Cardioversion - shock setting

[Soxy1234]

Is there any evidence that the harder it is for a cardioversion to shock the heart back into normal rhythm ( requiring a higher shock setting) then the more likely it is to stay in that normal rhythm?

[Hidden]

That sounds like a loaded question Soxy, did they have to try 2 or 3 times? I cannot say it’s something I’ve heard of before so it will be interesting to hear what others say…….

[CDreamer]

Only experience I have is of Mr CD who was shocked x3 - NSR lasted 7 secs. Least it proved that NSR was possible so drugs were tried & 3 years down the line on maintenance dose & less than 1% AF in a year.

[Desanthony]

I wouldn't have thought so but interesting to find out if there is any such evidence.

[BobD Volunteer]

I think the reverse is more likely. If a person is easily reverted then the heart may be less re modeled meaning AF may not return so soon. If several shocks are required the chance of long term success would appear reduced.

[Jalia]

I would be inclined to think the reverse , as Bob does. I've had dccvs which have almost always converted me back on the 1st shock and a couple have lasted 3,/4 years.

[rosyG]

that would seem counter intuitive- agree with the others here!

[Soxy1234]

My logic is that if an irregular heart is difficult to adjust, once it is corrected and back in regular rhythm, then it should be equally difficult to change.Why can't it be equally resistant to change when back in sinus rhythm?

And yes, Flapjack, a question loaded with wishful thinking - 4 attempts!!

[BobD Volunteer in reply to Soxy1234]

Short lecture on the mechanics.

Think of a printed circuit board. You spill coffee on it and various functions start shorting across so you press I and P prints for example. Wipe off the coffee and things return to normal but leave it and the board gets etched so every time you press I then P prints.

In your heart, a rogue signal leaves the top left pulmonary vein for example and starts an AF event. If you can prevent that happening then AF will not sustain.

When lots of rogue signals fire off at once they start to "etch " the inside of the heart and form a permanent pathway. This is known as atrial re-modelling.

Cardioversion (DCCV ) is akin to re -booting your computer, ie switch it off and re-start it so that all circuits return to normal. If that doesn't easily happen then something is damaged inside and you need to call you local computer geek to fix it. No amount of re-booting will help. With AF, once the atrium is re-modelled to a certain level, returning NSR may well be impossible however many times you zap it . If your heart needs several jolts at increasingly higher joule settings then it is likely already close to irrecoverable.

[WhitstableWanderer]

Three zaps for me, at increasing levels, finally got me back into NSR, but only for four days... Happy to be deemed permanent AF now as mostly asymptomatic.