Cardioversion

It's amazing how all buses turn up together after a long wait!

This morning I got a phone call inviting me into hospital for a ECV tomorrow morning as my INR has been stable and above the 2.2 recommended for the last 3 weeks.

Just been reading [www.afibbers.org] for some personal information/tips about cardioversion, and noted down the use of magnesium infusion and TEE, neither of which have been mentioned to me - yet.
Need to ask about a previously mentioned change from Bisoprolol to Sotalol.
Will ask about Pilocarpine for glaucoma, mentioned on General Health board.

Wondering whether status quo is better left as is at the moment as I'm due to go away next week by bus and train, [6 hours] for up to a month. when I will be seeing an ophthalmologist I trust! and may need to help my husband with his health/imminent operation for an aneurism.

I started regime of beta blocker, ACE inhibitor and warfarin in June and at the moment can cope..... it doesn't seem like such a good idea to upset the status quo.... but am I taking at serious risk of causing more damage to my heart by not agreeing to be shocked!!!!! - though I am planning to go along tomorrow for a check up.

Any facts, thoughts etc greatly appreciated also bearing in mind I am living on my own.

Joyce, what is the downside to being converted? If it doesn't hold, you can go back to the beta blocker & ACE inhibitor - I assume you'd continue with the warfarin anyway. On the other hand, is there a plan to keep your heart in rhythm. This is what the EP asked me 12 years ago, when I asked for an ECV. He said he'd do it, but didn't have a good plan to keep me in rhythm. I then proposed my plan of using electrolytes to stay in rhythm, with a backup of flecainide on-demand if that didn't work. He agreed to that & I've been following the plan since.

George

GeorgeN Wrote:
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> Joyce, what is the downside to being converted?
>
> George

Death? and no spoken plan yet..... need to address that. Seem to think CV didn't work for my brother though he must have converted himself and now carries PIP - not sure which/what and can't get him on phone today.

Thanks for your response

Joyce



Edited 1 time(s). Last edit at 11/28/2016 04:09PM by Joyce.

Joyce, you are not going to die from a cardioversion! I've had 16 total and am still kicking the last years ago now. Staying in poorly controlled AFIB out of misplaced fear of an ECV will only lead to more structural remodeling which overtime most often leads to entrenched long standing persistent AFIB and a much harder nut to crack and restore durable NSR. This is especially true when you don't have ready access to a maestro-level LSPAF ablationist with a tremendous track record of vast experience in persistent and LSPAF ablation.

As George said, about the worse that will happen is you are back in the same situation you are now, but odds are good this ECV may buy you some good time in NSR to better deal with your your travel plans and husbands procedures.

Best wishes Joyce , just be careful to not over think the situation and make decisions based mostly on misplaced fear.

Be well, Shannon



Edited 1 time(s). Last edit at 11/29/2016 07:41AM by Shannon.

Thanks Shannon. I did catch up on some of your posts this week

Apart from my fear of an assault on my heart, I do fear making myself feel ill, which apart from some exercise intolerance I don't at the moment.

Anyway I'll see how today's appointment goes. And I haven't lost sight of seeing Dr Ernst, which would be an easy trip from the Midlands, so maybe OH and I will have to put up with each other shortly

Joyce

The use Mg Infusion is not widespread, I would ask your Dr/Hospital ,and then post back here on what they said. Take the study I referenced in my Post, it has a Protocol listed. If your Dr's office is busy, they may not want to take the time to think about something new. EVC's are one of the most common Hospital Procedures, and their process is routine and streamlined and they usually want to get it over with as soon as they can, and go on the next Patient. They will probably say something like their is not really an established Protocol for Mg Infusion. They would probably feel comfortable at least giving you a lesser amount than the 3 Grams in the 1st hour called for in that article. You might ask the Dr. to give the Mg first, then if after several hours, if you don't Convert, then proceed to the ECV.

A TEE is given to ensure that their is no clot in the Atria before doing the Shock. It's given to people that have not been on Blood Thinners for at least 21 days. Sometimes either the Patient does not want to take thinners, or would rather get Converted right away. They do it right before the Shock, so it's just a little more Anesthesia, and only extends the procedure by 10-15 minutes.

I too like Shannon, have had many ECV's. I only did that 3 week regimen of Blood Thinners the first several times. Once you make the decision to ECV, then you might as well do it ASAP using a TEE in place of the 3 week Anti-Coagulation waiting period. The exceptions to that would be if you want formulate a Post-ECV plan first, or the scenario that some triggering issue, like an ongoing stressful situation is still present or that their is some other causal factor that needs time to rectify before doing the ECV.



Edited 3 time(s). Last edit at 11/30/2016 04:31AM by The Anti-Fib.

I did go for the ECV yesterday, actual procedure wasn't anywhere near the ordeal I feared. However I felt dreadful later on when got home, freezing cold and shaking, and heart feeling similar to June event which sent me to hospital in the first place.
Went to bed with hot water bottles even though flat is warm, and thankfully feeling better today.

