cardio version

[Patchwork123]

I have just had a cardio angiogram, fortunately all arteries etc were fine but I was surprised to be told I would need a cardio version as I am in persistent AF I had no idea! My heart rate was hovering around 100 and just over.

The consultant told me to double my bisoprol to 5mg twice daily in the meantime, I am also taking ramipril, apixaban and antervastatin he said I could be waiting about six months. I was just wondering how successful the cardio versions are.

I was also considering an ablation but as I believed all the medication was working well, I have no symptoms and feel fine I had put this to the back of my mind. I am now wondering if this is going to be inevitable.

I would appreciate others views and experiences.

[BobD Volunteer]

Any and all treatment for AF is only ever for quality of life (QOL) . Provided that rate is controlled there is no difference in outcome.

If you are asymptomatic (unaware of your AF) then QOL is unlikely to improve. OK have the DCCV (Cardioversion) when it is offered but it may not revert you to NSR and may well be a waste of time. Ablation should not be considered until after you find out if NSR is even possible for you.

[Patchwork123 in reply to BobD]

thank you BobD yes I think I would most likely have the cardioversion when it’s offered.

[pusillanimous in reply to Patchwork123]

I had a cardioversion and one shock I was back in NSR, I don't use a lot of gadgetry at home to check my heart, just a not very reliable BP machine, as I am basically asymptomatic, but in every annual routine checkup in the past 4 years that I have had with the Cardio, I have been in NSR. I take 1.25mg Biso, 5mg of a statin . Eliquis and 25mg of Spiractin for my AF and BP per day. Cardioversions are quick and easy, go for it !

[Patchwork123 in reply to pusillanimous]

thank you for the information 😊

[SusieQ2023 in reply to Patchwork123]

I have had 18. Nothing to fear. Wish I could have one now, but four ablations later, my right pulmonary vein is stenosed and my EP is trying to find someone who can stent it. So, I remain an afib, coughing my head off and weak as a kitten. I chose to have the ablations, so I don't blame anyone but myself. But, I certainly wish I had never done more than have the cardioversions. I am so lucky that my heart is still in good shape--no blockages, good ejection-fraction. With a-fib, I think less may indeed be more.

[Patchwork123 in reply to SusieQ2023]

Thank you for your reply and sorry to hear you are having problems. I will consider the information you have given me thank you.

[Hidden]

It’s a very common treatment plan to offer a patient with persistent AF a cardioversion. From a medics perspective, it’s the quickest and easiest way of finding out if the patient can be reverted back to normal sinus rhythm and if so, to establish if they feel significantly better. The cardioversion may not work, it might work for minutes, hours, days, months or even years, there is really no means of knowing but as long as it works, the patient is generally deemed to be suitable for an ablation. Ablations are not without risk, but again most medics consider them to be minimal but some patients take a different view and making the decision to proceed can be difficult. This is even more difficult if the burden of AF is low and/or the way it affects quality of life is, in the patients view, minimal. The other consideration is that AF medication is often potent and if the symptoms get more difficult over time, dosing is generally increased as do the side effects associated with the drugs.

Only the patient can make the decision based on the advice and information provided by their doctors, all I will say is that I went through the same process and have had one cardioversion, two ablations and with a bit of help from Flecainide as a PiP, I have been free from AF since late 2014 after my diagnosis in June of the same year…….listen to what others say, a lot also depends on your age only because the younger you are, the longer you are likely to be taking medication. Good luck and hope this helps….

[Patchwork123 in reply to Hidden]

Thank you FlapJack. I have had PAF for around 18 years I am now aged 70 I was taking Sotolol all this time up until about 18 months ago when my symptoms were becoming troublesome. The cardiologist put me on bisoprolol and flecanaide which seemed to be working well, I developed swollen ankles and after an echo I was told to stop flecanaide as the heart muscle wasn’t working as it should and I have been on my present medication since. I don’t seem to have any problems apart from feeling a little tired. The angiogram was done a few days ago which is when I discovered I was in persistent AF but was not aware if this, in the past I have always felt every abnormality and did have regular symptoms this is why I was surprised to learn of my present situation. I guess if the rate can be brought down by increasing the bisoprolol I should be thankful that my quality of life is ok. I am not sure whether I would go through with an ablation if it was offered in the future.

[Hidden in reply to Patchwork123]

Sounds like you have got things fairly well under control!

