cardioversion

[Ongreendolphinstreet]

hi, I had my first Cardioversion at St Richards Chichester on 11th March. (First diagnosed early January but probably been in AF since Sept) It worked initially but reverted to AF very shortly after. Since watching the very helpful video interview on this site with Prof Gupta, now realise that most revert within 12 months and it’s a sticking plaster pending ablation. I have been offered a second version but only if I take Amiodarone 6 weeks prior and it will take 2 weeks plus for the consultant to prescribe it. Have others had the same requirement? There’s a 12 month waiting list for ablation at Hammersmith hosp. And 6 to 9 at Southampton (it’s not done at St Richards). In the US ablation is the first intervention as the outcome is better if done early. Looks like I have a 12 month wait on my hands.

[Jalia]

I'm afraid it's not unusual to have a 12 month wait for ablation these days. 6/9 months at Southampton doesn't sound too bad . Is Brighton any better? ( Part of your hospitals Trust....)

Taking Amiodarone prior to a dccv will of course enhance the chances of success for the procedure and is often used.

I've had very many cardioversions over the years, many have lasted 12 months or more, a couple 3/4+ years and a few 6 months. More recently my one in January this year only lasted 8 weeks and was repeated last week. I'm awaiting my 5th ablation which I understand will be hastened.

[Ongreendolphinstreet in reply to Jalia]

Many thanks for the response jalia, I didn’t appreciate that you could have so many cvs and ablations. Do you come off the amiodarone after each procedure? I’m told there are unpleasant long term effects (more than 2 yrs). I’ll certainly check out Brighton hosp.

[Jalia in reply to Ongreendolphinstreet]

I believe that Amiodarone is normally continued for just a few weeks post cardioversion. . Although there are patients taking Amiodarone long term, as a rule it is not generally prescribed for longer than 12 months.

Don't take my ablation and cardioversion record as normal .....I'm rather unusual, having just had dccv no 27 🤔. ...... 2/3 ablations and possibly 3/4 cardioversions would probably be considered more normal. .

[secondtry]

Suggest a private appointment with a trusted cardiologist to have a frank discussion on drug, lifestyle and ablation options; there are so many to consider in conjunction with your personal circumstances before making your own individual 'gut feel' decision.

[Karendeena]

I waited 16 months for an ablation at Glenfield in Leicester

[Ppiman]

An early ablation has not, I believe, been proven to be better, with the many studies looking at this not reaching any at least definitive conclusion. It's worth keeping in mind that the American mostly private medical system is much more commercialised than ours and can lead to a different viewpoint forming. What does seem to be the case is that persistent AF responds poorly to ablation.

What treatment is best for an individual depends upon the symptoms they suffer while in AF. An elderly friend has had persistent AF for very many years, and needs no treatment. His first cardioversion failed straight away but he coped well. Nowadays, he takes only his daily anticoagulant and remains well. My son's colleague has had, I think, six ablations, yet his AF (with atrial flutter, now) has returned and he can have no more ablations. He, too, copes well with his AF. In my case, fingers crossed, I cope with a daily bisoprolol and apixaban.

Steve

[Ongreendolphinstreet in reply to Ppiman]

Hi Piman, on further investigation I think you’re right that the evidence is inconclusive. I was earlier relying in part on a ‘wellness hour’ youtube interview with a Dr Sawnhey (3 years old) but a more recent 2023 (albeit limited) study supports your comments. tctmd.com/news/outcomes-jus...

[Ppiman in reply to Ongreendolphinstreet]

Thanks for the link to a very interesting clinical review. I can see I’m somewhat out of date on this.

I still find myself feeling that an ablation (especially having recently read a detailed report on how the procedure is carried out), isn’t to be entered into as lightly as electrophysiologists would wish us to.

My son’s teaching colleague has had, if I recall, five or six ablations over a fifteen year period and now, in his seventies, with his AF having returned along with AFl, he has been told that he can have no more because of the scarring and contraction from the previous procedures. He’s coping well, thankfully, with drug treatment - but what about that “scarring”?

It’s also interesting that the cut off point for this study was just a year, and that, by that point, half of all the patients had suffered some occurrence of an arrhythmia (it’s not made clear if this included the “blanking period”).

