Cardioversion for irregular but normal range heartbeat

[Hallane]

Hi all,

Due for cardioversion soon. I have had persistent AF sine April 23. HB normal range 55-90 but always irregular. No p waves for 10 months according to my Kardia. On anticoagulant, beta blocker and statin.

From posts read it seems most who have Cardioversion have episodes of higher rate HB.

My questions please:

-For those who with normal range HB what was your success period of NSR if any at all.

-Of this group who was prescribed additional medication post cardioversion.

-did any of this group go on to have an ablation.

Please reply if you have the same characteristics.

Thanks

[CDreamer]

I’ve never had a cardioversion, went straight to ablations but I have several comments I hope you find useful -

Why 10 months wait for cardioversion? The sooner cardioversion is done the better the chance of achieving and maintaining NSR.

It is usual in persistent AF to give drugs both prior to and following cardioversion to give the best chance of success. Have you discussed medication prior to cardioversion?

Is the cardioversion to see whether or not an ablation might be possible?

What are your expectations if you have been in AF for this long, with low HR I am assuming you are not that symptomatic? If so why go ahead with Cardioversion?

Health Warning - other people’s experiences are no predictors for what your experience will be.

[Hallane in reply to CDreamer]

Thanks for your reply. The wait for cardioversion….Well maybe because I was asymptomatic (only discovered the irregularity when my wife , a nurse gave me a hug and told me to see a GP) Maybe should have presented at A&E but I felt fine…

It took ages then to get through the NHS process. Had an Ecco but only after a pressed for it. Then GP referred because the report said a coronary consultation was appropriate. Now comes the postcode lottery bit. We live in Cornwall and because of the shortage of consultants in all health matters and the aged population we are about the worst in the UK. Was advised 15 months wait but managed to speed it up to a 5 month wait.

I know what you mean about why am I chasing down a CV. Why not just take the medication and forget about it.

I was influenced by the informal discussion regarding the Ecco result. Was told that although I can walk 5 miles now if AF persisted in 10 years I’d be crawling to get to the bathroom. (Their words not mine) Aged 67 now.

[Desanthony in reply to Hallane]

Similar situation herein Wales when I was diagnosed in 2016 with persistent AF waited over a year for first cardioversion as there was no cardiologist at our hospital and hadn't been for 14 months. Eventually paid to see a cardio privately and tried all sorts of medication which didn't agree with me. I had 3 cardioversions all of which kept me in NSR for about a total of 3 out of 4 years. Unfortunately, missed out on an ablation because of Covid and afterwards found my heart had remodelled itself and further cardioversions or ablations would be unlikely to work. I now have permanent low rate AF and only taking anticoagulants as any rate or rhythm control medication beta blockers or calcium channel blockers make me feel worse than the AF. Still managing to do all the things I did before diagnosis - gym at least 4 times a week, gardening long walks uphill and down dale, swimming cycling etc.

[Hallane in reply to Desanthony]

Many thanks for that. Interesting to hear from someone with similar issues.

[OzJames]

yes when I’m in AF my HR is between 80-90 at rest. When I take metoprolol HR drops again and when Flecainide is added as a PIP it comes back to about 70-80. My background I had AF for over 30 years say once every 4-5 years and self converted with exercise. In 2022 about to go overseas I went into AF so cardio puts me on both the drugs I’ve mentioned and when i returned booked in for CV. So that’s about 4 weeks in AF. Converted first time…. Went off drugs after CV . lasted 3 months before I overate and had another CV with same protocol… went off drugs about 2 weeks after CV this one last nearly 10 months. I’m now on low dose metoprolol and am more careful about my triggers.

[Hallane in reply to OzJames]

Thanks for your reply. Interesting about the medication differences.

I know why I’m on Edoxaban of course to reduce stroke risk.

Statin ( Atoavastatin ) to reduce a chloresterol aspect.

But Nebivilol I’m not sure about as I thought this was for rate control. My highest rate is 90 after exercise and normally 60/70 ish. So wondering if I need rythym control not rate control. I clearly need to ask!

