Cardioversion

After 14 days of Afib, I went in for a cardioversion. After 1 shock I was back in sinus rhythm. 2 days later I went for a walk, and am now back in Afib. Before the 14 day Afib episode the Afib was only lasting 24 hours. I am waiting to schedule an ablation. Has anyone else gone back into Afib so soon after cardioversion? Is this indicative of potential success of an ablation?
Thanks!

Deleted as it was a duplicate post.



Edited 3 time(s). Last edit at 02/04/2024 12:36PM by GeorgeN.

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Dini
Has anyone else gone back into Afib so soon after cardioversion? Is this indicative of potential success of an ablation?

Nineteen years ago, I was in the midst of what turned out to be a 2.5 month episode. The EP and I were discussing what to do and he said, "I can cardiovert you, but the issue is how to keep you in rhythm after the cardioversion." This is still true today. At that point, he wasn't a fan of ablation or the rhythm meds. He said, "you are doing well out of rhythm (meaning my afib heart rate was < 100 BPM and I was relatively asymptomatic), why don't you stay there?" I told him I had a "Plan B" that included modifying my endurance training protocol (reducing intensity), electrolyte supplementation (primarily potassium & magnesium) and a script for flecainide on demand from him. He accepted my proposal, I used a loading dose of flec to convert the episode and I've been basically following this protocol since, with some tweaks.

My understanding is your reverting to afib soon after should not be indicative of the potential success of an ablation in the hands of a top EP. EP's like Natale handle patients with longstanding persistent afib.

Thanks so much for the information. I will continue on with metoprolol and look into supplements. What type of magnesium did you add: citrate, taurinate, etc?
I’ve been hesitant to try flecainide, as my dr has said I can not use it as a pip, due to my age. That it’s recommended to stay on it, but that there is a risk of a serious arrhythmia, etc.
Also wondering why my resting heart rate is higher after my cardioversion; it was is the mid 60s and is now mid 70s.
Can cardioversion cause damage?

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Dini
What type of magnesium did you add: citrate, taurinate, etc?

I've used every magnesium compound that I am aware of, including several where I've had to react ingredients to make my own (like bicarbonate water & acetate). In my case, they all work as long as I take a sufficient quantity. My bowel tolerance it abnormally high (more than 10 times the 400 mg RDA). Everyone is different, but glycinate is usually a safe choice.

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Dini
Has anyone else gone back into Afib so soon after cardioversion? Is this indicative of potential success of an ablation?

Sooner -- 12 hours. Cardioversions interrupt the rhythm but they do nothing to treat the underlying problem. I don't think it says anything about the success of an ablation. What says the most of about that is the EP who does it.

I can beat that...regrettably.

New Years Eve 2022, I went to the ER after several hours in AF. The gentleman internist offered to try a cardioversion, which I though might put me back into NSR, and I was good until the following afternoon. News Years Day, near supper time, I went back and got cardioverted a second time. I wasn't home three hours when I went back into AF. Just sitting watching TV.

Back to the ER next morning, and was cardioverted again. The AF returned not 20 minutes later. They upped my metoprolol and sent me home. And, as Carey and others were kind and gentle to point out, I probably would have converted on my own inside of a few more hours. Which I did. Happily, the EP's clerk phoned a week later and asked if I wanted to have the slot for a cancellation she'd just received. That was for Feb 14th, and I'm happy to say I have been in firm NSR ever since...knock on wood.

In total, I have had four cardioversions. None of them has been sustained for more than a few hours, and the first, in September of 2021, never did work. They zapped me three times, and when I came to, the mood wasn't great.

You mention age. In mid 2015 i was in permanent AF for almost 4 months. I was born in 1950. Metoprolol was sooo bad for my energy that i chucked it out after a few days - was not worth living with it.
Asked the cardiologist to cardiovert me to which he agreed but thought that it would not work. It lasted 1 hour.
At my next visit i insisted on another cardioversion to which he reluctantly agreed to. In the meantime, between the two cardioversions, i found a good alternative practitioner (she actually lectures at Monash uni in Melbourne to med students about natural meds).
I followed her advise, took some Hawthorn Berries extract as well as some teas (forgot what ones). Perhaps coincident but haven't had any need for another cardioversion since.
Had lengthy periods without any AF for a few years. These days unfortunately i still have AF, usually lasts a few hours to a day or two but i take Flec as required PIP..
Must admit i've become a bit slack with diet and stopped drinking teas two or three years ago.

Hope it all works out for you!

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gloaming

In total, I have had four cardioversions. None of them has been sustained for more than a few hours, and the first, in September of 2021, never did work. They zapped me three times, and when I came to, the mood wasn't great.

Unfortunately I hold a 54 record. Usually they lasted a week but towards the end 30 minutes. That was after three ablations with the Natale-just to mention it maybe your genetic disposition when it fortunately even the most skilled and kindness EP can’t help.

The metoprolol saps my energy as well, in addition to leaving me lightheaded etc.., perhaps I can find a good alternative med Dr. I will definitely try the Hawthorne berry, I actually did have that supplement a few years ago, will definitely try that again.
Regarding age I am a few years younger than you, but for some reason my EP said the PIP was no longer an option because of my age and chadsvasc2 score. I would be wiling to do the flec as PIP, but do not want to add it permanently as I have so many sensitivities to meds. I don’t know why the pip is an issue.
Thanks for the input. It’s fantastic to have some perspective, and learn how others manage.

I have not heard that admonition of not using flecainide as a PIP for someone in your age range. Maybe you would want to get another opinion.

Yes, I would absolutely ask for a rationale. The Dr. should take all of eight seconds to explain his/her reasoning. Personally, I don't buy it, but then I'm not allowed to call myself 'doctor'.

I don't buy it either and I can't imagine what your CHADS-Vasc score has to do with it.

I’m not sure the reasoning, but as of today they don’t want me taking any anti arrhythmics until after I see my EP next week. Maybe I will have an answer at that time that I can share.

Maybe they hope you'll settle into something 'natural' for your heart as it is right now. If they do another series of ECG or issue a Holter, they want to see the unvarnished truth.

Also, I’m in the process of scheduling an ablation, and I’m just wondering if it’s better to schedule for beginning of a week like a Monday or end of week like Thursday. I’m not sure if it matters, but thought I would see if anyone has any knowledge of this.
Thanks

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Dini
Also, I’m in the process of scheduling an ablation, and I’m just wondering if it’s better to schedule for beginning of a week like a Monday or end of week like Thursday. I’m not sure if it matters, but thought I would see if anyone has any knowledge of this.
Thanks

Will you be staying overnight in the hospital? Good to check if your EP will be in the hospital that day after your ablation, for rounds and also if there are any unexpected complications. If you can be the first procedure of the day that is usually a good thing—everyone will be fresh.

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Daisy

If you can be the first procedure of the day that is usually a good thing—everyone will be fresh.

You run the possibility that he isn’t fully awake because he has to arrive quite early. I prefer the second of the day.

It would be the first of the day I believe at 8 am. It would not be an overnight stay.

I don't think it works quite like that. Any one person can have a bad night, maybe two running. I don't know how EP's and other health care providers self-regulate, but they can have a bad Sunday night's rest as easily as one mid-week.

If a doctor arrives at work sleepy, they're going to be just as sleepy if not more so in the afternoon. Want to see me sleepy at work? Check with me about 2 hours after lunch. I'm with Daisy and would prefer them being fresh.

The thing is, almost all doctors are morning people, especially surgeons and proceduralists like EPs. I think that's because their residency gave them no choice but learn to become a morning person. Most of them I know arrive at work by 5-6 am and they've been doing that their entire careers.