For the last 18 months, my AF seems to have got worse, and I have suffered badly with a shortage of breath. I have had 2 lung function tests and 2 consultations with a Respiratory Consultant who has told me that my lungs are “normal”. I am on a very long list to see an NHS Cardiologist, and therefore decided to ‘go private’.
I was given a Zio ECG pack to wear for a week, and am due to see my Cardiologist next week to hear the results. I am pretty sure he will suggest a DC Cardioversion which, as I am self-funding, will cost up to £2500. I am therefore considering whether that money would be well spent, since I am told there is no knowing how long the procedure may last. It makes me wonder whether I would be better off trying anti-arrhythmia drugs first. I have already tried Bisoprolol and Diltiazem, but these seem more concerned with lowering the blood pressure than actually treating the AF.
So, I would greatly appreciate some indication from those who have had a cardioversion, whether or not you thought it was worth it. How long did it last and were there any problems?
Many thanks
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Dastardly
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Any and all treatment for AF is for quality of life QOL. A cardioversion is not used to necessarily cure AF but if it is successful in putting you back into NSR even for a matter of hours then it signposts the way for other treatments such as an ablation to be successful in treating your AF. An ablation will usually keep you AF free for a much longer period of time than a cardioversion though some people have found that one cardioversion works and they are in NSR for many years - 2 of mine lasted for over a year each for example. I couldn't get on with any beta blockers, calcium channel blockers or other rate/rhythm control medications as they made me feel worse than the AF itself. Diagnosed with persistent AF I had 3 cardioversions which kept me in NSR for 3 out of 4 years. I was due to have my ablation the April after the first lockdown started so it had to be cancelled after that cancelled a further two times because of Covid outbreaks in the hospital and in the cardiac unit. The following year when things were all clear again I was hoping to have the ablation (I was still in NSR at this time after my 3rd Cardioversion which kept me in NSR for 15 months, but I had to have all the scans and tests again and it was found that my heart had remodelled itself so further cardioversions or an ablation were unlikely to work. When I went back into AF it was now permanent AF (no different form persistent only that now I would not be offered anything other than medication to treat it) As my heart rate is well within normal range; average resting rate in the mid to high 50's and peaking oacassionally during exercise at 130 I am just on anticoagulants (Eliquis aka Apixaban) to manage stroke risk.
As I notice you are in the UK is it not possible for you to ask your consultant to add you to his NHS list for cardioversion and then possible ablation? I think a cardioversion now must cost £2000 or more and an ablation must cost over £10,000 now. When I was first diagnosed back in 2016/17 an ablation cost £9000.
It's cardioversion or nothing for me I'm afraid. You are absolutely right about QOL and, as a 78 year old with metastatic prostate cancer, I don't need, or want the hassle of ablation. I'm not sure how much NHS work my consultant does, but if I wanted to be an NHS patient of his, I would have to go to the back of a very long waiting list. All sorts of ethics would be involved in that decision, and I think he would not take me on.
Anyway, I have enough money to pay for the odd cardioversion. I's just whether or not I feel that is the right way to go.
Go for the drugs, probably flecainide. Personally I wouldn’t even think of ablation before a trial with appropriate drugs, and I would think twice before a DCC for that cost before appropriate drug trials. I hope your cardioguy gives you that option.
Cardioversion (DCCV) is not a cure for AF as I'm sure you know and may be successful or may not . If successful it could last ten minutes, ten weeks or ten months. Despite what many may tell you, it is not without risk either as anybody who has followed me these last many years will know. If you like me seem to be the one in five million things happen to then it is an expensive way to find out.
Chemical cardioversion with a drug like flecainide would seem a cheaper and less risky way forward.
I thought I had replied to you, but nothing shows. Anyway, I am coming to the conclusion that I am not looking for a cure for AF, as much as looking for a way to tone it down a bit and make my QOL a little better. I am therefore drawn to your concept of a chemical cardioversion. There will, of course, be side effects that would make NSR look attractive, but I am a stoic, and have learned to accept these.
Diltiazem and Bisoprolol are intended to treat HR as well as BP and both have a mild antiarrhythmic effect. Your cardiologist could suggest several things depending on your average HR and how long you have been in persistent AF (I assume you do have persistent AF?). It’s really difficult to give a sensible answer without more information so you may just have to trust your cardiologist. Even then I suspect the result could depend quite a bit on luck.
