Shocking Watt

Big tough football player brought to his knees by fear of ECV.

[nypost.com]

Now I am wondering if Susan should be in the NFL. She's way tougher than JJ Watt.

In all seriousness it's a little scary the 1st time but one gets used to it. Right Susan?

I asked the internist who attended me, when I went to the ER the first time with a particularly nasty episode a year ago if she thought a cardioversion would help. She said we have little to lose, although it would be the quick 'n dirty kind, not where they stop the heart and then reactivate it a few seconds later. This was simply a tiny does of propofol and three jabs at the button, all they are permitted to do with cardioversion.

Unfortunately, it didn't take, and I came to just as the helpful nurse pressed the 'giver' for the third time. I recall the pain, hearing me groan and utter, "Oooh, that's painful." The internist and the nurse were very apologetic, but what I remember most is having my pecs spasm for the next two minutes or so. Not very pleasant, but I can't say I have a 'bad memory' of the occasion. I wouldn't hesitate to do it again if...IF...I thought it might work on me.

For those reading who are new to this, propofol is given during endoscopy, sigmoidoscopy/colonoscopy, and when they need to prevent you from associating pain with procedures....cardioversion being among them. You recover from propofol quickly after it is stopped, and recovery is that much quicker. It's just that when I got that third permitted jab...

“I talked to cardiologists and electrophysiologists from all over the country,” Watt said

Unlike the average person who doesn't even know what's going on during their 1st AFib event let alone talk to Cardiologists and EPs from all over the country within the span of a day or two.

LOL.... Ask any EMT, paramedic, or ER nurse and they'll all tell you that the biggest sissies when it comes to medical care are the biggest, toughest guys. I'm not kidding. I've had many frail little old ladies just smile and apologize to me for waking me up late at night when inserting an IV, and even more big, tough guys cry like babies at the sight of a needle. It's predictable as hell: the tougher they are, the more they cry and whine.

"it would be the quick 'n dirty kind, not where they stop the heart and then reactivate it a few seconds later."

Does anyone know what this nurse was referring to? Normally on an ECV, they shock the Heart, and the jolt of the electricity wipes out all of the existing electrical activity in the Heart, until the bodies own impulse comes in through the SA node. The heart reactivates on its own.

"Unfortunately, it didn't take, and I came to just as the helpful nurse pressed the 'giver' for the third time. I recall the pain, hearing me groan and utter, "Oooh, that's painful." "

They just let up on the propofol a little to quick. Your are lucky to have had this experience, With rare exception they try hard to keep the patient completely knocked out for the duration of the procedure. I have tried with my own to ECV's to have them leave me semi-awake, and they have been adamently against it.

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PavanPharter
Big tough football player brought to his knees by fear of ECV.

[nypost.com]

Now I am wondering if Susan should be in the NFL. She's way tougher than JJ Watt.

In all seriousness it's a little scary the 1st time but one gets used to it. Right Susan?

Hahaha
52 ECV and going strong. I’m there micromanaging everyone to make sure the machine is set to synchronize and not defib (I caught the error once so if you get ECV ask), joules amount (75 for flutter and 100 for Afib is enough-more I get bad skin burns but I always come prepared with creams), propofol amount (40-60 depending on how high my hr is. At >200 I want to be knocked out and have a nice nap but not too much that I’m not alert when a Lyft takes me back…to a discussion for them to lay out a sterile towel on the counter to place my mouth guard afterwards because I break my front teeth without it and don’t want to lose my mouth guard which is always in my purse. It was a gift from my dentist who has a year warranty on his bondings and I got good use of it.

Anyways I am a repeat patient and the same ER doctors knows. Only once I arrived semi out of it with higher hr and they just zapped me and I didn’t care.

Watts is silly. An ECV is nothing.

I had well over 200 episodes of afib before my first ablation and only one ECV. I always converted on my own and was on rate control and blood thinner meds, so no more ECVs. No episodes longer than 72 hours, so this begs the question----

If on a rate control med and blood thinner, how long is too long to stay in afib? Why all the ECVs for some? An ECV makes sense if one is not on a blood thinner or rate control med, but what is the danger of waiting to self-convert if taking the drugs?

