Cardioversion

[Pindarus]

I recently had a Cardioversion for persistent AF. This worked immediately but very quickly reverted. I have never been aware of the AF, I only get the notification from my BPM. My BP is reasonable (medicated) and my heart rate is always about 66. My main problem is exhaustion and breathlessness. The cardio mentioned that if the cardioversion failed I should have an ablation. However is that any more likely to prove successful than the cardioversion?

[Paulbounce]

Hi Pindarus.

A cardioversion is a quick fix - it's highly unlikey to last forever. However if you went in to sinus for a short time then it's likely you will be offered one.

So will it prove to be more successful than a CV? Got a coin in your pocket? Toss it and see. For many the answer is yes - for some the answer is no. You may need a 'top up' as for some afib returns - for others it doesn't. It's luck of the draw.

Ask your cardio about Pulsed Field Ablation. If you can get one of those (for me personally) I would jump on board right away.

Good luck.

Paul

[Hidden]

I’m not medically trained but as I understand it, cardioversions and ablations are two very different procedures and neither are considered cures although an ablation generally will help control AF symptoms for much longer. That said, from what you have said, your AF symptoms seem to be fairly well controlled with medication, however, in the UK, medics tend not to offer ablations on the NHS unless they are reasonably confident that the patient will benefit.

A cardioversion does not do anything to change the way your heart functions, it is essentially like hitting the reboot or reset button on a computer which generally causes the heart to re-start and function normally for a variable amount of time. An ablation is very different. Using catheters, probes are passed through the veins and into the heart and any areas which may be causing rogue impulses which result in an irregular heartbeat are either “burned” or “frozen” so that tissue is scarred. This eventually forms a barrier which prevents the rogue impulses from occurring and enables the heart to function in normal sinus rhythm. Neither procedure is without risk but the risks associated with an ablation are greater than those with a cardioversion but in medical terms, the risks are generally seen as moderate to low.

One important thing to bear in mind that if a CV fails, ie sinus rhythm does not return at all then most medics would say that an ablation is unlikely to be successful. On that basis, hopefully in your case sinus rhythm returned, albeit for a limited period……hope this helps, I’m sure others will share their views.

[Paulbounce in reply to Hidden]

Hi FJ.

'one important thing to bear in mind that if a CV fails, ie sinus rhythm does not return at all then most medics would say that an ablation is unlikely to be successful'

As a matter of interest (and it would be interesting to hear from USA members) this is not true in the USA. I have been discussing this with a retired doctor (Frank) in America who has dealt with many afib patients. He has referred many patients who did not return to sinus with a CV for an ablation. He said the success rate was very good. He has worked as a doctor for 40 years and knows his stuff. I can copy and paste our discussion but would ask for his permission first to do this. I could ask him to hop on board here if he has the time. He would make an excellent addition to the forum and has much knowledge to share.

Paul

[Hidden in reply to Paulbounce]

I think you are right Paul but I think this tends to relate to those fortunate few who have access to the various forms of Mini-Maze and possibly the Pulsed Field Ablation which I have no knowledge of. As we know at the moment here in the UK, unless you have access to private treatment, most have to wait in excess of a year for a standard ablation and it’s rare for an EP to offer one to anyone who has not responded well to a cardioversion.

[Tomred in reply to Hidden]

hi, im in uk and cv failed for me 3 times but i was offered an ablation 2 years later, just saying.

[Tomred in reply to Tomred]

ps .sorry didnt mention, i didnt accept ablation.

[Hidden in reply to Tomred]

I guess with 1.4 million people having AF there will always be exceptions. If you are happy to say, it would be interesting to know why you rejected the offer and whether or not you have had any regrets……

[Tomred in reply to Hidden]

Hi Flapjack, basically i think ,we all make up our minds on any given topic by what we read or hear from others, and i think what swayed my opinion most was someone on here saying they had 20 ablations and another saying that an ablation had , [if i remember right,] ruined their life, i know personally after having failed cvs, my paf seemed to get worse and for a year after all sorts of funny things was happening to my heart, like buzzing feeling plus strange kind of beats, ,thumping etc . regrets on refusing,,, sometimes , i wonder did i make the right decision, i do sort of regret when im in a bout of paf , but when im in nsr i try to forget about it .

[Hidden in reply to Tomred]

Interesting, it’s always a difficult decision to make. Back in 2015, I was undecided about having an ablation. At the time, my Cardiologist, who was not an EP and not particularly enthusiastic about the procedure said that if he was me, he would go for a Cryoablation, so I did. Because the EP had a problem treating one of the 4 pulmonary veins, I did need a second RF ablation and so far, so good.

I think it’s only natural to be influenced by what we read on forums but I believe it’s also important to consider that forums tend to be largely used by folks who experience problems. When I had my procedures, there were around 8.5k ablations being carried out annually in the UK alone and apart from the common issues associated with the blanking period, most of posters seem to drift off the forum and get on with their lives. I guess there are no easy answers……

[mav7 in reply to Paulbounce]

@Paulbounce and for Pindarus

When time permits, ask his opinion on the success of maintaining NSR with a successful cardioversion then immediately to begin antiarrythmic/rate control drugs. I have read there have been success cases.

Pinarus, you may want to inquire about this from your doctor before electing to have an ablation.

[Paulbounce in reply to mav7]

Hi Mav.

My suggestion (based on my own experience) is to ask your cardio about starting antiarrythmic meds BEFORE a CV not after. Take Flecaninide as an example. You'll likely start off on a lower dose (say 50mg 2 X a day). This might then be increased to 100mg 2 X a day as your body adjusts. After a CV carry on taking that dose to help you stay in sinus. I would give a ball park figure of starting about 8 weeks before a CV to allow your body to have a build up first - it's then in your system. This is not medical advice but some something to discuss with your medic.

Paul

[mav7 in reply to Paulbounce]

Thanks for recommendation !

[Desanthony]

The fact that the cardioversion worked - even for a short while means that an ablation is likely to work too and work for longer - you may need one ablation or you may need more than one. the fact that you have been offered one suggests your Dr believes this will work for you. It is best to have one as soon as is possible so that your heart hasn't remodelled itself to the extent that further procedures would be unlikely to work - as happened to me during Covid. If I were you I would definitely go for it.

[riffjack846]

Same thing happened to me last 2 times I had a cardiovert. Only thing that stopped my afib was amiodarone and then an ablation. I've been AF free since Dec. 30. Peace.