Since developing AF I’ve had a few questions that I can’t seem to find answers to and so was wondering if anyone here knew the answers.
1. I understand that when in AF we effectively loose 15%-20% of heart efficiency resulting in less oxygenated blood leaving the heart. A cardioversion is meant to put us back into NSR and therefore regain that 20%. But what about ablations and pacemakers?
2. I understand that AF generally causes the heart to beat faster than normal and that this can make people feel ‘tired’. What do we mean by ‘tired’? Is it physically tired like we’ve run for miles and now can’t take another step or is it sleepy tired? I don’t seem to get physically tired but I can fall asleep at the drop of a hat.
3. What is the point of doing cardioversions when they so rarely last any length of time? I know everyone is different but it generally seems to be months or weeks rather than years that they last and so seem to be of minimal benefit to the patient.
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Peakoverload
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Cardioversions (DCCV) are not a treatment they are a test. If you can be put back into NSR AND you feel better in that state then it opens the door to other treatments like ablation.
I would not agree that a cardioversion is just a test.
I have had more than 20 cardioversions over the years.
The reason I was given each time was that they did not want me remaining in AF for any amount of time regardless of any subsequent treatment that might be decided upon.
As I was diagnosed with PAF I was normally able to return my rhythm to NSR with extra Flecainide. Cardioversion was used when I was unsuccessful.
Following my numerous cardioversions, which in my case always returned me to NSR, I always felt so much better as being in AF was always symptomatic for me. I know jeanjeannie50 has in the past said that the feeling on waking after a cardioversion was wonderful and I couldn’t agree more.
A cardioversion is used in two scenarios: One, when the patient has dangerous symptoms and drugs have failed to restore NSR/safe HR, and two, when a patient has persistent AF and needs/wants treatment to restore NSR to avoid heart failure or discomfort.
The lower heart performance should only last until soon after an episode of arrhythmia has ended. If it continues then that is a sign that the heart is no longer coping with the physical stress. An ablation is the usual treatment for that and if successful adequate circulation should be restored.
Pacemakers are a bit more complicated - often put in when there are episodes of too slow heart rate affecting circulation, but different pacemakers are used in differing situations.
The tiredness feeling is a mixture of both physical, like you can't take another step. That's happened to me many times. I would feel like sitting wherever I happened to be. It's also sleepy tired too, that would strike me at night about 9.30-10pm, was just like a switch being turned on. It was discovered I had an underactive thyroid too so I guess that may well have contributed to how I felt too.
I loved having cardioversions, for me it was like an instant cure. After I'd had quite a few I was told I wouldn't be offered any more, they lasted days, weeks, months and years for me.
2) for me it’s like others have said like a switch is turned on and suddenly I’m like a very light headed rag doll. I feel depleted of energy, like my muscles have run a marathon, I struggle to do anything ( but when I have AFIb generally my HR goes nuts 165 +)
3) I couldn’t function if they didn’t cardiovert me. Also I suspect I would end up with heart failure / heart attack with the crazy load on my heart.
I’m new to this all too so I’m still learning how to handle it / reduce the triggers and causes etc. So maybe it will be less dramatic in time for me - I’m also still going through finding the right drug mix / levels so hopeful we will find a way forward so I can get on with my life without fear of another ‘attack’ and when and where that might strike. Last one struck 2 months ago after my having spent two weeks sailing to Majorca and ended up in intensive care for 3 days. Needless to say I wasn’t allowed to undertake the return sail back to mainland Spain.. that caused chaos & great expense.
1. Never had a cardioversion nor has it ever been suggested. My understanding - there is a limit as to how many scheduled cardioversions are considered within a time period.
Had 2 ablations - lasted 3 years, RST Pacemaker was my silver bullet and did it for me. AA had a webinar on RST Pacemaker very recently- worth a watch.
2. Tired for me meant could not stand upright, a feeling of a tap being opened in my feet and all energy drain out - usually on the floor by that time - one way or another.
3. I can’t see the point other than in the scenarios already outlined but seems to work for some but I would think for either test or emergency are the criteria normally.
You will be redirected to heartrhythmevents.org/users... and asked to register before you can watch the video recording.
Arrythmia Alliance is the parent charity for AFA, STARS & Arrythmia Alliance although there is a similarly named organisation in US which is not part of this organisation.
hi, I have PAF and when I go into AF my heart beat is very fast around 210. When this happens I usually end up in hospital, I feel very sleepy tired after this and can take a couple of days to feel back to normal. x
1. When your hear is in NSR it is the most efficient, ablations and pacemakers keep you heart in NSR
2. Both
3. Cardioversion should bring your heart to NSR, this is good, they last from anything from minutes to a lifetime, remember the people that are “fixed” rarely come on hear so you will be surprised at the success rate. Also the success rate of ablations.
