Wife went into persistent AF back in March and she finally got her cardioversion performed yesterday. Sadly, it was unsuccessful after the 3 attempts and she's back home with some lovely scorch marks that are itching like hell. The discharge letter says she'll be called back to cardiology in next 4-6 weeks to discuss what next.
Do people have any experience of what the next steps might be? I thought I read in this forum that ablation is less likely to succeed when CV doesn't work.
How very disappointing for your wife....and you! Plenty of E45 should help with the itching.
I understand that ablations are less likely to succeed if cardioversion fails but wait to see the cardiologist before you get too disheartened.
My multiple cardioversions always worked on first zap but I still needed 4 ablations.
First a question before I answer your questions - was your wife loaded with medication called Amiodarone prior to the cardio version? Amiodarone increases the likelihood of cardio version. This may be suggested as next step, as it was to my husband. CV still didn’t work but he stayed on Amiodarone and very gradually - took about 3 months but re regained NSR. He has stayed on Amiodarone since - this was 5 years ago now. You will hear a lot of negatives about Amiodarone but it is the one med that gives the best chance of NSR, if that is your aim.
Many people find living in persistent AF is much less symptomatic than living with PAF so maybe an option to do nothing if QOL is reasonable and heart structure good.
There really are no other likely treatment options as if CV failed it’s very unlikely ablation will - which is why CV is usually offered before going on ablation list.
If QOL is very poor then Pace and Ablate would most likely be suggested which as the name suggest is Pacemaker implant followed by ablation of the Atrial Ventricle node (AV) were the electrical connection between upper and lower chambers of the heart are ablated meaning that you become 90% dependant upon pacemaker for rest of life. This helps many people and if you are in Devon and seeing the team at Exeter/Plymouth - they have good experience of this procedure and did an excellent job for me, although the PM worked so well, I cancelled the AV node ablation - that was in 2018 and although I still get occasional AF it’s quite tolerable with very light symptoms, I had horrendously symptomatic AF prior. Please know this will not stop the palpitations but pulse will then be regular, hence symptoms such as extreme breathlessness, fatigue etc should be far less.
Final option would be Mini-maze hybrid which is only offered in certain locations, is performed by a thoracic surgeon alongside and EP and I believe is becoming better known and more available. MummyLuv is the expert. This is a much more invasive procedure but more likely to be a more long lasting or even permanent solution - if you are a suitable patient for this procedure.
Maybe research all before the consult and have a very good understanding of options so that you can discuss with cardiologist (which I hope IS an EP?) with some knowledge of benefits and risks of each treatment.
I hope that is of some help. Best wishes
Thanks CDreamer. No Amiodarone used, and as this is second time CV has failed she's currently adamant there won't be a third time. Currently she's under North Devon District Hospital.
Hi there and thanks for the tag CDreamer . I could not cardiovert, I was given a catheter ablation but it failed too. Mini maze has stuck now for 16 months which is amazing after 5 plus years of persistent afib. It’s worth asking for a referral to Malcolm Dalrymple Hay at Plymouth, he is a cardio thoracic surgeon doing mini maze. He’ll be able to discuss that option with your wife and then she can consider which option is best for her.
Thank you MummyLuv. Didn't realise it was being done in Devon.
I think N Devon was Torquay? The CCG was absorbed by Devon & RD&E team.
Aqueous cream is great for those burns!
Re the future, it is important to understand that all treatment is for quality of life and that there is no difference in end result whatever the treatment so long as rate is well controlled and the patient anticoagulated where appropriate. Most people in persistent AF agree to accept permanency and the body soon gets used to it. In fact many people are asymptomatic and quite unaware that they have AF until either they have a stroke or it is found during routine tests.
I always consider cardioversison as a test rather than treatment to see if NSR can be obtained and yes you are right in thinking ablation may not be offered but one possibility is three months or more of amiodarone and a second attempt at cardioversion before a final decision is made.
Thanks Bob. QoL is not what she wants it to be. Walks have to be short and on level ground which can be a challenge in North Devon. We got a working cocker in January and she's missing out on the daily walks.