[OzJames in reply to Hallane]

my Cardiologist suggested the low dose I’m on is not so much for rate control but more to suppress the natural adrenaline spike that can sometimes bring on either ectopics or my AF. The rhythm control of Flecainide is suggested by him to help pre-CV to assist in a successfull CV and post CV for a week or two to help settle heart and ensure I don’t pop back into AF.

[Desanthony in reply to Hallane]

As I said above no rate or rhythm control worked for me as being low rate my pulse rate was low anyway ad any medication dropped it into low forties and thirties, which made me feel really ill, dizzy, breathless and fatigued. I never had a high heart rate - highest about 120 to 130 when exercising in the gym usually around 70 during the day or lower and at rest on average about 56

[Belle11]

In my first bout of persistent AF, my heart rate was reduced from in the 100s to 80 or 90 with drugs, until a cardioversion 9 months later put me back in normal rhythm, and I stayed in normal rhythm for over 3 1/2 years. So delay doesn't necessarily mean a disappointing result. I went back into AF last September, and am due another cardioversion in 2 weeks time. This time my heart rate has been mostly around 80 or so, like yours, but I'm short of breath on walking and hoping I might get another good period of remission. Hope your CV gives you a good while in rhythm too.

[Hallane in reply to Belle11]

Thanks for your reply and your comments regarding the delay for a CV.

Seems I’m in a similar situation to you. My average HB is around 75.

Last week I did a 6 mile walk fairly briskly. On the flat I can really motor along but as soon as I get to any uphill parts I slow right down.

[BrotherThomas]

I'm probably considered to be in permanent AF but only on the basis of my cardiologist telling me to go and never darken his door again! My resting HR is 55 to 70 and is irregular. The irregular heart rhythm is the only symptom I have. I've had 3 cardioversions each about a year apart all successful. They lasted for a maximum of 4 months on the basis that the first post CV was done after 4 months and I was back in AF. Personally, I don't think they lasted more than a few days despite taking amiodarone for about a year before and a year after the CV.

The only effect I noticed is that my blood pressure has been slightly higher since the last CV but still well within the normal range.

I've not had an ablation and no further treatment is planned unless my condition deteriorates.

[Hallane in reply to BrotherThomas]

Many thanks for replying. My cardiologist has suggested we look at ablation if CV doesn’t work. I get the impression they will only make one attempt.

[BrotherThomas in reply to Hallane]

Perhaps but many people on here have had several ablations so more than one is possible.

[mav7]

Hallane The beta blocker should be keeping your heart rate in its present range. Heart rate could be higher if not for beta blocker.

The goal of the cardioversion is to convert your heart to NSR (normal rhythm). If he has not discussed, ask your doctor if an antiarrhythmic drug would be proper pre and/or post the cardioversion to help success and maintain NSR.

[Spoiler]

the longest I was in afib was 8 months, which preceded my “3rd” and last afib ablation April 28th last year. They said no more afib ablations, but would for flutter. It has been completely successful so far, but unless your heart rate, mine was a high rate (130-150) beta blockers did little to lower the rate, although I have been on them almost 10 years since it all started. Cardizem always works as far as lowering the rate, but does make me feel very yucky. Leg cramps etc. I did take Flecainde after surgery for a few months, currently only metoprolol and warfarin and doing well. The longest a cardioversion worked for me was 20 months and it was in the beginning of my diagnosis. It has always totally blown me away a person is not just incapacitated with afib because mine is just awful… with high rates that just make me ill. It just tells me we are all SO very different, each person and the exact area of the heart that is affected. Mine happened to be in a atypical area, the back wall of the heart, not the pulmonary veins. These EP Dr.’s are truly brilliant or at least mine was. I feel I have a new life, feel great and way less drugs after 9 years of a roller coaster. I wish I had been more open to pursuing ablations sooner, but I was afraid. Blessings to you on your decisions.

[maurice2]

Ten months is quite a long time...I was three months, after persistent AF following episode of pericarditis. It went well, I just get ectopics, in clusters usually. I'm on apixaban as my doctor says I'm a stroke risk just because of age & history (64). I do daily fast walks to keep my fitness up. Resting HR is around 60, was around 80 with spikes up to 130 (if I tried to do anything much) with the AF.