Thank you to all those who have recently posted replies to my recent question ‘Has anyone had problems with Flecainide not working?’. Your answers have clarified the some of the options to discuss with my cardiologist, hopefully in a couple of days.
I propose to gradually stop taking Flecainide but I expect my persistent AFib, which commenced just over a week ago, to continue. I expect to be prescribed an alternative antiarrythmic (he mentioned amidarone as a possibility last time I saw him) but I will ask him about the suitability of a cardioversion. My question is how many of you have had success with cardioversion when in persistent AFib? And if successful how long does it last? Has anyone had their AFib permanently fixed with cardioversion and do you still need to continue taking drugs? My heart rate is currently under control taking Verapamil and I have few symptoms other than awareness in my chest of an irregular heartbeat at times. I am able to exercise without ill effects although I don’t push myself too much. I regularly monitor with a Kardia device and BP monitor. I am a 73 years old male.
Any thoughts would be much appreciated. Thanks everyone.
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golfwatcher
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I’ve been in persistent AF for nearly a year and on the waiting list for ablation. During this time I’ve had 2 CVS (cardioversions). The not so good news is that neither kept me in NSR for longer than a week. The good news is that even just a few days of NSR following a CV is indication that a catheter ablation is worthwhile. Unfortunately because of the long waiting lists every day takes me further from the hope of a successful outcome. My cardiologist expects I’ll need a couple. Don’t be afraid to get yourself on a waiting list asap and give yourself time to weigh up any risks. These are quite low for CVS. I was put on amiodorone prior to my last CV as it can help things along. I didn’t have any side effects but it’s not often considered a long term fix due to longer term damage of thyroid and liver. I miss it though, I felt stronger despite the persistent AF!
Thanks. for your reply. Just wondering if your persistent AFib is under control and do you suffer any symptoms? What drugs are you on while waiting for the ablation?
I don’t think “under control” is an expression I’d use for persistent AF as I have always been quite symptomatic and particularly uncomfortable at night. Over the last 10 months since I was diagnosed my resting heart rate has gradually increased to anywhere between 74 and 98 which I’m supposed to feel thankful for as it’s lower than many! I can’t take meds that reduce blood pressure such as bisoperol because my blood pressure is already a healthy low. Aside from Apixaban, I have recently started Digoxin which is an old-fashioned medication derived from foxgloves. It apparently slows the heart and at the same time strengthens the pump action, but as with all strong meds it comes with side effects if you’re unlucky. If that fails I’ll go back to using propranolol which is another good old fashioned beta blocker preferred by my GP and that can be taken as a pill in pocket. We’re all so different in our treatment needs and responses to different meds. I do know that procedures such as ablation tend to be offered to the symptomatic, so don’t do what I tend to do and say “not too bad” or “fine thanks”!! 😅
Agree with Rainfern, if a CV works, even for a short period, it will it indicates that you are more likely to be suitable for an ablation so it’s best seen as part of a treatment plan rather as treatment in itself. It’s really impossible to say how long it’s likely to work for, just hope that it does, they normally do 🤞
If you think of cardioversion (DCCV) as a test rather than a treatment you won't be dissapointed. If it works then you may be suitable, for an ablation. If not then such would be a waste of your and everybody elses time. Since there is no best treatment for AF so long as rate is well controlled and the patient anticoagulated a long and productive life can be expected regardless.
That's a good way of looking at it. I've heard that any treatment has to improve or maintain quality of life. So I'll have to decide whether CV followed by ablation is worth the effort and risk compared to a lifetime of drugs. Thanks for your input.
Off topic slightly, but I have to say that, although I’m sure there are others whose opinions are just as valid, when I see a response on any subject from BobD , that’s my first go to. Succinct, balanced, and to the point. (Apologies to those who disagree with Oxford commas). Amazing that when I first joined six years ago or so, I considered him a pedantic old f*rt, but that was only a misunderstanding about blood thinners. 🤣
The good news is I recently returned to NSR naturally after two weeks in persistent AF. I was referred for cardioversion only for the ECG to show I had gone into bigeminy instead, now NSR. The bad news is that CV is not a cure and if successful even for a long period wouldn’t mean you can come off drugs and expect to stay in NSR.