I would say I have long standing persistent AF, but my recent Zio ECG patch will confirm that when I see the cardiologist. All I know is that I don't physically feel it. For example, I had an ECG before I saw him last, and my HR was 148, but I had no idea I was in AF. so, that is the good bit. The other side is that if my heart is constantly beating around that level, it can't be good. My Omron BP Monitor shows permanent fluttering, but the HR is anything from 65 to 95. I am told these monitors cannot accurately measure the heart rate.
Neither Bisoprolol or Diltiazem have had any effect on bringing my heart rate down, so I think the time has come to look at alternatives. It will be interesting to see what my cardiologist thinks.
Hi, My cardioversion put me into sinus rhythm for less than 24 hours. I had a cardiac ablation about 2 months later which, after many months of "settling down", has completely eliminated my AF.
I usually check for AF with my Samsung Galaxy watch a couple of times a week and the last time it gave an AF result was last November.
If I was sitting with you offering my thoughts I would want to explore your resistance to ablation. You seem relaxed enough about Cardioversion, and in terms of the experience, or 'hassle' to use your term, they aren't that dissimilar.
It would be a shame, in my opinion, to completely discount a treatment option that your Cardiologist might feel is the right one for you.
I think the gentleman's metastatic cancer may be the reason and he seems to suggest that ablation is unlikely to be offered to him either.I just wanted to say, I have had cardioversions and an ablation and I'm not sure why you would say they are not dissimilar.
Would love the name of your EP, as in my experience, they were extremely dissimilar in procedure, recovery and result. 😁
I thought about acknowledging the differences between the two procedures in my post but wanted to keep it to the point. I didn't find much difference personally; in both cases I went to the hospital, waited in a cubicle, went down to the cath lab, was anaesthetised, had it done, went onto a ward, was discharged the same day and went home.
Of course the procedures themselves are completely different and there's an awareness and some discomfort when being ablated, but I didn't find the experiences much different on the whole.
As I said If I was chatting to the OP about it, I'd want to explore his stance on ablation. If he told me it's not an option because of another condition, then fair enough, subject closed.
Oh no, I was saying that if the OP told me his condition didn't allow an ablation, that would be that; the subject would be closed between he and I. 🤝🏻
Hi. I've had about 8 cardioversions now and they have lasted anywhere between 4 days and 2 years. So, a bit of Russian Roulette. I have faired better having one, whilst being on Amiodarone.If your private consultant is also NHS, I believe they can add you to their NHS list at a point where you need treatment rather than necessarily having to go to the back of the queue......... I'm sure others who have gone the private route an advise better than me.
I understand you not wanting to be meddled with if you're dealing with metastatic cancer and an ablation is high class meddling. Cardioversion is a good place to start and I would definitely ask your chap whether, in view of your circumstances, an NHS one can be arranged sooner rather than later.
Apart from not wanting an ablation, I now add multiple cardioversions to the list as well. I admire your tenacity and staying power, but that is not for me. I have maybe 2-3 years left to live and all I am really hoping to do is to be able to breathe more easily. If I can achieve that chemically, then that is the route that most appeals. If my cardiologist suggests a cardioversion, I think he may get a 'no' from me.
Mine have been spread across 8 years. I personally, would try one, at least to see if it does work but I'm in the regret what you do rather than regret what you don't do camp 😁.I'm waiting for open heart surgery to repair a valve so, I'm probably looking at cardioversion as very minor compared to that or an ablation. My first cardioversion was daunting so do understand why folk worry about having one.
My layer ones have lasted 2 years + after taking Amiodarone prior and after. Perhaps your chap would considering that as its clearly helped me maintain NSR for extended periods, as I know it has others. Hope whatever you decide, there is some way of relieving your symptoms. Bisoprolol made me extremely breathless but I'm fine with Diltiazem.
I used to be indecisive, but now I'm not so sure. I have to confess, I was initially quite willing to have a cardioversion, just to see what it felt like being in NSR. I'm not worried about the procedure, but I am now leaning towards trying Amiodarone first, so at least I have something going for me if cardioversion fails. I, too, am in the full steam ahead and damn the torpedo's brigade. Wishing you had done something is a very negative experience.