Ken- I think how rapid the ventricular is beating and symptoms determines if one should wait it out or go to the ER. Last weekend I had a killer 29.5 hour flutter and was unable to get to any hospital since I’m abroad on vacation. No ride. I had to wait it out. I’m told heart failure takes a week or so in tachycardia. I don’t know if an accumulation of events and burden can weaken the heart as well or if it’s one long event…so I recommend calling your EP for advice specific to you in how long you should wait.

You maybe lucky in getting a successful chemical conversion. I prefer them. I wasn’t lucky until lately with trial and error on dosing until I found the Cardizem dose of 15mg “push” (8 minutes slowly pushing into my vein), not a drip in an IV bag over 24 hours, will convert me. I had a bet with the RN. I got a high 5 when he pushed the end of the 15. I asked him if I’m pacing at 55hr and I was. He tolerated my instructions since it always work. Once I only got 10mg and told the dr it won’t work. I couldn’t convince him on the extra 5. I didn’t covert and I had to be admitted for a long episode.

It’s important to be in tune with your body and see what works for you. Obviously this is a big dose but if one has a pacemaker it may work without stopping the heart.

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susan.d
Ken- I think how rapid the ventricular is beating and symptoms determines if one should wait it out or go to the ER. Last weekend I had a killer 29.5 hour flutter and was unable to get to any hospital since I’m abroad on vacation. No ride. I had to wait it out. I’m told heart failure takes a week or so in tachycardia. I don’t know if an accumulation of events and burden can weaken the heart as well or if it’s one long event…so I recommend calling your EP for advice specific to you in how long you should wait.

I'd like to know more on this as well. I was in AFib with RVR for 8 days back 18 months ago. Saw PCP (mistake but didn't know any better) on day 3 and got hooked up with standard meds including Eliquis. Problem was Metoprolol Suc was not bringing my rate down to a good level. PCP referred me to a cardiologist but did not treat it urgently or send me to the ER. I was hanging on to see an EP I scheduled the next week but finally went to the ER on my own ahead of time on day 8. I converted chemically and released with drugs. I've learned a lot over the last 18 months, including sleep apnea diagnosis, which I use CPAP everynight. My AFib is very infrequent and brief but do get ectopics I try and manage. My testing (3 Echos, MRI, CT Angiogram, Lung Function Tests, Stress Test, Nuclear Stress Test, Cardio Pulmonary Test, tons of labs Troponin, BNP, NT Pro BNP, CRP, etc.) has all been pretty decent but I've never felt the same since that 8 day event. A new normal I suppose.

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Ken
If on a rate control med and blood thinner, how long is too long to stay in afib?

People spend decades in afib without harm. My sister spent 25 years in persistent afib and was otherwise perfectly healthy until her death due to unrelated causes. As long as you're anticoagulated and your resting heart rate remains under 100, life expectancy is the same as someone who's never had afib. So if you're asymptomatic, it doesn't limit your lifestyle and your heart rate is well controlled, there's really no good reason to take antiarrhythmic drugs or undergo an ablation.

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BobsBeat

Ken- I think how rapid the ventricular is beating and symptoms determines if one should wait it out or go to the ER. Last weekend I had a killer 29.5 hour flutter and was unable to get to any hospital since I’m abroad on vacation. No ride. I had to wait it out. I’m told heart failure takes a week or so in tachycardia. I don’t know if an accumulation of events and burden can weaken the heart as well or if it’s one long event…so I recommend calling your EP for advice specific to you in how long you should wait.

I'd like to know more on this as well. I was in AFib with RVR for 8 days back 18 months ago. Saw PCP (mistake but didn't know any better) on day 3 and got hooked up with standard meds including Eliquis. Problem was Metoprolol Suc was not bringing my rate down to a good level. PCP referred me to a cardiologist but did not treat it urgently or send me to the ER. I was hanging on to see an EP I scheduled the next week but finally went to the ER on my own ahead of time on day 8. I converted chemically and released with drugs. I've learned a lot over the last 18 months, including sleep apnea diagnosis, which I use CPAP everynight. My AFib is very infrequent and brief but do get ectopics I try and manage. My testing (3 Echos, MRI, CT Angiogram, Lung Function Tests, Stress Test, Nuclear Stress Test, Cardio Pulmonary Test, tons of labs Troponin, BNP, NT Pro BNP, CRP, etc.) has all been pretty decent but I've never felt the same since that 8 day event. A new normal I suppose.

