I had 4-5 episodes of AFIB about 4 years ago. It ended with me getting an ablation in December of 2018. I had been AFIB-free 3.5 years. Last week I had an episode. My heart was not beating too fast and I was not feeling too bad. That's quit different from what I had 4 years ago. Anyways, I did the cardio version at the hospital like I used to do.
BTW, 4 years ago, I controlled it very well with Flecainide until the ablation. Zero AFIB for 9 months while waiting for ablation.
1. What are the odds that this was a one time bad luck?
2. Should I start taking Flecainide again? I already take 25 mg of metoprolol for skipped beats.
3. I am going to Spain and Portugal this summer for 6.5 weeks. I'm from Canada. As far as I know, I now have a pre-existing condition so cardioversion will not be covered by standard private insurance. What insurance company, if any, would cover me?
4. How much would a standard electrical shock cardioversion cost out of pocket in Spain or Portugal? It take about 2-3 hours here in Canada so I am trying to estimate the cost. 500 US/hour??? Is that reasonable? Anybody ever paid for a 10 minutes sedation plus a cardioversion?
Thanks,
R
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Reg8
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Don't know the cost, but at this point, if your doctor permits, taking Flecainide as a PIP (pill in pocket) might be a better choice, even if your insurance covered electro cardioverion. Then, if afib becomes more frequent, daily flecainide, or a touch up ablation might be next steps.
Are your "skipped beats" that bad that you need daily Metoprolol? For many, including myself, beta blockers come with undesirable side effects, so you might ask your doctor for a trial off them. The exception would be if you end up taking Flecainde where beta blockers are often used as a safety measure in case you go into a fast flutter.
Hello, I tried 200 mg of flacaine as PIP 3-4 times. It has never worked for me. I need to ask my doctor about trying 300 mg.My side effects are minimal. I'm very lucky from that point of view.
Yes, 300 is often used and that's about the limit. But if 200 didn't work, no guarantee with 300. Also, at that dose I would assume your doctor would want you to take a beta blocker like Metoprolol and/or a calcium channel blocker with it or 30 minutes before for safety reasons.
Another strategy when on vacation would be just to control your rate with the metoprolol and or diltiazem and hope you naturally convert quickly.
That was my strategy for a long time and I usually converted between 6 and 36 hours and once the rate was controlled I could go about my business. The downside here is that if you don't naturally convert, you might be stuck in slow afib for weeks which isn't a great idea. On the other hand, once your rate is controlled it might be more cost effective to hop on a plane and go home to be electro cardioverted than to pay for it locally. I'd call a local hospital where you are headed to get comparative costs and also ask them exactly what they do because not all hospitals may do it the same and the best surprise at a new hospital is no surprise.
1. What are the odds that this was a one time bad luck? - Who knows how long a piece of string is?
2. Should I start taking Flecainide again? I already take 25 mg of metoprolol for skipped beats. Only your doctor could advise.
3. I am going to Spain and Portugal this summer for 6.5 weeks. I'm from Canada. As far as I know, I now have a pre-existing condition so cardioversion will not be covered by standard private insurance. What insurance company, if any, would cover me?
You would have to research unless someone from Canada chips in. I would imagine any insurance cover would only apply to emergency and I doubt that AF be considered an emergency but you would need to check that out with the insurer.
4. How much would a standard electrical shock cardioversion cost out of pocket in Spain or Portugal? It take about 2-3 hours here in Canada so I am trying to estimate the cost. 500 US/hour??? Is that reasonable? Anybody ever paid for a 10 minutes sedation plus a cardioversion?
Research - don’t guess. I know that my husband had a planned cardioversion privately in UK and it worked out at about £2-3K about 4 years ago. It’s not just the cardioversion, it’s recovery and observation time after - I think he had to stay in for 4 hours. That meant a hospital room at daily rate, food, anaethetist, Electrophysiologist, nursing and all the pre work up costs.
Are you on anticoagulants? Whilst both Spain and Portugal have excellent healthcare systems, having been treated in Spain for AF, I was never offered a cardioversion but then I’ve never been offered one in the UK either.
I doubt very much if you will find a clinic which will perform one for you without extensive work up and your medical records. There would probably be a waiting time, private healthcare isn’t just a walk in and be treated, unless it’s an emergency. Also depends upon where you are going to be and for how long. The Costa del Sol does (or did) have an excellent specialist hospital which treated AF. If you did find a clinic which would give you a cardioversion without all the above, I not sure that I would be going there as there are some pretty dodgy private clinics in Spain, can’t say about Portugal.
Hope your AF resolves very soon and enjoy your trip.
What an excellent reply to the original query! I was thinking myself that, considering the relative ineffectiveness of a CV that it's a very expensive option.