Anyway, I do wish you all the very best for your open heart surgery, and hope it is all you want it to be.
Thank you. Being in nsr is better than being given the keys to the cheese and onion section of the Walkers crisps factory. 😁.I was put on Amiodarone prior to being cardioverted the 2nd time as the first attempt lasted 4 days.
The Amiodarone has never put me back into nsr on it's own but has helped keep me keep in nsr for long periods after cardioversions and for the past 3/4 years, I've taken it continuously.
Let us know what you decide to do and how things go.
Mine was successful (over 2 years now) but I was in my early 60's and quite fit. Got even fitter after with change of lifestyle (strict med. diet, no alcohol, daily exercising), still got some arrythmia (early late beats sometimes in clusters) but no AF as far as i know. I waited a few months to get it on the NHS, not ideal...if I had to try another c.version and there was a long waiting list I'd probably pay for it.
Good to see that things are going well for you. Clearly, the more you put in, the more you get out. My case is a bit different to yours. Late 70's, no testosterone, and an aversion to diets and lack of alcohol. My aspirations are simple. All I really want to do is to walk up the stairs and not be gasping for breath at the top. No, its not my lungs - they are one of the few bits that still work reasonably well. Lots of oxygen in the blood, but poor pumping.
So, back to the drawing board, I think. I like the idea of being in NSR, but not the possibility of having that for only a short space of time. Time for my Cardiologist to earn his money, and come up with a workable solution.
Are you taking a beta blocker? I'm on bisoprolol, which makes me somewhat short of breath, a friend recently diagnosed with AF wasn't short of breath until he was put on bisoprolol, and a number of people on this forum have talked of the same connection. There are alternative drugs that could be tried if that's a factor. I'm still better in NSR than in AF though.
It really is impossible to say how long a cardioversion will last. I've had two. The first lasted 3 years 8 months, the second has lasted 6 months so far. I also made some dietary changes, after reading up about possible triggers, and having noticed after my first CV that processed meat triggered ectopics.
Sometimes people have been able to have an NHS cardioversion after a private consultation, so it could be worth asking.
Hope you are able to find some relief from your shortness of breath.
I was on Bisoprolol, but, like many others, it made me really breathless. I really don't know why it is still so widely used. I am currently taking Diltiazem which is a sodium channel blocker and, although it is doing a good job in reducing BP, it does nothing to alleviate AF. Glad to see you have had such good success with cardioversion. If I decide on a cardioversion, I will certainly ask if my consultant if I can have it on the NHS. However, I think I would prefer to try the anti-arrhythmic drugs first. I'll see what he says.
I was in persistent AF until I had a cardioversion last July which lasted all of 5 days. 3 months later I started taking Amiodarone which eventually put me back in sinus rhythm. The only side effect I have noticed is the skin sensitivity. On the positive side I look like I've been in the Bahamas for 6 months. I'm on the waiting list (12 months now) for an ablation which will be my 3rd. I was also able to come off Bisoprolol. Resting HR mid 50s and 140 max on exercise.
I am heartened to see how well you seem to be getting on with Amiodarone as I have read that the side effects can be 'challenging'. Sometimes it seems the side effects are worse than the condition they are treating. Anyway, I would be very happy to give Amiodarone a try if my Consultant will prescribe it. Fingers crossed.
Hi I have had shortness of breath due to being on betablockers and have tried 3 now. It's a known side effect of betablockers. I am now off them completely and much better. That is just my experience obviously you would need to confer with your Doctor - although I had one Doc who denied betablockers can cause shortness of breath!
Yeah, I have tried betablockers in the past and they just made my breathlessness worse. I am now on calcium channel blockers which are an improvement, but only slightly. I think I really need to have anti-arrhythmic drugs that will reduce the level of my AF. I can live with that. I hope my cardiologist will agree.
I can only say in January of 2023 I met my EP for the first time (after two recent trips to Emergency Room in US because of AF caused fainting/dizzy spells.) He had me cardioverted two days later. I have been in NSR ever since and that's been a relief for me. I understand I could go out of it today or tomorrow, but so far I'll take it, it was worth it for me.
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