I just did a quick google about possible outcomes of constant/persistent/intractable AF, highlited, and what follows is the first item:

In several studies, patients who develop these sustained forms of AF (persistent/permanent) also have higher rates of cardiovascular disease (CVD) morbidity, including cardiovascular hospitalizations and 7 heart failure 11, 12; recent studies suggest that thromboembolism rates may be higher as well. 7, 13 There are data from recent prospective studies suggesting that patients who develop sustained forms of AF may have a higher subsequent mortality. 11, 12 It is also well established that success rates associated with ablative or medical therapies aimed at maintenance of sinus rhythm are lower once AF becomes persistent or permanent. 1, 14 Therefore, understanding factors that predispose to sustained forms of AF may lead to preventive and therapeutic approaches that may lower AF‐related morbidity and improve response to traditional therapies.

From my readings, stroke and heart failure are the two you'd like to forestall, forever if possible. But, if you are fibrillating, no matter if you are on an anti-coagulant or not, you run a considerably higher risk of stroke than you do when in NSR. Also, the longer your AF persists in an active state, the more wall thickening and the growth of myocytes you develop from the direct stimulus feedback your heart is giving itself to beat more effectively. Anyone who has had AF formally diagnosed is going to be watched for enlargement of the left atrium. There is also a higher risk for mitral valve damage over time, and that, too, is looked for periodically.

There is also the problem called 'remodeling'. Over time, your heart restructures itself AND your rhythm signaling to adjust to the persistent AF. This makes mechanical fixes much more difficult, ablations among them.

AF is different for all of us. Some of us have AF at only 95 BPM, while others can rise to 180 and the readout still shows AF, not flutter. However, you cannot sustain an HR of 180 for long, not when you're north of 55 or 60. This was made clear to me by the gentleman who performed my angiogram in March who, when he came to discharge me later, said that I have SVT when I am in distress and that my rate is too high. The person actually inserting the catheter muttered, "Too many ectopics" shortly before he withdrew the catheter, leaned over me, and said I was pretty much clear, minor deposits only." So, I suddenly found myself on 100mg daily of metoprolol, doubled from 50.

AF must be treated sagely, even aggressively, for as long as one is able to sustain and tolerate a given protocol. It adds years to your life if you submit to treatment of a kind. But some forms of AF, and its accompanying risks and associated disordered rhythm, such as SVT, are very serious and need attention. Pronto.



Edited 2 time(s). Last edit at 10/04/2022 03:55PM by gloaming.

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In several studies, patients who develop these sustained forms of AF (persistent/permanent) also have higher rates of cardiovascular disease (CVD) morbidity, including cardiovascular hospitalizations and 7 heart failure 11, 12; recent studies suggest that thromboembolism rates may be higher as well. 7, 13 There are data from recent prospective studies suggesting that patients who develop sustained forms of AF may have a higher subsequent mortality.

That's actually a bit misleading. First, because the comorbidities are only correlations and no cause/effect can be concluded. In fact, studies that look directly at the question show that when heart rate and stroke risk are well controlled, longstanding AF does not cause heart disease, heart failure, or any other life threatening conditions. In fact, it's often the other way around. Heart disease, including heart failure and valve disease, often cause AF. As I said earlier, life expectancy with well managed AF is the same as people without AF. Second, keep in mind that their data includes people who are not well managed. There are many people out there with asymptomatic AF who go years not even knowing they have it, and sometimes the first symptom is a stroke (I personally know of 3 examples). Even if they do know it and are prescribed an anticoagulant, compliance rates are downright awful. Nearly half of all people with AF are poorly compliant or entirely non-compliant with their anticoagulant. And finally, there are doctors who are not well educated in AF management. As recently as 2010 my PCP tried to prescribe aspirin for me instead of referring me to an EP. I think that happens a lot.

