Has the science behind ECV changed since this 2008 paper?

Thanks (BTW - about to have 2nd ECV....)

[bjcardio.co.uk]

"This website is intended for UK healthcare professionals only"

Some good points, but lacks overall vision of treatment of AFIB, at least in reference to our perspective as patients. This author probably never had AFIB. I feel a hell of a lot better, being in NSR for these 8 months since my ECV. We already know that ECV is not a cure-all and will resume NSR for an indefinite period of time. The UK NHS saves money by leaving people in AFIB, and rationing out ECV attempts.

In your case it appears ECV therapy is wise especially since you are so attentive towards figuring things out, and a good candidate for giving a try at resolving your AFIB without Ablation.

What Anti-Fib said.

There's a good reason why that article has zero comments even after 12 years. It's loaded with misunderstandings on the author's part. He seems to think ECV is considered a long-term treatment, which it certainly isn't now nor was it in 2008. It can be part of long-term treatments, but nobody considers it a treatment expected to provide lasting results on its own. It's usually combined with antiarrhythmic drugs with the idea that the ECV will stop the arrhythmia and the drug will prevent it from recurring. A few people get lucky and get months or even years out of one even without drugs, but those are pretty unusual.

So I guess the answer to your question is no, the science of ECV hasn't changed since 2008 because it's not wrong.

Thanks Anti and Carey - I wanted to be sure they weren't shocking the crap out of me just for fun.

It ain't worth only 90 hours of NSR. I need this one to stick.

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NotLyingAboutMyAfib
It ain't worth only 90 hours of NSR. I need this one to stick.

I would gladly do an ECV for 3-4 days of NSR. In fact, there was a time in my life when I was doing just that. I was in the ER being cardioverted 2-3 times per week. Trust me, it is worth 90 hours of NSR, or at least it was for me. An ECV is a nothing procedure. It's an hour or two out of your life vs. many hours or days out of your life with AF. As I recall, I believe Anti-Fib has even done more than I have.

I think you are making to much out of the success of this. If it doesn't work for very long, than you still have the options of making changes and more ECV's, or Ablation. It is certainly worth trying, since you have made all of the changes to help recently, in particular dropping the Metropolol. Persistent AFIB is tough, but you are worthy of the challenge.

Thanks all. I guess you can sense I am getting really frustrated with this whole damn thing. Nothing has helped so far and I've really tried everything that I can think of and others have offered.

I am googling desperate long shots at this point -

Round-Up and AF

Insecticides and AF

Teflon and AF

etc.

Sorry about your frustrations, but pretty much everyone here has been there, done that. You're not going to find discoveries everyone else has overlooked for the last 3000 years. Your choices are drugs, surgery, ablation, or complex solutions as described by George, Steve Carr, and a few others. And I agree with Anti-Fib. You're making too much of the success of this. Give it a try and see how it goes. Worst case is you wasted a couple of hours of your life. I do that on youtube almost daily.

My first ECV lasted only 1 hour. This was after about 3 months of permanent afib. The cardiologist advised against a 2nd ECV because he thought it would not work.The second one was after waiting for another 4/5 weeks. I insisted and it did work, that was at the end of 2015 (age 65). I had only a few episodes since. The longest one was about 2 weeks if i recall and converted at the end with Flec after taking it for one or two days. These days i take 50mg every evening (missing now and then). I did make changes which are unproven and alternative getting a lot of info from afibbers.org -THANK YOU! If they didn't help, they certainly haven't harmed. My blood test values seem to be good.
Hope you have an even better result NLAMA!

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Joe
The cardiologist advised against a 2nd ECV because he thought it would not work.

In 2004, at age 49, I was about 2.49 months in to a 2.5 month episode during the first 4 months of my afib journey. My EP said I was doing well out of rhythm (<100 BPM) and suggested I just stay there. His rationale was while he could convert me, he wasn't sure how he could keep me in rhythm. He didn't think ablations were ready for prime time and did not like chronic use of rhythm meds for me. I suggested I had a "Plan B" which included an ECV, use of electrolytes to keep me in rhythm and a prescription of PIP flec if I went back into afib. The EP accepted my plan. Wrote me a script for flec and initially suggest I take a loading dose to try to convert, then said the data said it wouldn't work, due to my long time in afib. He told me to schedule an ECV, which I did for a couple weeks hence. I went home, filled the flec script and decided to try it (a loading dose). It worked after 20 hours. I've been following my plan successfully since. It has morphed into what I suggested for my son-in-law posted here (and continues to be successful for him).

Here's the problem right now. The current cardi (unwarranted as far as I can tell) has re-frightened me into oblivion about the use of flecainide due to a high CAC score - but I have none of the other problems that should prevent me from taking flec and as noted I've already tried it before without issue. Many days on it but no conversion.

Hoping the lower D and calcium will help and I am willing to try it again but I think I should get another work up (echo, stress, CAC, etc ) to determine if my heart is getting better or worse from a structural point of view. I imagine being in AF since october isn't making my heart 'stronger'. I don't know.

If this ECV doesn't take, I want to get a cardi that says it's OK to take flec (I'll go to hospital er waiting room as before (if they let me in) in case things go south.

Instead of met suc is it possible to take Diltiazem or some other better med?

I have nothing against getting an ablation by Dr. N. but at the same time, if I can fix this w/o one that would be preferred.

I also have to weigh the odds on him retiring, me not having good insurance... and other factors that would make what might be the inevitable, an ablation years from now an impossibility.

George - I will read it again and see if there's anything I am missing.

Joe - thank you for the positive experience. I really want this one to stick.

Carey - ever since the very start of this when I got that book about AF - ablation seemed like the end point so I am resigned to that if need be. But one thing I can't get my head around is how after 56 years working normally and with no apparent genetic issues, how my heart seems like an unstoppable force when it comes to not wanting to be in NSR.

I've been very careful about exposure to everything that supposed to be a trigger, I'm taking all of the things that are supposed to stop AF and still not successful.

I described my AF as chihuahua and not pit bull originally but after months like this, you really want that tiny dog to stop biting your ankle.

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NotLyingAboutMyAfib
Here's the problem right now. The current cardi (unwarranted as far as I can tell) has re-frightened me into oblivion about the use of flecainide due to a high CAC score

I don't know where your doc even got that idea. The contraindications for flecainide are structural heart disease, heart failure, recent MI. A high CAC score simply isn't a contraindication. I wouldn't hesitate to take it without fear.

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But one thing I can't get my head around is how after 56 years working normally and with no apparent genetic issues, how my heart seems like an unstoppable force when it comes to not wanting to be in NSR.

You don't know there's no genetic basis. But even if there isn't, I can give you an example of why you have AF. You trained as an elite athlete for years, and doing that is hard on the heart. It causes atrial stretch, and atrial stretch leads to atrial fibrosis. Fibrotic tissue doesn't conduct electrical signals, so that results in areas of your atria that are slower at conduction that the rest of the tissue. A mix of tissues that conduct and don't conduct is a recipe for AF and AFL. There are a whole lot of former hard core athletes out there with AF.

I agree. # 1 on the genetics - none that are known or knowable right now.

About the athleticism - yes. Definitely - and including the high lactate levels I used to endure for extended periods 17-18mmol

And then the middle age neglect, weight gain hyperinsulinemia/glycemia, hsCRP, glycation - all my bad.

But new hope in DHEA and T levels. It will take a while to fix so I am going ahead with ECV tomorrow AM.


But less hope this one will stick now that I see my labs