That's interesting. Any idea what caused the return to NSR and what drugs are you taking to try to keep it that way. I went into persistent AFib when my dose of Flecainide was increased. I wonder if there's a chance of returning to paroxysmal AFib when I come off it.
I was in AF due to a combo of hot weather, stress and an infection. Cardiologist told me I was stuck in AF but once the ‘triggers’ went so did the AF. I only take Diltiazem 180mg per day, but been referred to cardiology again so I’ll see what they come up with. Interesting about the increase of Flecainide, I seem to remember you’re not the only person affected that way.
My cardiologist increased the dose because it wasn’t decreasing the frequency of Afib . But it did the opposite. Good point. I’ll give it a go but I’m doubtful that it will work. Thanks.
I'm in persistent/permanent afib but every now and then I go into NSR it has totally confused my cardiologist unfortunately the last NSR was 26th June it had been ok for a few weeks then suddenly back it came and I've been in constant afib since then, it's the nature of the beast sent to torment us
If it's woken me at night I take 1 metoprolol a rate control beta blocker. I've had sotalol and amiodarone in the past but I didn't do well on either so I'm in af all the time but it mostly doesn't bother me
I do feel happy when I get NSR occasionally I know I've had done all that's available to try to cure me but
I was put on Amiodarone for a short period which worked very well - zapped my arrythmia! However as - I think - Bob said it is known as the Domestos of arrythmia drugs " it kills all known arrythmias " but it can have a bad effect on lungs, thyroid, liver etc. But short term with a low dose worked wonders for me. That plus the RF ablation has given me a good respite from Afib and hopefully it will continue for à while. I was so happy to drink champagne at my son's wedding! It was little things like not having a coffee or à glass of wine I found a bit misérable before my ablation that plus nearly passing out whenever my heart reverted to NSR after an episode of Afib. It once happened on the motorway . PAfib is worse in some ways than permanent Afib as you are subconciously always on the alert for the next episode lol. Anyway as someone said before me perhaps put yourself on a waiting list for an ablation. The wait can be long but that gives you time to go over the pros and cons with your Dr and you can opt out if you decide not to go ahead.Take care.
If you search online, you'll find that the results from studies do vary a lot but that, following cardioversion, you would have between a 20% and 45% chance of being AF free after twelve months.
Is that the percentage for people in persistant Afib?
My EP told me it was 90% for people with Paroxysmal Afib with no other pathologies. I wonder if as golfwatcher has only been in persistant Afib for a week if his success rate may be higher than 20 or 40 % if he is successfully cardioverted as soon as possible followed by an ablation ( though the waiting list seems long).
I was just wondering as I never had persistant Afib but was heading that way ( episodes longer and closer together) which prodded me into action of having the ablation 😁
I’ve edited my post as I meant those figures to be for cardioversion only. It seems that the success rate for that is near 100% initially but that recurrence occurs in most people within a year.
The trouble with the studies is that it’s clear just how different individuals are with AF and how these differences can alter the chances of success enormously - even though the doctors aren’t able to pin down just what kind of person will do well and which won’t. It seems that the individual deep down cause of AF really isn’t fully understood, and so how life will pan out for a particular sufferer is equally, or much of it, guesswork.
Ah ok 😄 I understand better thanks!Totally agree with how different Afib is for us all. One of life's mysteries. But at least on it's own ( no other pathologies) with rate control and anti- coags it's not life- threatening. How are you doing these days?
Hi Lily - thanks for asking. It's been back trouble this last two or more weeks, something I haven't had in maybe twenty years, or at least not like this although it's on the mend (I hope). Thankfully, throughout, my heart has been feeling "tickety boo" rather than "rickety boo"! At least there's been no AF or racing thankfully. I live with ectopic beats, but even they have been fewer. My GP put me on a small dose of bisoprolol back in March before I had a minor op and it seems to have done the trick - fingers crossed.