Not sure changing yesterday from bisoprolol to sotolol is such a good idea, but agreed to try it.
Does anyone know how 2.5mg daily bisoprolol compares with 40mg times 2 daily sotolol?

Everyone was kindness itself and very patient with my doubts and questions, but didn't ask about above comparison as didn't see new pack of pills until I was leaving the closing Day Ward.



Edited 2 time(s). Last edit at 11/30/2016 03:52PM by Joyce.

Reacted badly to Sotolol, 3-ish hours after each pill violent afib kicked in.
Phoned hospital, offered an appointment for next Tues or go to GP which I did.
ECG looked barmy, doc phoned hospital himself, wondering whether to get ambulance, but it was agreed I could come home and take bisoprolol which did indeed lower my HR and allow me to cope with going to bed!

Feeling better today but not as good as pre CV attempt. NSR lasted about 8 hours.

Next hospital appointment is Jan 3rd when I'll be asking for referral to Dr Ernst.


Anti-afib. I did ask about magnesium. One senior said "magnesium has nothing to do with afib". Other senior said he knew about it but draw back is inflammation in vein it is put into ........



Edited 1 time(s). Last edit at 12/03/2016 02:12PM by Joyce.

Joyce,

Believe me, magnesium has got lots to do with AF and many other bodily ailments.There are numerous studies that point out just what a depletion of magnesium in your system can do to the healthy functioning of your vital organs and processes.

My cardiologist dismisses anything I say about supplements and basically refuses to listen to anything I say about how I have managed to keep my heart in good shape for the last 10+ years. I have learned to be my own best friend in matters of the heart. 💓

I truly believe most of us with AF are are well informed and well read and probably have more insight into our particular condition than many heart specialists.
Jackie, Shannon, George and many others on this site have been my PIP on some of those long lonely nights in AF when nothing is working except fear.

All the best.

JoyWin, yes I know. This board and its wonderfully sharing posters has been such a help to me.
I used to post regularly myself but have had many quiet heart years..... don't know what was trigger thi year.
Fear has (I think) mostly departed in general. Mistrust of mainstream medicine is high, sadly.
Wonderful for emergencies and surgery. Bu**er all use for chronic stuff and or nutrition.
More is known about livestock nutrition than human.

Joyce

Joyce,

Your previous post is why this forum needs a Facebook-style "Like" button!

Yes, a lot of mainstream medicine excels at treating acute illnesses, broken arms, etc. But anything chronic must be your own fault.

Tiresome, really.



Edited 1 time(s). Last edit at 12/04/2016 08:53PM by wolfpack.

All:
This will be my introductory post here @ A-Fibbers
First, some background. On December 29th, 2016, I went to my gastroenterologist for a pre colonoscopy physical. The Physician's Assitant found my heart to be exhibiting "regular rate and rhythm" but I was exhibiting High Blood Pressure (HBP) which was not a surprise since being an idiot, I had discontinued the use of my CPAP machine when I retired in March of 2015. So I immediately returned to nightly use of the CPAP machine in order to get my HBP back under control. Two sleep studies confirmed this and was reasonably compliant while working and normal BP reading while on the CPAP machine.
On January 4th, 2017, I had good results from colonoscopy but presented with A-Fib during and after the procedure. Huge surprise! So the next day, I saw a cardiologist based on my gastro's recommendation. I am a 6’ 4”, 66 YO male who smokes approx. a pack/day and weigh 280 lbs and have had several years of borderline high blood glucose numbers and A1Cs in the mid-6s range over the years.
Visit with first cardiologist on January 5th was a bust due to his attitude but agreed to a echocardiogram and nuke stress test at his office on the 19th of January. Second meeting with this cat was on the 26th to get results of the two tests. His recommendation was the same as the first visit which was Xarelto and Lisonopril for HBP for four weeks in advance of cardioversion.
Due to our unease with this cat, we went for a second opinion. We just saw this new guy this past Friday and a way better experience. He listened, fully read all the paperwork we provided to him on the tests and blood work, asked pertinent questions, had a good sense of humor and we (Jennifer and I) are mondo comfortable with this Dr. So he prescribed Carvedilol and Eliquis for four weeks with a cardioversion scheduled for the 27th of February.
As a side note, I am an ardent supplementarian for years and a consumer of organic food/vegetables and only grass-fed and finished beef and bison and organic free-range chicken. Also, I am freaked out about taking Big Pharma prescriptions and do not want to be on these scrips for any time longer than absolutely necessary. Will source and purchase magnesium glycinate, potassium and taurine and begin with them. My new cardiologist said that he takes Krill Oil as we do which was encouraging.
Finally, am open to any wisdom and experiences y'all can bring to the table.
Thanking y'all in advance

Uncle Albert