My husband had an RBBB heart attack with one stent 18 months ago. Following that he contracted Afib. He is a sportsman, who lives for his sport and is otherwise very fit with a low heart rate - on Apixaban, ramipril, rosuvastatin and lansaprazole. He has a cardiologist though waits a long time before each appointment and it would appear to me doesn't seem to be offering the best or even any advice. He has never been offered a cardioversion or anything else and suffers from time to time with tiredness and some breathlessness which naturally impacts on and frustrates his sport (real tennis).
Whilst it is possible that his low heart rate causes the tiredness and breathlessness I wondered if the above circumstances warrant a cardioversion or if there are any other helpful suggestions as if so maybe we'll book a private appointment with an EP consultant.
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Swimsyroke
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Many of us do better in normal rhythm than remaining in atrial fibrillation. That's partly due to more efficient heart pumping, as well as less side effects from some of the afib drugs.
Depending on his individual circumstance, cardioversion is just one number of strategies, which might include anti-arrhythmic, medication's and ablation. Seeing an ep definitely could be helpful.
You are in the UK as I am. In Europe a cardio or an EP are broadly similar specialists since both will offer an ablation if needed. The cardio will merely refer your husband to an EP colleague if an ablation is deemed useful. An EP is a cardiologist with extra training on the procedure - both are similarly specialised regarding the heart.
Tiredness and breathlessness could be side effects of his medications.
After the heart attack and stent and when able to see the cardiologist, did he receive a followup EKG and Echocardiogram to evaluate the condition of his heart ?
You mention low heart rate, could you share the average and also blood pressure ?
Cardioversions are meant to restore NSR (normal sinus rhythm) most often followed with antiarrythmic drugs to maintain the NSR. Perhaps the doctor feels it is not warranted at this point and perhaps a concern with his heart condition (just a guess).
My experience with cardiologists and medical professionals is that they can seem aloof and sometimes don't communicate well. But that is your decision on seeking other opinions. Perhaps a private evaluation should be considered.
Finally, it is a difficult transition but necessary to have to reduce an active lifestyle like tennis. As a former runner, I have done the same.
I can answer this from experience : The symptoms that your husband is a reflection of my past , as I to have stents and had all the issues you mention.
Cardiologists are hard to get in front of and in this respect you need to push very hard to get to see one. I see you say you have already are seeing one which is good but you need to insist that appointments are more regular and thorough .
To do this you need to fight your own corner and you need good evidence as to why your case should be looked at in greater detail
Firstly , you need to keep a regular log every day that shows your heart rate ( you can easily do this if you have an Apple Watch ) or manually
Next to that how he feels through the day ie
Headaches, feeling dizzy, unwell, breathless , tired . Feeling hot . And what you are doing when it happened
Do this for a good two weeks or more : This will be good for him to trying to identify his pattens and also in readiness to fight your corner .
With your log in hand , go to your GP ( or hospital ) and advise them he is feeling unwell
You present your log of events and request a full blood test . ( If it’s a hospital they will do this anyway they will look for troponin protein to see if the heart is damaged in anyway ) but this is one of the tests you need
You ask that they write with an urgent appointment with the cardiologist ( if you are not happy with the one you have change it to another hospital it’s your right )
Ask for a full review of your medications ( this to draw a line in the sand as it were ) as to what meds are doing what and why and if they are really necessary or should they be changed ? ( They will keep feeding you the same meds without question if you don’t challenge)
Keep that log going while you wait for cardiologist . When you see him/her present the log and state matters are getting worse, and you want further investigations to ascertain what is going on. If they reluctant go to A&E when you are really feeling unwell and try this avenue ( even go to another hospital if you don’t get the support you need )
This should then set a course of action to see what the issue is with how your husband feels
For me ( a mirror image ) saw me dumping one cardiologist and insisting a referral to Royal Brompton London, then back to my local hospital for more tests ( and believe me there were many ) and despite this neither hospitals could pinpoint the problem I wore a holster monitor to record the heart over 4 days still nothing, stress tests, nothing … then I started passing out, and collapsing ( this is where you husband could end it if he doesn’t push for diagnosis ) … again nothing found and this went on several times and being rushed to hospital by ambulance is no fun when you are confused and cannot think straight .
To cut the story short they put a heart recorder in my chest which sent the results automatically at night every night .., and then it was found . I was suffering with A/fib ( arterial tribulation) and my heart was dropping through the night and day to 32 beats a minute without warning and also my heart was having a job to restart during an the A/fib attacks at night … so you see how difficult it was to find, but they found it . It took me around a year to get this far and diagnosis but at last I had the result … The outcome was I now have a pacemaker , my heart rate is now 62 bpm and no more breathlessness, headaches, tiredness or passing out . Your husbands health is now in his hands … Go chase it before it’s to late .
Thank you so much Quovadisuk for your detailed account. My husband hates fuss but I will do my best to keep those daily records and information.I am so glad that you finally got sorted out - no thanks to the professionals without your push push pushing them. Well done.
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cardioversion
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1st cardioversion 