That's great news ( for the heart 😊)Backs really a bloomin' nuisance! I get back spasms ( sciatica 3 or 4 times a year) and usually heat patches and walking sort it after à couple of weeks. But this time I have a pain in one buttock that is lingering ( very painful when standing after sitting or bending to put socks on). I think it might be the Piriformis or sacroiliac joint ....or simply age 😅 I'll try and see a sports physiotherapist.
I’m 65 and had persistent atrial fibrillation with a low heart rate from November 2022 until the beginning of this month when I had a successful cardioversion, so I’ve been back in normal sinus rhythm for 3 weeks. I have much more energy and don’t get breathless whenever I walk anywhere now and I’m very much hoping that continues. I’m still on a low dose of Isosorbide Mononitrate, which is a vasodilator that helped alleviate the chest pain which came with the breathlessness, and I expect to be on that until I get an angiogram to check there’s nothing else going on. I’ll be on Warfarin for life because I also have a mechanical aortic valve. They think my AF was sparked by a virus (possibly a cold, possibly COVID - no positive test result) that I caught in November, so I’m being very careful not to catch anything now and am still wearing a mask when indoors with large groups of people.
Thanks. Hope you remain Afib free. What did you take during the 9 months to manage your heart rate? Did you take anything leading up to the cardioversion e.g. amiodarone?
Thank you. I was taken off Bisoprolol because my heart rate kept dropping to around 30 - 40 bpm but wasn’t put on anything else other than the vasodilator when my chest pains on exertion started around May, as I was already on Warfarin. Things improved a lot when the chest pains stopped but I now need an angiogram to make sure it was just due to the AFib and not narrowing of the arteries. The cardioversion was much easier than I had expected and I felt better immediately so I wouldn’t hesitate to have another one should I need it. I’ll probably be on the vasodilator until November, which is when my next appointment with cardiology has been made.
Perhaps but it does help many ( like me 😊) if taken for short periods under supervision. I had very fast arrythmia in the blanking period after my ablation and my heart was beginning to not like it ! My ejection fraction ( EF) dropped to 29% and my atrium was enlarged and no other drugs helped . I think saying it's a " death drug" could make some members refuse it even if their dr prescribes it. But I admit I was scared when I was prescribed it! 😄
After being in persistent AF for 8 months during covid, a DCCV returned me to sinus rhythm. Since then I have gone in an out of AF for periods of 4 or 5 days but none of them has (so far) become persistent.
I was in persistent AF for 9 months in 2019. I had a cardioversion in Jan 2020, 9 months later, and have remained in NSR since as far as I know, for over 3 1/2 years now. I'm on bisoprolol 6.5mg, and rivaroxaban.
I've also taken note of a few foods that seem to lead to ectopics, and avoided them - aged and processed meat particularly, and fatty lamb seemed to give me ectopics too.
Hi I had PAF every4- 5 years and self converted within a day or so. That went that way for 30 years. The. in August last year I couldn’t self convert so put me on Metropolol and Flecainide to see how I went for a month no luck getting back to NSR so cardioversion was done at the 5 week mark. Back to NSR for 2 months then I flipped back into AF in December and another cardioversion within 3 days of going into AF. Been fine so far and on Metropolol only. Though the Flecainide didn’t convert me they say it could have helped settle rythem
I started out with AFIB as early persistent in March last year. Had 2 cardioversions in April, the 2nd after I was put on Multaq for a week. Neither lasted in NSR more than 5 or 6 hours. I fired my EP at Sentara Norfolk General in VA.
I then had Pulsed Field Ablation at the Cleveland Clinic in May and have been in NSR ever since.
Attached is the graphic I created to better understand AFIB and how to deal with it. It has 4 pillars vertically and 5 swimlanes horizontally. I hope it gives you better understanding as well.