I suggest is that you just bear in mind is that for many, the bigger the Bisoprolol dose, the more troublesome the side effects can become but there are alternative beta blockers/calcium channel blockers available. If you live in the UK and are a NHS patient, given the current climate, you can be fairly sure that if your Doctor offers you an ablation after the CV, he/she will be confident that it will be the right thing to do from a medical point of view. Agreeing to let someone tinker about with your ticker is, of course a different issue but bear in mind, waiting times can be up to and over a year so there will be plenty of time if need be, to change your mind………

[javo123j]

It worked for me in a way. I like you, was in permanent afib but reverted to NSR after CV. It lasted over 2 years when afib came back but only as paroxysmal afib which to me is vast improvement.

[Patchwork123 in reply to javo123j]

Thats good news and very encouraging. Thank you for replying.

[LMCPL]

Hi Patchwork 123, I’ve had 3 cardio versions.

The 1st lasted 3 days, 2nd lasted a month & the 3rd 3 months. Have been offered Ablation, but not taken that option as yet because I think I’m lucky as the medication & exercise routine I’m on keep me pretty good ( most of the time )

Exercise is the best medicine. Since being diagnosed with Af 3 & half years ago & having 2 stents fitted, I’ve walked 1,000 miles, Cycled over 3,000 miles & 6 months back started swimming …….( 110 miles !) I am 1 of the lucky ones.!

Never smoked, hardly drink

[Patchwork123 in reply to LMCPL]

Thank you, that’s really good news for you.

[secondtry]

My brother developed persistent AF (after a Covid jab 🤔) and his cardiologist told him a cardio version wasn't worth trying as he is asymptomatic with good QOL.

From what I have been told by my cardiologist (I am very symptomatic!!) it is important the heart settles therefore a daily dose rather than PIP for my Flecainide. I think this advice may also be relevant to those that have repeat cardioversions and also those that insist on pushing themselves with exercise post diagnosis.

[Ppiman]

My now elderly friend was, like you, but many years back now, one day surprised to be told that he, too, was in permanent AF. His pulse was not so high as yours, however, mostly being fairly normal. All he has had as treatment since then has been warfarin prophylaxis for blood clots and he's been fine for many years with no major changes in his heart health, given his age (90 this year). Is your resting pulse always around 100bpm, or could that have been anxiety?

I gather that an ablation for permanent AF is less likely to succeed but a cardioversion seems to be something all cardiologists like to do to see if the heart can, even temporarily, revert to NSR at all. This seems to be a sign they like to know about.

Steve

[Patchwork123 in reply to Ppiman]

Thank you fir your reply. I am quite an anxious person so could be that it’s not something I keep a check on as I think it would make me more anxious and as I feel fine I don’t think it’s necessary.

[Ppiman in reply to Patchwork123]

I’ve read that these things are all ways to try to relieve symptoms from AF rather than cure whatever is causing it (which often remains an unknown).

As you’ve had an echo-cardiogram and all has been reported as otherwise well, I’d relax! I think I would speak to my family doctor about the cardioversion. He or she will have lots of experience of these things.

Steve

[Patchwork123 in reply to Ppiman]

thank you for your comments

[bassets]

Good luck with whatever you decide to do.

[Patchwork123 in reply to bassets]

thank you.

[Bodydoctor12]

I’m in persistent AF and had A cardioversion on Feb 15th - I’m still in NSR. I’m slowly weaning off the Biso as advised by my cardiologist- now down to .625. The highest I was on was 7.5 and ive Had terrible side effects on almost all the meds so far.

[Patchwork123 in reply to Bodydoctor12]

That’s positive for you, I hope it stays that way. That’s the down side isn’t it the side effects. I just feel a bit weary and cough a lot.

[Bodydoctor12 in reply to Patchwork123]

I don’t feel weary at all but certainly at the higher doses I was on , up to 7.5mg, I was in a depressed state which I did not like at all. I’ve had hot but cold heat like sensation in my hands and feet and despite the very low dose I’m still having bursts of tingling in both. I don’t like it at all. I’m now wondering if it’s the APIXABAN. I went on to VERAPAMIL to see if I tolerated that better but no, that was worse with awful side effects - insomnia, constipation and a horrible sense of chemical burn throughout my body with metallic taste in my mouth. They just don’t suit me!