After 4 ‘failed’ ablations, I yesterday had a cardioversion for atrial tachycardia.
I went back into NSR after only one shock on the lowest setting and my EP was pleased with how the procedure went.
Does anyone have any advice about how I can try to stay in sinus? I know it’s a bit of a lottery but I’d like to do whatever I can to stay in rhythm. Should I rest or get back to gentle exercise?
At the moment I’m taking 5mg Bisoprolol and 5mg Ramipril in the morning and 5mg Bisoprolol, 2.5mg Ramipril and Rivaroxaban in the evening. The plan is to gradually reduce the betablocker over time, but not just yet.
Any thoughts would be much appreciated
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frankiec5
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If you know what your triggers are avoid them. Unfortunately many of us do not know our triggers. Take it really easy for at least a week. Avoid alcohol, caffeinated drinks ie tea and coffee, spicy food and maybe best to take small regular meals rather than eat a large meal as that can sometimes bring AF on too. Keep well hydrated. If you normally exercise then get back slowly taking it really easy and building up slowly. Exercise is good for you any way so if you do not normally exercise take short walks on the level and gradually build up to going further - if you wish to. I always went back into AF after lifting something heavy. Picking up a heavy box of books and from turning a mattress. It seemed to be a mix of bending and picking up a really heavy weight that did it for me. When you go shopping if you carry bags to/from the car then use more bags and split the weight between them rather than carry two heavy shopping bags at once. Don't rush things and leave plenty of time for journeys and appointments so that you avoid stress. Try not to get stressed by other things - hard I know but stress seems to be a trigger for a lot of us.
Thank you so much for your advice. I’m afraid I don’t know what has triggered my return to af on the past four occasions. My lovely husband does all the heavy lifting bless him. I don’t drink alcohol and I avoid caffeine so nothing obvious springs to mind.
I’m desperate to get back to my daily walks but I will do as you suggest and take it really easy for the next few days.
It’s really difficult not to keep checking my heart rate every hour or so but I will make a concerted effort to stop this (potentially stressful) obsession and just check morning and evening.
Fingers are firmly crossed that this blissful NSR is a permanent fixture
Yes I only know what put me back into AF after my cardioversions though after my second I have no idea what it was, and no idea what put me in to start with as like you i hadn't drunk caffeinated drinks for decades due to an overactive bladder and have never been a drinker, was fit, healthy and not overweight. It's just one of those things. Just take things easy and do your best.
I’m soon to be exactly where you are. I have a CV Monday following a second ablation 3 months ago. I wish us both well that this is a “permanent fixture.” I believe it’s possible. My heart signs are good, I think. This reversion to flutter and tachycardia has kept my HR in the 100’s and 110’s—instead of bpm’s from 140-170. It would seem something in the last ablation changed something.
I’ve also discovered that I actually feel okay, tachycardia or no. Maybe a little draggy, but not like prior reversions to fib &flutter. I could live with this HR if I had to. As children until ages 4 or 5, our heart rates in the 100’s even low 110’s are normal. I figure that means my heart knows how to beat at that rate without damaging itself (vs rates like 160–which makes me miserably fatigued and foggy). I could be making up a pure fantasy, but it gives me comfort.
And at least with flutter, my HR is steady, unlike with afib when the beat is all over the place, allowing blood to pool in the left atrial appendage. I’ve had an LAAC with a Watchman, so I feel protected against stroke.
All in all, I’m going into this LAST cardioversion with a lot of optimism.
But like you, I need a post-cardioversion plan to give it the best chance of working. Desanthony have us some excellent advice. Thank you, Desanthony.
Nothing is going to ruffle my feathers in the coming two weeks, minimum. If I note a little tension, I remind myself to smile and take a deep breath. It works as a stress reliever. Nothing is more important to me right now than staying in NSR. Stress is its enemy. I am going to put myself and self-care selfishly first—come hell or high water. (-: With a smile.