That’s impressive! I can follow most of it although being relatively new to the topic there are some terms I’m not familiar with as yet. Thanks for posting it.
Hi there, I'm quite similar to you in that I'm a 72 year young male who enjoys exercise, cycling for me. I've been in persistent AF for about a year now and I had a Cardioversion a month or so ago which unfortunately only lasted 5 days. I did feel better while in NSR but my symptoms are not too bad at all generally. I take 2.5 bisoprolol which keeps my resting HR below 100. I get the thumping in the chest and fight or flight symptoms mostly when I'm at rest. When cycling I try to keep HR below 140 although to be honest the beta blocker doesn't let me get much higher as I get breathless. I've just had an echo scan so waiting on those results and then hopefully a review with the EP probably October now. The arrhythmia nurse has suggested Amiodarone but I don't fancy that yet I may try it after the Summer is over, if it ever happens. I've had 2 previous ablations in 2010 and 2018. Persistent AF has been easier to cope with than Paroxysmal.
Yes you’re similar to me but have been on the Afib journey for longer. Interesting that it became persistent even after 2 ablations . I suspect amiodarone will be suggested for me, too. We’ll have to compare notes 😊. Thanks
As I feared my cardiologist is going to prescribe amiodarone. I’m looking at the side effects and drug interactions and I’m feeling extremely hesitant. I plan to discuss it further before deciding.
I was in persistent A Fib for 9 months after first diagnosis, then had a CV. The CV worked and I've been free of symptoms for 5 years now, but I don't consider it a 'cure'. Just happy to be free of symptoms.
I was prescribed Sotalol after AFib inception, but it didn't control the rhythm before the CV; don't know how much/if it does now. My EKG results are usually classified as 'abnormal', even though my pulse feels regular.
Yes, I have an EKG at each cardiologist visit (about 2X/year). He doesn't bother to tell me the actual results, just says that was EKG was OK. The term abnormal for an EKG can include many different things, such as co-morbidities, previous heart events, anything that affects the reading.
I have been in permanent af all my life, but didn’t realise until I had a couple of cardioversions whose effects were short lived. I couldn’t believe the difference being in NSR made, even if only for a few hours or days. I subsequently jokingly tried my Kardia on my son who is a Sat diver, so has stringent annual medicals, and he also has permanent af! He mentioned it to the consultant who performs his medicals and he said it was nothing to worry about and was already recorded on his annual notes as “a regular, irregular heartbeat”. 🤷♀️
A cardioversion if successful, will sign post the way to further treatments such ablation be successful and will last longer. I had 3 successful cardioversions all with persistent Afib. the first lasted for about 12/13 months the second around 8 months and the third 15 months. After the second cardioversion (which I got quickly because I was waiting for a knee replacement due to take place at the end of August so had the cardioversion towards the end of July and kept in rhythm all through that experience) I was put on the waiting list for an ablation but unfortunately I was due my ablation in April 2020 a couple of months after the third cardioversion in February 2020. You've noticed the dates? Of course the ablation was cancelled due to lockdown. I was offered a date towards the end of 2020 but one date I had to cancel due to the death of my brother-in-law and the next date was cancelled due to a Covid outbreak in the Cardiac Department - go forward to June 2021 and had to have all the tests and scans again and it was found that my heart had enlarged and so any further cardioversions or ablations would be unlikely to work. So now I am in persistent AF but getting on fine. I still go to the gym 4 or more times a week and do everything I used to do and still at the age of nearly 80 finding it hard to take things easier! AsI couldn't get on with rate control medication or beta blockers I am only on apixaban as an anticoagulant and enjoying life. Good Luck with whatever you decide to do. I still wish I could have had the ablation but making the most of life without it.
Thanks for sharing your experience. Great to hear that you are so active at your time of life with persistent Afib. Just curious if between cardioversians you took anything to manage your rhythm or rate.
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