Cardioversion for atrial flutter--also have heart block

Hi all, Hoping for some input as I have questions and anxiety about an upcoming cardioversion. I had open heart surgery at 3 yrs old for ASD and VSD repair and had left bundle branch block following surgery. 12 yrs ago I developed complete heart block requiring emergency pacemaker implantation. Still very Grateful that my life has been normal and full. Brief episods of A-Fib 8 ys ago and since then relative calm. Last week had a brief AF episode but later same night I went into atrial flutter and remain in it still a week later. My cardiologist placed me on Pradaxa and is planning a cardioversion but indicated I need to be on the Pradaxa at least a month prior to the conversion to prevent blood clots. I am worried about being in atrial flutter so long, and the effect on my heart. I don't understand why it is assumed I won't convert on my own? and why I haven'...I feel mild dizziness, light headedness, but overall I am able to function okay, working fulltime but only from home since this occurred,as I'm afraid to take the subway. Dr. ruled out transesophageal cardiogram as my situation is not an emergency. I'm not on an anti arrhythmic,never have been.

I was so distressed, fearing the worst, the first couple of days,and while I have calmed myself a bit I am still worried. Fearful of stroke, sounds like there is risk after the cardioversion of stroke,and I don't know how to plan to ensure I am not alone, and whether its smart to work at that point or take a brief leave of absence ? Wondering also about what to expect with the cardioversion, and if having heart block presents any unique issues with cardioversion. I welcome any information and support that you guys may have.

thanks so much from my heart...

Hi Lindz, welcome to the forum. Sorry you found the need to find us.

Your cardiologist's plans make sense. Although it would be kinder to do a TEE to rule out an atrial clot and cardiovert you right away, putting you on Pradaxa for a month instead is common practice. You didn't say how fast your heart rate is but I'm guessing it's not super high or he probably would cardiovert you right away. Although it may not be comfortable, the month of flutter won't do you any harm.

You will have to remain on the Pradaxa for a while after the cardioversion. That's because cardioversion has a "stunning" effect on the atria that persists for several weeks afterwards. They don't pump as effectively as they should and so clots become more likely. The Pradaxa will protect you from that risk. You really don't need to be fearing stroke as long as you take the Pradaxa consistently.

Will the flutter convert on its own? Maybe. The trouble is, unlike afib, flutter is actually a very stable rhythm. I dealt with it for years and it would continue for me indefinitely until either a chemical or electrical cardioversion was done. I lost count of how many cardioversions I've undergone but it's somewhere north of a dozen or two.

As for the cardioversion itself, that's a breeze. They'll start an IV, get you hooked up to an ECG, and then knock you out with a short-acting anesthesia. The cardioversion itself takes seconds. Bang and it's done. Then they let you wake back up, monitor you for a while to make sure you stay in rhythm, then send you home. The whole process is a couple of hours, with almost all that time being you recovering from the anesthesia.

The heart block shouldn't present any particular problems. They will place the cardioversion pads well away from your pacemaker to protect it, and they'll probably interrogate it afterwards to make sure it's still functioning properly, but otherwise that's just not an issue.

As for your job, there's no reason to take a leave as long as you feel you're functioning adequately and the dizziness you mentioned doesn't present a safety issue. For the same reason I wouldn't avoid the subway, or going out to eat, or anything else in your normal life. Atrial flutter isn't a disability.

So try to relax, put up with it as best you can, and don't stress out about it. With any luck you'll convert on your own soon and avoid the whole thing.



Edited 1 time(s). Last edit at 06/10/2018 06:49PM by Carey.

What Carey says (as usual!)

Lindz, hello. I also had VSD in 1961 and occasional AFIB starting in 1998. This forum is
a life saver. The mag, K, taurine are an absolute must for me. Do take bit of sotalol
to offset bad eating habits. Good luck. Dale

Thank you so much for your reassuring input all. Carey, it sounds like you've been on this journey awhile...appreciate the normalizing perspective and your kindness in sharing. I needed that.

So since I have a pacemaker, the atrial flutter shifted it into "fixed mode" which is good, as it protects heartrate, and means my heart is not super fast, but it doesn't do what it normally does upon exercising. So, since it won't raise my heartrate with activity I can still be active, but if I take a flight of stairs, or walk up a big hill I get super winded. That's why I'm concerned about the subway -- take BART into San Francisco for work and it's 3 flights up, (escalators often not operational).

Thank you mwcf and dale, for your input as well. I see a number of you mention mag, K, taurine etc. I'm unfamiliar with these,can you help bring me up to speed on the role they play? Thanks again!

Potassium lengthens the atrial refractory period - the time during which atrial cells can't be excited. It slows the heart rate. Magnesium is sort of the "helper" ion that get potassium into the cells. Since potassium is readily found in many foods, it is often not needed to supplement unless there is a specific reason to do so. Magnesium, on the other hand, is not found in many foods so supplementation is often a very good idea. The taurine is an amino acid that can also have a beneficial effect on the heart. Many folks, particularly vegetarians/vegans, can be deficient in taurine as it comes - as the name suggests - from red meat.

Of those three, it's best to start with just magnesium. The best form for oral consumption is the (bis)glycinate chelate (look for Albion TRAACS label) as it is more readily absorbed by the gut than some of the cheaper forms like magnesium oxide and even magnesium citrate. Start with low doses and work your way up until you establish what your bowel tolerance is. Too much magnesium, in any form, will have you running for the bathroom. You don't want to have that happen, as it means a net loss of electrolytes rather than a gain. Once you've got the magnesium equation figured out, then you can move on to the other supplements as you see fit.

It's a journey, and it takes time to figure out what works for each of us as individuals. Patience and persistence is key, as we all have learned.

Magnesium supplementation is contraindicated for those with heart block. This from the peer-reviewed literature as well as the gurus of integrative medicine that people like to refer to such as Carolyn Dean. It can also slow HR.You should talk to your Dr about whether your pacemaker mitigates the risks. Also, the magnesium dosages usually recommended here are in excess of what even the supplement bottles suggest. It is ill-advised to recommend supplementing magnesium with heart block without specialized knowledge, any more than with kidney disease. Please consult you Dr first.



Edited 1 time(s). Last edit at 06/12/2018 09:55AM by safib.

thanks wolfpack and safib for the helpful information. I picked up some magnesium yesterday but didn't start taking it yet...will ask my congenital heart cardiologist.

You guys have definitely helped me to regain perspective and move out of my fear. Thank you so much...it's always a challenge maintaining calm, as we know anxiety can exacerbate symptoms.

Thank you.

Disregard my comments about supplementation until you’ve had a chance to talk it over with your cardiologist.

You’re certainly right about anxiety being a “force multiplier” when it comes to heart woes. We all know it!