Worry and stress do not belong in a first aid kit for a healing heart. Tension and pressures from others to meet their needs, not ours, don’t either. Nor do things like going back to a daily work grind or pushing ourselves to get through our to-do lists. Post-cardioversion is a time to read in bed in the morning if you feel like it, to eat only the food you want to eat, in small amounts, (and let others prepare their own if a simple salad isn’t enough for them), stroll when you walk, let things on your to-do list slide, sit quietly and focus on your breath or meditate even if for just a minute or two, seek joy in the ordinary things of life, which aren’t really that ordinary when you think about it, like majestic cumulus clouds or the fragrance of a lilac. That’s my plan anyway it can’t hurt—but doing the opposite can
We’re always looking for triggers. I have two possibilities in mind for what triggered mine:
1) A too-large lunch—I certainly did not need that pie for dessert!—followed too soon by a long walk and then light yard work that involved bending, lifting, weed-pulling. Too much food too much exercise too soon. That’s very similar to what Deanthony reported from his experiences. The minute I came indoors from the yard I knew it. I had reverted. I was momentarily crushed—but caught myself and got about the business of notifying my EP, who ordered a CV. I found that comforting. A way forward.
2) A new drug that might have upset my tender heart is the other possible trigger I’ve thought of. When I looked back over the past three months, there was only one thing that I had done differently regarding what I put in my body: I took hydrocodone for two days to relieve an exceptionally painful TMJ episode that acetaminophen barely touched. My PCP prescribed it. When I asked my EP team for recommendations for pain relief when acetaminophen didn’t do it, they told me to go to my PCP. Not their job, I guess. I have since read that an opioid does affect one’s heart negatively, but usually in large doses over a period of time, which was not my case. We used it to break the pain cycle, and it worked. But at what cost to my heart? I don’t know, never will. But I’m not taking any more hydrocodone, I can assure you. I’m seeking other modalities for TMJ relief.
Our hearts have been through a lot. They’ve been wounded. They are healing. How to make a cardioversion last? No one has the answer, but a calm confidence and good self-care can’t hurt. Our hearts don’t need any shots of adrenaline from stress or overdoing. I’m going to try to make no exceptional demands of my heart in the healing period, leading as quiet and routine and boring life as I can. This is not the time for social gatherings, meeting work demands , dining out with a glass of wine, doing anything we don’t want to do. Boundaries. Heart-protective boundaries. And a light and optimistic spirit, as best we can.
As the old saying goes. "Make haste slowly". Listen to your body and take it easy . Make sure you can talk at the same time as any exercise and if you can't then stop.
BobD: Make sure you can talk at the same time as any exercise and if you can't then stop.
Is this what works best for you, or do you have some data source showing it best for everyone? Personally, I also try and keep my heart rate down to talking levels, however there have been studies that show that many respond better to more intense interval training. It's quite an individual thing.
Exactly ! frankiec5 is an afib patient in her early 70's. She does not need intense exercise and will benefit from moderate daily walks as approved by her doctor.
i before the e except after C. Perceive! Good one.
That's interesting about talk but I find it was TOO LATE and I had reached the top of the stairs to talk. Breathless it didn't feel like. Loss of even oxygen more like it.
Good point Jim. I personally enjoy doing a bit of interval walking - increasing to hurrying and then jogging for up to a minute. I then stop and let my HR come down - usually within 60 seconds. My heart never kicks off in this situation, nor has it done so in more taxing uphill climbs (which these days I definitely take slower than I used to), nor during gardening tasks such as mowing. My heart likes to surprise me either during a meal or immediately afterwards! So, yes, we're all different. I like to take exercise in some form most days and miss it if i dont. However, I wouldn't push myself into anything more extreme than the above unless an emergency called for it.
Yes, doing "intervals" does not have to be intense and your "interval walking" is a good example of a sound exercise approach where you push a little beyond the "walking and talking" approach.
After a cardioversion don't do anything to raise your heart rate for a week or so, no walking up hills, or lifting anything heavy. Do not exert yourself in any way and allow your heart to gain strength beating at it's correct rate. I once made the mistake of walking up a hill the day after a cardioversion (have had quite a few) and my heart went straight back into AF. Oh, no alcohol for a while after either.
Something that sets me off is making a big effort with something and holding my breath. My last week’s worth of AF was set off by wrestling with a flat pack tv stand. Stretching up to high shelves is bad too. I once set AF off by flicking through the high rails in a fashion shop sale - I’m quite short and have spinal problems so it was a big effort - bang 😬! I have just read a book by a cardiologist which stated that stress is the main trigger for arrhythmias and the purpose of prescribing beta blockers is to prevent Adrenalin spikes.