In the UK private cardioversion costs £1500 plus consultant fee I expect too (£250). The UK is always more expensive than rest of Europe though. However I've had no trouble getting insurance despite needing cardioversions in the past.
I'm new here but not to LPAF, unfortunately. So, I feel for your dilemma and your 'journey'.
First, let me say that one thing which hasn't cropped up in either your post or subsequent comments is anticoagulation. When I was first diagnosed medics would want to Warfarinise me as soon as look at me, and maybe leave it at that with a beta-blocker (the old rhythm v rate dogma). Which complicated the whole business of getting into AF episodes for more than 48 hours, because, after that, a month of Warfarin would be required before most cardios would look at electrocardioversion. Now the pendulum has swung 180, and despite new DOACs with antidotes and no INR or dietary hassles, you might have to get a TIA before getting a DOAC!
Nonetheless, my point is if you were electrocardioverted in a hospital setting a lot of fuss would be made about coag risks. And, no one would contemplate cardioverting you without a transoesophageal echo (TOE) to exclude a thrombus in your left atrial appendage, which could otherwise be shunted somewhere you wouldn't want it, ruining your whole day.
My view is, if you've been in an AF episode for a spell, and you're not on routine anticoagulation of any sort, and have no recourse to any, then chugging 300mg of flecainide may well be effective an achieving chemical cardioversion but it is also playing Russian Roulette with a TIA or worse (a TIA is not obviously 'transitory' at the time, trust me).
As I say, time was I was given precautionary heparin syringes (by A&E) to extend my window for private cardioversion without Warfarinisation. And I also had a collection of DOACs from one time or another that I could administer to the same end. However, more recently my cardio felt my CHADS did not indicate a need for a DOAC, until I have a stroke. Go figure.
That said. In answer to your questions:
1. You seem to have had a very good post-PVI run. I bet your surgeon has long since 'declared victory' (mine did). Pardon me, but maybe you got a bit careless with your lifestyle changes - it's natural after a successful-looking ablation. Odds are this was an unfortunate confluence of stimuli - dehydration, inflammation (a common cold), stress, a beer or two, heavy meal, overexertion, who knows what the 'substrate' is, and even whether a PVI does more than 'patch' it temporarily). The natural recession back to more frequent episodes is gradual - AF begets AF (and vice versa). So, just get back with the programme, in terms of elementary supplements, hydration, sleep, stimulus-avoidance etc., as a first bulwark. Tricky on holiday, I know. But you may put off another episode for months, if not forever, that way.
2. You wouldn't have been prescribed flecainide, I presume, unless you have non-vavular, possibly lone, AF, with no obvious cardiac or haemodynamic anomalies, because as Tambocor it proved lethal in such cases. Something worth bearing in mind always, because LAF is a diagnosis of exclusion, and flecainide is notoriously proarrhythmic. 50mg per day of flecainide prophylaxis for your holiday would probably be good insurance, but you could equally just take a 50mg tablet with your BB when you sense an ectopic or have that eery (often self-fulfilling) feeling of AF onset. It may quickly subside if you distract yourself.
3. Been a while since I travelled because of Covid but I have used this search engine: allcleartravel.co.uk/. There are several specialists in this area. The pre-existing condition rigmarole is fairly sandard. The main focus is on whether you have had a lot of consulting (voluntary or otherwise) in the past year, and cost comes in at about £60-70 for 10 days if LPAF is the main issue. It will probably work out at a much less than proportionate premium for a longer spell. And at least you are coming FROM N. America. The real cost hike is heading that way!
4. Similarly, privatehealth.co.uk/conditi... indicates around £2,000 for a private electrocardioversion in the UK. And I would think, having had a couple myself privately, that it is not only par for the course here (as others seem to suggest) but that it is a decent ball-park for Europe too. The main issue is always the local medics assuring themselves that their backs are covered, and just getting a TOE and hospital room to do the procedure on an outpatient basis (more costly if they want a preamble, anticoagulation and overnight, of course). Having lots of paperwork to hand, like a clinician's note (and judicious translations), as always, is helpful for purposes of reassurance (yours and theirs).
Coming back to my initial theme, though. Think very hard before a DIY CC with 300mg of flecainide, just for expediency. It may avoid a lot of fuss, but it may not work, and is best not experimented with away from home for the first time. There is invariably a tachycardic phase in the process of chemical cardioversion from AF to NSR with flecainide in my experience. And while this may be ameliorated with simultaneous administration of a BB, this may severely depress BP (especially if, like me, you are naturally a bit bradycardic) and in combination with excercise (even a brisk walk can be helpful in cardioverting in my experience), syncope, heart failure and stroke are serious issues.
However, likelihood is that all this disclaimer is merely a storm in teacup. And I'm sure a great holiday is just the tonic you really need!
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