I had exactly the same unable to walk uphill except slowly and breathless. I had permanent AF diagnosed in April 2018 but no idea how long I had it before that. I had a CV but back in AF in a day or so. Went privately to an EP which led to return to NHS for another CV which failed after a couple of days, 3 months amiodarone and an ablation in January 2019 and came off the amiodarone. Thankfully after reading all the advice on here about recovering after an ablation I am still in NSR and physically fit at 76. I can recommend ablation.
Thanks. Interesting to know Ablation is still an option.
Oh that’s disappointing. I at least had 5 or 6 days of NSR before slipping back into persistent Afib. What is it with these vagrant hearts? I’m waiting for an ablation but will probably need a couple or more, so I’ve also made enquiries about the mini maze. I did find it useful to book a private consultation at Exeter Heart to discuss options if for no other reason than you get seen fast and have longer to discuss options. I’m currently taking Digoxin (foxglove derived) and that has reduced symptoms while I await ablation with a bit of trepidation.
Thanks. She was on Digoxin after her first fskled CV in 2019 but then self reverted shortly afterwards so was taken off the Digoxin.
Aqueous Cream is best for burns, as advised by the Radiologist after having treatment for breast cancer, it works a treat.
Mine worked for 2 hours.As it was during strict covid measures I had to walk for 10 minutes to get to hubby waiting in the car as most hospital exits were shut.I didn't think that helped at all.I went on some months later for what I thoughtvwould be an a fib ablation which actually turned into a flutter one .Very best wishes .
Thanks. Reverse happened on Thursday. Public car park was furthest away from mobile Vanguard operating suite but luckily downhill so she had one if her longest walks for a while just to get there.
It will, I suspect, depend entirely on any other heart issues and her symptoms from the AF. An elderly friend, now 90, has had permanent AF for many years with few symptoms, and my son's older friend at 77 is similar but somewhat more symptomatic (he has also had several ablations that have eventually failed).
Steve
I was offered the Hybrid Convergent Ablation so that is an option worth investigating. In the meantime, the Amiodarone loading prior to the DCCV may do the trick, it did with me so mention that to your team.
Gosh, I was horrified to read that your poor wife has 'scorch' marks, per soul!. I had a cardioversion six years ago, one zap and all was fine - I am an asymptomatic affiber, but I have not had to have a repeat - all my ECGs and Echos have been fine. I had my cardio appointment last Tuesday, and his comment as usual was 'see you in a yearunless you have a problem.' My main problem is control of my systolic BP, the diastolic is normal, but these days , the common meds. like Lisinopril and Valsartan give me weird side effects, We are trying 1.25 mg Biso morning and evening, but I get so tired.!
I remember the itchiness after my ablation - as they also did a cardioversion at the end. I hope that your wife gets better news about what’s next. Though I am one of those on here for whom ablation has not worked and I have been advised to keep going with rate control and anticoagulation only.
I was very disappointed initially, but there is life in persistent AFib as long as the rate can be controlled. Of course the mini-maze is great if it’s available where you live, as others have mentioned. It isn’t possible at the moment where I live, on the NHS.
If the rate can’t be controlled then ‘pace and ablate’ is the other option - and this has been suggested for me. However, it looks like Bisoprolol is keeping me ok for now. Not as great as in sinus rhythm, but in the end I realised that I’m really not doing too badly. I get tired, and my legs feel heavy on hills and stairs - but I can still get up them, slowly.
So it’s not possible to second guess the next step as we are all individuals. I went into the three month appointment following the ablation, expecting to talk about a cardioversion and a further ablation. It was a total shock to learn that the amount of fibrosis in my left atrium made further procedures inadvisable. Even a cardioversion would have meant years on Amiodarone. Took me quite a while to come to terms with it - but got there, even if I sometimes get annoyed at the lost chances to diagnose the AFib. In the end, feeling angry was only affecting me further, and I needed to move on.
Had 5 cardio versions over 2 years didn’t last , fitted with a pacemaker followed 3 months later with an ablation almost 2years ago. So far no problems.
Good luck to you both.
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