An instructive event I had was when I used an epipen for a wasp sting. An epipen jump starts adrenaline. And it jump started a major afib episode in me. Lesson learned.
But smaller stresses, for me even just getting frustrated at the computer when I’m trying to cancel a subscription service and they make the process impossibley Byzantine, on purpose, can get my “juices” flowing. We don’t want our frustrated and ticked off juices flowing when we’re recovering from a cardioversion or ablation. And I mean, after all, how important is canceling a streaming service compared to heart health?! Gotta keep our eyes on the prize and not get distracted by adrenaline producing irritations of daily life that truly aren’t important in the whole scheme of things. I think I’m writing this just to remind myself! I’m prone to letting little things get under my skin. That’s a no-no in heart health recovery—and maintenance.
"Tachycardia" could be many things and sometimes harder to treat than afib. If it is flutter, than daily anti-arrythmic's like Flecainide can be helpful. Not sure about other tachycardia's like AVNRT, but I was once prescribed Flec for that as well. This is really an ep question. As far as exercise advice, it's an individual thing. The idea of "walk and talk" is just one approach which may work better for some than others. There is also interval work, where you get your heart rate higher for short intervals. Some studies show this may work even better.
As for exercise, I think Bob’s and Jean’s advice will be best for me to follow. I shall try to ‘make haste slowly’, take care not to overdo it and give my heart time to settle into its new rhythm.
Exercise restrictions after CV are not the same as after ablation. I was never given any.
My point regarding exercise was more longer term anyway. As I mentioned, "walk and talk" may work for some, but interval training also has had some demonstrated benefits. Very individual thing.
Jim
Talking during a brisk walk with a friend brought mine on. After 3 cardioversions I’ve learned to be more aware of overdoing it and to slow down in life generally and ‘pace’ myself (I’m 77) Avoid or limit certain foods, no coffee or alcohol. I avoid stress if I can help it.
for the first few days just take it easy with exercise, i then only did level walks for around 4km each day for a couple of weeks. After that i felt confident to go back to Reformer Pilates, weights, golf and after a month back on the indoor bike doing 10km rides. Every person is different. I've had 3 CV's since August 2022 and have got more relaxed about walking on eggshells if you know what i mean.
Thank you for the advice. I know exactly what you mean by ‘walking on eggshells’. That is precisely what I’m doing at the moment!
After 3 cardioversions and 4 ablations since I was first diagnosed in January 2021, I’m very anxious to protect this new-found sinus rhythm and not do anything to jeapardise it.
I shall take it easy for a couple more days and then slowly get back to my daily walks. I really need to lose some weight now as I want to be fit enough to enjoy a trip to Australia in September. Fingers are very firmly crossed!
just be positive and don’t push too hard sometimes it’s the nerves, stress etc.. that brings on a hoppy heart, breathe in/out through the nose mindfully for a few minutes a few times a day, just normal breathing. A bit of fitness definitely helps me
I’ll ask my EP about this. For the moment, he’s advised me to stop Diltiazem but remain on 5mg Bisoprolol twice a day and Ramipril- 5mg in the morning and 2.5mg in the evening - as well as Rivaroxaban of course.
Personally, having tried a few things and read of so very many, I think there's nothing whatever to be done except, perhaps, to take it easy at times when the heart will be not wanting instant stress or not be ready for it. It's these stress points that affect the heart most, I have read and experienced myself, sometimes even pulling and pushing at it and setting off ectopic beats, which are able to precipitate AF.
- After waking, get up slowly and let the body become accustomed slowly to activity.
- Do not crouch down or stand quickly from a lying or sitting position until you are fully awake.
- Drink but not large volumes and without gulping as, in some people, the oesophagus presses against the atrium and this can set off PACs.
- Eat a good breakfast of protein and fruit, rather than lots of cereal (which can bloat) such as egg, yoghurt, a round of buttered toast with jam.
- Avoid sugar dips so eat meals earlier rather than later.