As far as remodeling goes, if you make the decision to remain in longstanding persistent AF without attempting rhythm control, thus changing your status from longstanding persistent to permanent AF, remodeling just doesn't matter. Remodeling only matters if you're ever going to attempt rhythm control via drugs, ablation, or surgery.

True enough, Carey, however the person to whom I responded mentioned a prolonged AF with some speed. That's danger territory because of what we've been discussing. A person who is well controlled is not likely to have rapid AF for 8 days...? If that was the end of it, drugs or no, then it's a different story. But if our sufferer is repeatedly dealing with similar episodes, he/she begins to flirt with progression and remodeling.

Yes, you're right.

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gloaming
True enough, Carey, however the person to whom I responded mentioned a prolonged AF with some speed. That's danger territory because of what we've been discussing. A person who is well controlled is not likely to have rapid AF for 8 days...? If that was the end of it, drugs or no, then it's a different story. But if our sufferer is repeatedly dealing with similar episodes, he/she begins to flirt with progression and remodeling.

You're replying to me and that was the only uncontrolled event I had, however it was scary and I'm experiencing some level of PTSD from the event 1 1/2 years ago. My CPAP has kept me out of AFib for the last year and a half without drugs. I've also never had any procedures (yet). I should point out my HR was not consistent and varied 80-110 sleeping, 90-130 sitting, 120-160 + during activity. I do experience PVCs and some PACs, which a small amount of Flecainide and electolytes manage on an as needed basis. I do have Flec PIP for AFib if needed, but haven't needed it yet.

My worry of heart damage from that event 1 1/2 years ago is significant. I had recently turned 58 when it unfolded. As I said in my earlier post, my extensive testing across several doctors (3 Cardiologists, 2 EPs, 1 Pulmonologist, 1 GI doc) has appeared pretty decent. I was an otherwise healthy individual prior to the event and it's eye opening how a person needs to be their own advocate. Mistakes happen everyday in the medical community.

LMAO "Watt is silly. An ECV is nothing"

You're awesome Susan.

Your story is much like my own. I had a single first event that took me to the ER because it was novel and worrisome. A second event about 8 weeks later had me into a cardiologist within about two weeks. After all the tests, and prescriptions for metoprolol, initially 25 mg per day, and for apixaban, I was symptom-free for nearly three years (barring a six week period around Christmas of 2017that wasn't so bad, but which lasted almost four weeks).

Then, a year ago, things began to slide as if trying to catch up for lost time. I have been to the ER three times since September of last year, each time with SVT and tachycardia.

My point is that many of us will enjoy a nice long holiday, and then things pile up, sometimes very quickly and alarmingly. I can only speak or myself, but I wanted to know everything there was to know about my changes, and I wanted help. I got both of them. Even though the past year has been somewhat challenging (okay, a lot challenging), I was already in the system and was already a known case, or quantity. It made the care system much more observant and willing to treat me because I was known to them, and someone was charting my 'progression', which I am confident is your path as well. Maybe not my experience, but the empirical evidence is that we all slide, even if on a very gradual slope. The quicker you get a grip on the thing, the longer you'll live and the better will be the quality of life while you are alive.

As for PTSD, and I don't doubt you have suffered as a result of this single episode, if it is severely instrusive and leaves you anxious much of the time, you should avail yourself of professional help. Cognitive Behavioural Therapy (CBT) has a pretty good track record dealing with intrusive thoughts, although I am not a clinician and don't keep up. A licensed clinical pyschologist or a psychiatrist should be your next course of action. Look at it this way: anxiety begets cortisol, and cortisol is nasty in the body's endothelial flesh. It causes inflammation, yet another problem, and reduces the production of Interleukin II, a bodily defence mechanism for the immune response.

This is getting windy...sorry. Bottom line, before you move on to other disorders, or into more AF, why not seek help and get yourself better?

