Waiting for Cardioversion

[GordonS]

After 2 successful ablations RF in 2010 and Cryo in 2018 AF returned sometime last year when I noticed that my HR was taking some time to come down after exercise. I had GP appointment in August and EP on 6/12/22. ECG on that day confirmed in AF followed by Holter monitor in January which shows the AF as persistent. I have been listed for a DCCV but have been told that the waiting time could be 5 months. Is this normal? My resting HR is reasonable at 95ish but getting lots of ectopics. Only intervention so far is to increase the Bisprolol to 2.5mg daily. Considering that I am managing a relatively normal life should I be thinking of adding a rhythm drug as well? Amiodarone or Digoxin perhaps. Thoughts please kind people.

[mjames1]

You can't have "ectopics" and be in afib at the same time. Ectopics are changes associated with a normal rhythm. But I assume it's all 24/7 afib since you are scheduled for cardioversion?

If the plan is to restore normal rhythm, then the sooner the better and for me 5 months would not be acceptable. Staying in afib that long potentially will remodel the heart, making the cardioversion and other future interventions -- medications and ablation-- potentially less effective. And what is the plan if the cardioversion doesn't hold, as it often doesn't? So definitely discuss daily anti-arrythmics like flecainide and ask about the feasibility of another ablation.

On the other hand, if you are ok with how you feel now, then the alternative is simply to stop trying to get into normal rhythm and just manage rate.

Jim

[DawnTX in reply to mjames1]

the longer you are with a high heart rate and more damage you are getting trust me I know it’s just happened to me this past year. I am at the beginning of heart failure. I had a pacemaker put in two weeks ago, and tomorrow they will connect and ablate my AV node. I know there are awful waiting times for all of you, but to keep you waiting that long for something that does not have a great rate of success or length of holding is awful in my opinion. You don’t mention your numbers, but still remember your heart is being exhausted and you are not getting the circulation that you need. There is a new program in the states with advertising it is called no time to wait and that is for a reason. Please try to get after them. I pray they help you sooner.

[GordonS in reply to mjames1]

Hi Jim thanks for the comprehensive reply. The report from the Holter monitor mentioned ventricular ectopic beats and V E runs. It's a bit double Dutch to me. As you say I am a little concerned that the longer I am in AF the less chance of any further treatment being effective. I have asked the AF nurse to have a chat with the EP to see if he would recommend any of the anti-arrhythmia drugs. When I saw the EP in December he suggested that a further ablation could be possible which would be RF with 3D mapping

[dmack4646]

5 months is about the norm now on NHS unless they deem it an emergency- a friend of mine who got AF after Covid with a HR of circa 125 had to pay for Cardioversion £3000.

[jeanjeannie50 in reply to dmack4646]

Goodness, that's a lot of money!! Might be cheaper to buy your own defibrillator. 😁🤔

[dmac4646 in reply to jeanjeannie50]

there was no way the NHS were going to do it - not considered enough of a problem - she is 70 had never had afib before and was really struggling - they used to cardiovert in these circiumstances..

[Desanthony in reply to jeanjeannie50]

Yes! My wife used to try and frighten me out of AF by jumping out at me around the house Just joking she does that often anyway - who knows maybe that's what started my AF

[DawnTX in reply to dmack4646]

wow that is just horrible. I am so sorry for all of you waiting and suffering. Many prayers going out to everyone with a fib.