds from your comments that your QOL is pretty good and that you do not find your AF too much of a burden. This is good as so many people find it intolerable.
The next thing that you need to consider is that cardioversion (DCCV) is a cure for nothing but more importantly it is a test to see if your AF can be reverted to normal sinus rhythm (NSR) which may indicate different treatments such as ablation which would not normally be considered until a DCCV had been tried. You will need to be anticoagulated for at least a month prior to any DCCV and you have not told us what drugs if any you are taking. Similarly ablation (if considered) will need anticoagulation for some time prior to and following regardless of long term requirements indicated by your CHADSVASC score (google it) .
Finally I must mention that AF is generally a progressive condition and whilst it appears that your AF is largely asymptomatic and persistent it is important to considerif it may become more of a burden to you in time.
If you asked me to choose in your shoes I would consider a DCCV as a first step to see if a) I can be in NSR and b) if I felt materially better in NSR and if so then would be able to consider ablation as a next step. If not then rate control and anticoagulation for the future.
Thx for the detailed, professional reply.
I am 74 on Eliquis and .50 mg metoprolol Persistent A F
That's interesting, you are the same age as my husband with mild AF, heart rate range the same and on DOAC and beta blocker. He has no symptoms. I picked this up from my Kardia device. He has not yet seen a cardiologist but I would hope he would be offered a cardioversion. Certainly I would not consider him a candidate for ablation( in the foreseeable future at any rate!)
Would definitely recommend to see a cardiologist for a complete exam.
Perhaps a primary care physician can request a Zio patch (link below). Wearing a Zio patch for 14 days will reveal the extent of his AF. The problem with AF is sometimes your heart will race well over 100 bpm without feeling symptoms - it can be silent.
Good Luck !
BobD
One more comment about cardioversion.
Great explanation on making a decision. My issue is I am somewhat apprehensive. I have read about possible side effects and they are rare, especially if being properly anti- coagulated.
And I realize the shock given is not as powerful like a shock given to revive the heart in crisis. But my uneducated thought is the cardioversion shock can't be all "roses" for the heart, correct ?
Thanks !
There is one member here who numbers their DCCVs at over 20 so can't be too bad.
Yes everything, even doing nothing, has risks but it must all be balanced. During the process the heart is monitored so that the shock is given at a precise time in the QRS complex to interrupt any anomalies and return NSR. The actual "belt" is measured in joules (a measure of power not volts or amps alone) and the first one is set very low. If NSR is not restored then a second slightly more powerful shock is tried and so on but rarely more than three shocks are given. The worst that usually happens can be slight redness of the skin where the pads are placed like sunburn which clears after a few days with aqueous cream.
Hi,
I don't know how many times they tried with my 3 successful Cardioversions but I never had any marks from the pads so presume the shocks were not that great and maybe just the one? I shall have to see if I can find out now - don't know why I wasn't curious before but then was so glad to be back in NSR and feel so much better.
I am not really worried about the marks on the chest. Just concerned about the effect on the heart. Of course, it is likely no worse than having AF. My only symptom is not having normal energy though I am in persistent AF with heart rate controlled by metoprolol. (70-85 bpm resting, low-mid 90's with walking fast)
May I ask how long did you remain in NSR after each cardioversion ? I know it varies from person to person but just curious about average time.
Thanks !
I have on average with 3 Cardioversions had a year in NSR each time 33 months out of the last 4 years. The thing is as has been stated already is that a successful CV - even if you are only in Af for a matter of days points out that other treatments will work for you such as ablation which will keep you in NSR for longer generally years and years. Be aware that some health authorities - such as mine and one I know of in the midlands only allow 3 cardioversions for persistent AF. AF I would say that being in AF is far worse for you than having a cardioversion.
Thanks for your insight !
What Bob said 😁. I had 4 DCCV prior to ablation, then 2 during my ablation and I may have to have another in a couple of weeks. As Bob said, it tends to be an indicator of whether you can go back into NSR rather than a long term solution, although some folks are lucky and stay in NSR for a long time.
Thanks for the reply !
If you desire, please share why the doctor recommended the DCCV's. Worsening symptoms, excelled heart rate over 100bpm ? Thanks !
Hi again. My first DCCV was 5 months after AF was diagnosed as I was very symptomatic and I don't do well with beta blockers. This one got me back into NSR for 4 days. I was then put on Amiodarone for 3 months and was cardioverted again and stayed in NSR for about 3 years, including 8 months of that medication free.
3rd last August following AF rearing his head again and back on meds. Back in AF last Nov when EP tried reducing the med dosage and finally a 4th in April a couple of weeks prior to my ablation.
5 and 6 were in the cath lab during the ablation and I may be having number 7 this month as, following the ablation, I'm getting episodes of AF again. Following my ablation, the AF doesn't tend to be with RVR anymore but on prior occasions, my heart rate would rocket, sometimes above 200bpm. Hope that helps.
Helps tremendously ! Thanks for sharing your experiences.
Good Luck in the future.
I had my first cardioversion after being in a-fib for 2-1/2 days. It knocked it out with a quick zap. My second cardioversion was a few days after my first (cryo) ablation, as my EP at the time had difficulty getting to a certain vein of the heart. As a result, my heart was inflamed from the procedure, hence my going into a prolonged a-fib episode. Both cardioversions were very easy and cured the problem immediately. My second (radio-frequency) ablation in April seemed (fingers crossed) to have done the trick.
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