It leaves me in a quandary with thinking about treatment for my own AF which is increasing in frequency. I know, in the end, that I’ll be guided by the EP I see who is in favour of ablations, of course. My hope, though, would be to use something like flecainide as PIP to delay the ablation. However, on the other hand, as I’m now 70, I wouldn’t want to leave a second ablation too long because of my age (my first was for AFl in 2019).

I suppose, as Bob here often states, that symptoms are the best guide to what to do next. I do hope mine don’t worsen as the anxiety attached to them is really uncomfortable.

Steve

[Jalia in reply to Ppiman]

Hi Steve, I wonder if you've seen my recent post on Epicardial ablation. I'm 79 and after a consultation with my EP last week have been offered a relatively new Endo-Epicardial ablation in 2 weeks time. This will be my 5th and last attempt . If unsuccessful it will he pace/ablate. I'm grateful to have been offered another lifeline as my episodes had me deteriorating badly .

[Ppiman in reply to Jalia]

Hi Jalia - I haven't so will look that out. This year has seen my having an increasing number of faster AF episodes and vastly more persistent ectopic runs which don't feel a lot different. I cope well with them but worry where this will lead.

Steve

[Ppiman in reply to Ppiman]

Hi again, Jalia. Having just lost twenty minutes worth of typing which floated into cyberspace thanks to this sometimes rather flakey website… I’ll start again!

I’ve just read your other thread and my - it was interesting but how coincidental and odd that only last week, I’d read a long clinical review paper of just your coming “op” (or “procedure”). I came to understand why it’s called a “maze procedure” - because it’s so a-maz[e]-ingly complex and involved. What clever people these specialists are. Goodness me. If that doesn’t work and cure your AF then I’ll be a-maze-d! Fingers crossed.

For myself, I’m just hoping my infrequent but increasing AF and frequent ectopics don’t become more symptomatic. I cope quite well with the AF at present which peaks at around 165bpm but is often less. I worry more about the ectopics which have worsened with couplets, bi- and trigeminy and what have you. I also have LBBB. It all make me quite anxious. I’m awaiting an echo and MRI to check my heart and especially ventricles are in good shape before the specialist will prescribe flecainide if it becomes needed. It was all fine when I had the same scans four years ago so I’m hoping that hasn’t changed - but it all adds to my worries.

What a life, eh?

Steve

[Desanthony]

I was diagnosed with persistent AF and my second cardioversion was done with amiodorone over a 3 month period - I think it was 6 weeks before and 6 weeks afterwards. I had full blood tests every month whilst on amiodorone and had no bad side effects but at the end of the course my thyroid level was raised by .2 but this reverted back to normal within 4/6 weeks of stopping amiodorone shown on full blood test. Funnily enough this cardioversion only lasted 6 months whereas my first one lasted 11 months and my third lasted 15 months.

[Ongreendolphinstreet]

many thanks to everyone who has responded. I’m in the foothills of what appears to be a long journey.

[Sweetmelody]

Yes, in the foothills, as all of us have experienced on this journey. I can see you are educating yourself. We have to, that and find an EP and cardiologist we trust and like and who will work with us in partnership with appreciation not resentment of our knowledge of our condition.

After learning of the ablation option on my own by researching NIH and PubMed and every book available on Amazon with Afib in its title, I decided that ablation was the course I wanted to follow. I felt it could get at and correct the source of the problem, with any luck, in ways drugs couldn’t.

I went through three cardiologists until I found the right one. She listened to me, educated me, worked with me—and referred me to the top EP in our area for a consultation. At last. That took two years.

And then I had to wait five months for the ablation. #1. It kept me in SR for a blessed year. But intense family stress hit, which I believe was a significant source of a return to aflutter predominately along with a couple of major afib episodes. Six cardioversions in five months, plus lots of drugs, and nine months later I had ablation #2–on February 6–this time for aflutter arising in my left atrium with a touch up on the previous afib pulmonary vein ablation. I’m still in the blanking period, but all seems to be going well, fingers crossed.

Afib certainly requires patience, both with ourselves and the medical system. Keep educating yourself and stay proactive. At least that’s what my experience has taught me really helps on this journey of the heart. Good luck!!