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gloaming
As for PTSD, and I don't doubt you have suffered as a result of this single episode, if it is severely instrusive and leaves you anxious much of the time, you should avail yourself of professional help. Cognitive Behavioural Therapy (CBT) has a pretty good track record dealing with intrusive thoughts, although I am not a clinician and don't keep up. A licensed clinical pyschologist or a psychiatrist should be your next course of action. Look at it this way: anxiety begets cortisol, and cortisol is nasty in the body's endothelial flesh. It causes inflammation, yet another problem, and reduces the production of Interleukin II, a bodily defence mechanism for the immune response.

This is getting windy...sorry. Bottom line, before you move on to other disorders, or into more AF, why not seek help and get yourself better?

Appreciate your input. Believe it or not, I've tried to hook up with some therapy many times, but the numerous places I sought out are not taking new patients (covid really put a hamstring on this, as well as many providers retiring, etc.). I'm getting regular exercise and do have meds if things get really tough. I'm anxious about the one event I had and the damage it may have caused but also angry with how carelessly some medical professionals treat a situation like that, or maybe they just don't know enough about the disease.



Edited 1 time(s). Last edit at 10/05/2022 01:58PM by BobsBeat.

I believe that it takes many weeks of almost constant AF for the heart to remodel itself. You had a horrible experience, and your doubts about your heart's condition isn't helping all this time later. I can appreciate how it makes you feel because over the past year I have experienced the same generalize dread. I wondered if this was 'it' for me after four good years with really good control.

As Carey takes pains to point out so often to those who seek assurances and some guidance, there is a rather disappointing range in competency across the field. Using a methodical, and an honest, approach to securing good help will take some doing and some time, but most of us eventually find that the effort, even the delay of gratification, was worth it. As the old saw goes, "Good help is hard to find."

I'm no expert, but if your heart rhythm has been steady, and you haven't lost any 'ground' over the intervening years, where would you suppose the damage might be, and how would you describe it? This is important in healthy grappling with your fear. If it's a generalized unease, but you have no specifics, then maybe you are your own worst enemy.

I won't go so far as to insist that you have no lasting or deleterious effects from that one episode, long and disturbing as it clearly was for you, but...I'd be willing to bet my next pension cheque that you should be doing something other than fretting over could of/should of stuff. Again, if your heart is beating well, and you haven't had a repeat, you have the same onset I did. 20 years ago, mountain biking on a real goat path, I stopped winded and had what I now know to be tachycardia. It went on for almost five minutes, and then down to my recovered rate of about 42 in an instant. Whew. About 10 years later, with a non-violent exchange with a redneck pickup driver, this time on a road bike, I found my heart pounding afterwards and had to pause until it subsided. Then, nothing for the next 9 years! Nine years, with tons of running, cycling, and hiking. Then, at the end of that 10 km run in June of 2017, the curtain came down for me. I didn't worry previously, and I have learned not to fret now. I suppose that, at 70, I'm doing a year better than my mother who passed with a rare cancer in her 70th year.

One other suggestion to you, and you'll have to work at this: learn about the stoics. Epictetus, Marcus Aurelius, Seneca (Nero's tutor), and the founder, Zeno. I have found that being stoic about my circumstances helps me to get on with living. You may find that it helps you to force yourself into that orientation as well. It's a thought.....

[reconsidermedia.com]

Thanks Gloam....

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Carey

People spend decades in afib without harm. My sister spent 25 years in persistent afib and was otherwise perfectly healthy until her death due to unrelated causes. As long as you're anticoagulated and your resting heart rate remains under 100, life expectancy is the same as someone who's never had afib. So if you're asymptomatic, it doesn't limit your lifestyle and your heart rate is well controlled, there's really no good reason to take antiarrhythmic drugs or undergo an ablation.

You are so right. I jumped the gun with getting my first ablation because I didn’t like my 67-80 hr symptomatic afib plus after my flecainide overdose I was wary of drugs and gave an ablation a try. So foolish… because for some, flutter can occur after ablations and the 67-80hr cage animal in my chest I am trying to fix by ablations is now 170-250 even with both hr control drugs like sotalol 3x/day and cardizem 3x/day and a pacemaker.

Reminds me of a line out of the movie Shawshank Redemption when “Red” said to the parole board that he wished he could go back and shake his younger self and warn him not to be a fool. But it’s done and there is no advantage of regret…just moving forward.