I think my first cardioversion failed

[Fishforfun]

I'm new here. I was diagnosed with Afib Dec 2021 by my GP. I saw a Cardiologist in June 2022 and he recommended a cardioversion. I had a cardioversion done on late June it was successful after one shock. My heart rate went from high 90 to 50.

But after a week my heart rate went back to 90. My thoughts are because of the increase in heart rate the cardioversion failed. I see my cardiologist in two weeks. I'm wondering what my next steps should be? Also has the cardioversion failed or has it succeeded I'm in sinus rhythm I just have a fast heart rate?

[mjames1]

First, welcome to the forum and as you probably know, none of us are medically trained so always keep that in mind.

A few questions -- Were you continually in afib for the six months between when you saw your gp and were cardioverted or did you go in and out of afib?

What medications are you taking? How did you know initially you were in afib? Were you symptomatic or did they just find out by accident in an office visit? Did you feel any different when you're in afib or not?

So to answer your question -- afib is an irregular heart beat. Normal rhythm is regular. If you can catch your pulse at your wrist, try and see if it is regular or irregular with pauses, etc. You can also get a home device like the Kardia or Apple Watch which will generate an ekg and tell you.

Jim

[Fishforfun in reply to mjames1]

I don't feel my afib, but based on my heart rate running fast (90's) I would say I was continuously in afib. I take Metoprolol 50mg for heart rate and Xarelto 20mg for blood thinner. My doctor detected afib during my physical Dec 2021. Detecting afib with my pulse I'd say it seems a bit irregular but hard to tell. Thanks for the Apple Watch tip.

[mjames1 in reply to Fishforfun]

I asked the questions because some lucky folks have the kind of afib where they don't even know it and it doesn't affect their life at all. They may need no treatment or drugs except for an anti-coagulant. Hard to tell if you're in that category from what you say and the fact you're on Metoprolol.

But back to the "next steps" you asked about. First, maybe time to get that Apple Watch or the less expensive Kardia so that you can better document and therefore better understand you condition.

Second, and I could be wrong because not privy to your complete interaction with your cardiologist, but leaving you six months in afib since the cardioversion doesn't seem right. You therefore might want to get a second opinion from another cardiologist or perhaps an ep, who is a cardiologist with extra training in arrhythmia's.

Jim

[Fishforfun in reply to mjames1]

I know not seeing a cardiologist immediately was not a smart move. My physical that detected the afib was in mid Dec. I had plans to spend the winter in Florida. I could not get an appointment with a cardiologist before my planned departure. So made the appointment when I got back in May. Will be looking into Kardia or Apple Watch, Thanks.

[tunybgur in reply to Fishforfun]

Yes, delaying seeing a cardio is not smart if you suspect there's a problem. AF begets AF, the longer it remains untreated the more intractable it becomes.

Cardioversion is extremely effective at converting AF sufferers back into NSR, unfortunately 80% return to AF within a year....that to my knowledge is the official statistic, so most require medication, ablation or other treatment to achieve a permanent cure.

My cardioversion lasted two months and I was then put on Flecainide which has kept me in NSR for the last 4 years.

Good luck and don't delay.

[Hidden]

I’m not medically trained Fishforfun but generally as long as a Cardioversion works, even for a short period, it indicates that you might be considered suitable for further treatment in such as an ablation, if that’s the route you decide to take. I see you are from the States where your healthcare systems are very different to here in the UK so some of what I say might not apply. If someone is diagnosed with persistent AF, in other words you are in AF 24/7, then a CV is used to see you can be reverted back into normal rhythm and if it does, and you feel significantly better, then as I said, other invasive treatments might be offered. At 90 bpm, your rate is not particularly high, in fact it’s just inside normal range. If you are not taking beta blockers or a calcium channel blocker then that’s good and it’s probably unlikely that this is why you may gone back into AF. However, how sure are you that you are back in AF. Do you have an irregular heartbeat when you feel your pulse. You may not know for certain until you have an EKG (ECG here in the UK) but you should be able to detect an irregular heart beat yourself. Search “how to feel your own pulse” on Google, it really isn’t difficult. If you haven’t noticed any difference in symptoms such as tiredness or shortness of breath then it’s possible that you are not in AF.

Finally, a CV rarely works for ever, it’s quite common for AF to return. Look upon it as part of a treatment plan and the results probably are not that bad……

[CDreamer]

Cardioversion often don’t last but the fact that you reverted into NSR after 1 shock is a good indicator.

Only an ECG can confirm your rhythm but a good indicator to tell if you are in AF or not is to take your pulse and beat out the rhythm - regular beat =NSR, irregular beat = AF.

Hope that helps

[Mugsy15 in reply to CDreamer]

With great respect for a veteran contributor CDreamer, I feel it's important to make the originator aware that cardiac rhythm is not as simple as NSR v AF. As I'm sure you know, there are many other rhythm irregularities that are not AF.

[CDreamer in reply to Mugsy15]

I was attempting to answer the question. Only a properly assessed ECG can interpret other arrhythmias so I don’t believe it helps to complicate when asked a specific question - which was how to tell if they were in AF or NSR because HR was 90, which is not abnormal - but may feel as though it is to some.

I think the collective answers covered all bases but please feel free to reply to the poster if you think something was missing.

Best wishes

[Jalia]

Hi, you say that you are in sinus rhythm but with a heart rate of 90. Therefore your cardioversion worked to get you out of AF !

Sometimes after a cardioversion the heart rate can be a bit faster than your previous normal rate , sometimes a bit lower, at least for a while. This is what I've found and I've had 22 so not without experience .

I wouldn't worry too much until you've seen your cardiologist . You may have nothing much to be concerned about but he is the expert !

[Singwell]

90BPM is high but not abnormal. But certainly get it checked out to see if there are other options to consider in the future. How do you feel in yourself?

[Ppiman in reply to Singwell]

A persistent rate of 85+bpm feels abnormal to me, SIngwell which, sadly, I get often enough, mostly without AF, and feel less than wonderful with it.

I know that a persistent rate of over 100bpm is called tachycardia, but I guess that is because that figure is deemed the minimum that would risk the health of the left ventricle.

Steve

[Singwell in reply to Ppiman]

Yes, that seems very sensible. These norms in any case do not take into account other factors. Glad you've said.

[BobD Volunteer in reply to Ppiman]

My local cardiologist advised that between 60 and 100 they would not treat as these are the normal parameters.

My normal HR is around 85-90 and has been since my atrial tachycardia ablation in 2019. The reason I am to have a pacemaker is that ECG shows I have 2nd degree block and if for any reason my HR dips below 60 then I start getting 3 -4 second pauses causing presyncope. Still not sure how that will work out.

[Ppiman in reply to BobD]

Bob - you are Mr Positive. I've met very few like you in my life with your wonderful level of positivity.

It will work out 100%.

Steve