It is part of the questionnaire used to assess whether or not you would qualify for a referral to a Sleep Clinic. The full questionnaire is called Epworth Sleepiness Score - but completing that will only get you a referral, it's not a diagnosis. Only full wired up testing equipment can diagnose SA.
I have often wondered whether cardioversions might not be more successful than a forum such as this would suggest. I gather that they also give the doctor useful information about the electrical activity of the heart.
As for pumping efficiency, I was told that it is uncontrolled tachycardia that reduces this, i.e. a ventricular issue, albeit one caused by the atrial fibrillation in this case. I have read that this drop in ejection fraction varies and that some people cope well with a low cardiac output, whereas others struggle with even a tiny change.
In terms of tiredness, I think this is hard to measure as it is so subjective. In my case, when my heart is "off" (whether AF or not, i.e. even if ectopics and palpitation), part of the issue is anxiety which adds to any genuine tiredness.
my AF would make me feel like I had little energy usually heart rate at rest was 120 or more. I would get AF once every 4 or 5 years and first one was over 30 years ago. it usually resolved with exercise. Last September I was cardioverted then again in December again. This time as the episodes were close together I reviewed my lifestyle made change’s virtually gave up alcohol and caffeine as they were my catalyst’s, I started taking magnesium and CoQ10 and daily exercise within limits. Practice slow deep breathing, only decaf and tea. Occasional sip of wine with dinner. I’ve discussed all this with my cardiologist who says what I’m doing may or manor help but it doesn’t hurt trying. We are all different. I know it will come back one day but feel doing what I do makes some difference. This is a great forum and I’ve learnt a lot from these great people
Had my 1st cardioversion in April 2020. Was still holding when I had open heart surgery to repair two valves in August 2021. This surgery returned my left ventricle and left atrium to normal size, and I'm still in NSR.
I scanned the replies here and it reinforces my view that everyone has their own experience of AF.
Cardioversions are not major procedures and do work for some people - so its a low risk (risk free?) "test": you are in and out the same day and the only after effect is the sedative and maybe a feeling of being smacked on the ribs (that only happened once when my doc shocked me three times to make very very sure). If offered, my recommendation is to have one and be sure to ask the anesthetist to add fentanyl to the cocktail they knock you out with.
I get short of breath / loss of breath when exercising - if I do anything more intense than walk I start to feel not dissimilar to having a flu. I don't think my A-fib makes me "generally" tired - but I am certainly a lot more tired after a hike than I used to be (and can not handle as long hikes either).
Yes being on forums like this makes us all realize how different AF is for each of us. Causes and burden felt, and therefore treatments, vary tremendously. Prior to my ablation (1st) this May, my EP who is 6 hrs drive away, told me to go to Emerg for cardioversion if AF symptoms were unbearable (HR too high, lightheaded, almost fainting, bedridden etc) … said purpose was for relief, to prevent heart remodelling in unhealthy ryththm, to help choose best arrythimia meds and to help move me up ablation waiting list. Because my AF episodes were almost daily, and 7 cardioversions in 4 months (all provided immediate relief and NSR immediately and lasted up to a week), i was moved from a one year ablation waiting list to 2 months. I’m only 3 months post-ablation, but so grateful to have my life back. At 65 yrs old, am back trail running, biking and playing pickleball (moderate intensity, still careful to not overdo it) … not one AF or ectopic since ablation. Aware it may return, ive done everything i can lifestyle wise (no more caffeine, alcohol, healthy weight and BP, don’t overeat, get downtime, took sleep apnea test, no NSAIds or medications except Apixiban etc.
I never had a cardioversion, or ablation, or meds for antiarrythma.
Reason as the AF came with the stroke and had the knowledge that all this was caused by thyroid cancer which I had to wait time and tests to have it removed.
AF has not left although the cancer has been removed thyroidectomy and 12 right lymph nodes (2 affected).
As I understand it if ones heart structure is abnormal, mine is as the behind chamber is enlarged one cannot have the above.
When my H/R was uncontrolled - 187 Metoprolol with pauses at night and then I demanded a H/Specialist who changed me to Bisoprolol 156 I stopped walking as I could not go on. Dr said that 02 not getting around the body. Also the day was long and I would sleep.
No energy, sweating a lot but no longer breathless - Metopolol banned. I was one who couldn't take ACE drugs earlier.
The locum referred me to a private H/Specialist. CCB Diltiazem immediately brought my H/R down 105 bpm on 180mg 1/2 dose.
I balanced and found CCB for rapid H/Rate and Bisoprolol for BP.
So now on
Diltiazem 120mg AM
Bisoprolol 2.5mg PM
=. 124/69. 60s Day and always 47 avge night no pauses.
I had my stroke Embollic at 2am!
I still get tired after a day out, walk but between 6-7pm. I'm awake early taking my thyroid pills.
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