- Avoid constipation or abdominal bloating as both can force the stomach higher against the diaphragm and heart and set of PACs > AF
- Avoid any other thing you know sets off ectopic beats.
I forgot to add to the list what set mine off this morning…
- avoid emotional stress through any kind of conflict.
This may be just me as an introverted kind of person, but the slightest personal conflict will cause palpitations and, this morning, those brought on three hours of AF.
It’s taken me a while to realise this, really. In fact, I’ve had some kind of problem with this long before I knew about my current AF problems - which makes me think that I was having some kind of issue in the past that was never identified.
I had one last week (one of many) but the only advice you'll be given is regarding what not to do following sedation.Just be sensible for a few days with rest, as obviously, your heart has been given a jolt, but other than that, if you don't know if you have a trigger (I haven't got anything specific) there's not much more you can do,
I've ended up with Covid 3 days after, so I have been concerned that it will trigger the AF again, especially with all of the coughing. Had some palpitations and ectopics but not checking my pulse every 5 mins.
Fingers crossed for a long stay in nsr for both of us. My last one lasted 2 years so I'm hoping for at least that. 🙏
I'm waiting for a valve repair surgery (issue caused by the AF) with a Cox IV Maze thrown in for free, so I know this is just papering over the cracks for me at the moment but when I'm in nsr (without bloomin Covid) it makes the world of difference.😊
You are right, afib treatments are a crap shoot. Exercise is good especially walking. Absolutely stay away from alcohol and other illicit substances they are huge triggers. Manage stress, take naps, get a good night sleep. Obviously, good nutrition, maintain adequate magnesium levels. I’ve had 5 ablations and two major heart surgeries and currently atrial paced on Multaq and in Sinus for now. I live my life within that context and keep my fingers crossed. Maybe someday they will figure out this afib enigma but the heart is a tricky thing. Most importantly try to maintain a positive attitude. It’s never easy facing all this but it’s always easier facing things with a smile than a frown. Best to you my friend.
Firstly, all the very best, and hope you stay in NSR!!!. Now 3 years ago I was told I had long standing persisatent Afib ( I was in it 24/7!!). My Ablation failed after one week ( the blanking period made no difference I was still in Afib after it ).
..I was resigned to the fact of being in Afib. I was then offered a cardioversion about 6 months later ( this February in fact ). Had the cardioversion and I have been in NSR ever since ( it took two shocks to convert me )..
What have I done ?..Well reduced my stress and given up booze totally...I loved the odd glass of wine, but I am sure when I had it it did not help, so if that was a trigger its not one anymore...Dosen't really bother me as I have the odd zero alcohol beer. and no more flutters. How long will I stay in NSR is any ones guess, but I am doing my best to keep it that way. To be honest I did not think cardioversion would work, so I have been pleasantly surprised..Look after yourself.
After all the procedures I’ve had in the past, I would love to think that this last cardioversion has finally sorted me out. Fingers crossed that I’m pleasantly surprised too 🤞
What is gentle excersise for you ?Cardioversion knocked me for a couple weeks so restup for a couple then I hopped on a stationary bike and kept my hr in the 90s gradually increasing the time each day. Thats Z2 for me but i am 82 yo male.
I shall certainly be resting and taking things easy for a couple of weeks. Then I hope to gradually get back to my daily walks. But I may not have your energy!!! Congratulations to you on your fitness.
TAKE IT EASY EASY EASY for at least two weeks. I mean really easy! Then when you do come off the meds slow slow slow or the heart can rebound. I’m 14 months post DCCV and still In NSR.
I have also had acupuncture and focused on what was causing the stress in my life and rid myself of it.
I had two cardioversions and went about my normal living as soon as I returned home. It wasn't that I was defying instructions, but that I really never got any after-CV instructions. Thankfully everything was fine despite that.
I find it interesting that so little post-CV information is given patients by the professionals. Just look at all the great information from the lists on this thread. That’s information all CV patients should get from their providers. This forum is invaluable.
Hi. My triggers are fluids. I need to keep well hydrated which can be difficult as I have HF. Alcohol is another. If you want to drink alcohol make sure you drink water before.
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Could I have some advice please?
Cardioversion
Cardioversion 
Post cardioversion exhaustion
