Cardioversion, TEE and pacemaker

[Guest guest]

Clear DayCardioversion of my husband is being planned. I asked his cardiologist

about ways to reduce the risks of death (less than 1% I have read), which

includes releasing blood clots. He said that the trans-esophageal

echocardiogram (TEE) could find blood clots better than the trans-thoracic

echocardiogram), but that the cardiologist with other doctors decided that the

TEE was a draw, considering his stated risks to the esophagus and vocal cords

with the TEE. Risks to the esophagus and vocal cords are not as serious as risk

of death, so I think my husband should have been offered the choice without

having to ask.

My husband's cardiologist also said that some people's hearts stop and won't

start with cardioversion (obviously a very low percentage), so they implant a

pacemaker then and there. Has this happened to anyone here?

For those who have had the TEE, would they recommend it as a hedge against death

by blood clot with cardioversion? What ways can injury to the esophagus be

protected against, other than getting a great surgeon?

Jo Anne

[Guest guest]

I did not have a TEE when I had my cardioversion. I had to have an INR of

between 2 and 3 consistently for 6 weeks -obviously was tested weekly--and then

went in for the cardiovert. I think they also drew blood that morning when I

was in the hospital. For me-- this was the easiest procedure I have ever had.

Lil

<

jakarasek@... writes:

My husband's cardiologist also said that some people's hearts stop and won't

start with cardioversion (obviously a very low percentage), so they implant

a pacemaker then and there. Has this happened to anyone here?

For those who have had the TEE, would they recommend it as a hedge against

death by blood clot with cardioversion? What ways can injury to the esophagus

be protected against, other than getting a great surgeon?

[Guest guest]

Hi JoAnne

Yes I think 3 weeks of INR between 2-3 is fine for a cardioversion for most

people. I agree with you about being conservative where one's health is

concerned and wish your husband the same positive cardioversion experience I

had.

As for spinach and INR...I like spinach too but since I have been on

warfarin I have had almost none. I love brussel sprouts and I think Isabelle

wrote

about keeping the portion to about 6 of them...I keep my portions of green

vegetables " reasonable, " unlike the days when I would scarf up an entire pound

of asparagus and think nothing of it.

Lil

In a message dated 4/1/2006 3:27:25 PM Pacific Standard Time,

jakarasek@... writes:

So the doctor is proposing that if my husband's INR is normal next week, he

will do a cardioversion. (He had just said the week before that he will do a

cardioversion when my husband is normal 3 weeks in a row.) I like our

doctors to be very conservative/safe about our health. I have read that 3

weeks

of normal INR before the cardioversion and warfarin for 4 weeks after is the

practice of one office. So I would feel better if my husband waited until he

had 3 weeks of normal INR before the cardioversion.

[Guest guest]

I had the same experience as LIl. I have had three cardioversions.

I have never had a TEE, but they did monitor my INR.

No, a pacemaker was never mentioned. They told me there is always a

chance of a problem during a cardioversion, but that is why ots done

in the hospital setting. They said they were equiped to handle any

problem that may come up. They evern fitten me for a throat tube

before doing the cardioversion. They said under the conditions it

was a very safe procedure.

Kathy

>

>

>

> I did not have a TEE when I had my cardioversion. I had to have an

INR of

> between 2 and 3 consistently for 6 weeks -obviously was tested

weekly--and then

> went in for the cardiovert. I think they also drew blood that

morning when I

> was in the hospital. For me-- this was the easiest procedure I

have ever had.

> Lil

>

> <

jakarasek@... writes:

>

> My husband's cardiologist also said that some people's hearts stop

and won't

> start with cardioversion (obviously a very low percentage), so

they implant

> a pacemaker then and there. Has this happened to anyone here?

>

> For those who have had the TEE, would they recommend it as a hedge

against

> death by blood clot with cardioversion? What ways can injury to

the esophagus

> be protected against, other than getting a great surgeon?

>

>

>

>

>

>

>

>

[Guest guest]

Thank you, I so much appreciate how this group answers and tells what their

experiences have been. My husband has had an INR between 2 and 3 only once in 6

weeks, and that was the third week.

At first, he took multivitamins that had vitamin K in them so his INR was too

low. Then the extra dosage of warfarin my husband's doctor gave him made my

husband's INR too high.

At the beginning, the doctor's office staff had advised my husband to eat the

same amount of green vegetables every week to keep his INR steady. They didn't

realize that spinach, which he likes, has 3 times as much vitamin K as the next

closest green vegetable he eats. So when he ate spinach he got much more vitamin

K.

And then neither of us thought about the spinach salad we eat as being a green

vegetable, but it most definitely is and has a very high amount of vitamin K.

So the doctor is proposing that if my husband's INR is normal next week, he will

do a cardioversion. (He had just said the week before that he will do a

cardioversion when my husband is normal 3 weeks in a row.) I like our doctors

to be very conservative/safe about our health. I have read that 3 weeks of

normal INR before the cardioversion and warfarin for 4 weeks after is the

practice of one office. So I would feel better if my husband waited until he

had 3 weeks of normal INR before the cardioversion.

Jo Anne

Re: Cardioversion, TEE and pacemaker

I did not have a TEE when I had my cardioversion. I had to have an INR of

between 2 and 3 consistently for 6 weeks -obviously was tested weekly--and

then

went in for the cardiovert. I think they also drew blood that morning when I

was in the hospital. For me-- this was the easiest procedure I have ever had.

Lil

<

jakarasek@... writes:

My husband's cardiologist also said that some people's hearts stop and won't

start with cardioversion (obviously a very low percentage), so they implant

a pacemaker then and there. Has this happened to anyone here?

For those who have had the TEE, would they recommend it as a hedge against

death by blood clot with cardioversion? What ways can injury to the

esophagus

be protected against, other than getting a great surgeon?

[Guest guest]

Hi

I had a TEE recently as I was scheduled to have an EPI, but went into AF a

week before.

At the hospital they would not do a cardioversion until the warfarin levels

had been the same for 4 weeks. The cardiologist doing the EPI suggested

doing the TEE, which was similar to having an endoscopy. I could not swallow

the

tube so they had to put me out in the end. I had the cardioversion a few

days later and I have been fine in normal sinus rhythm. I just continued with

the warfarin and beta blockers. I am now going in for an ablation tomorrow

and had to stop the warfarin and have two injections of heparin 500 mg twice a

day. My doctor said the reason they use heparin is because it does not stay

in your system as long as warfarin. Seems a lot, but you have to trust what

they are doing. Hopefully the ablation will work and I will be able to stop

all the medication.

Regards

[Guest guest]

Hi Kathy

Why did they do three cardioversions?

Did you have some success and then reverted to afib. The cardiologists

told me that firstly it would be dangerous in my case because I had very

low sinus rhythm of 30, then once I got the PM they said that it would

be pointless anyway because of the easy that I can switch between nsr

and afib.

ine

I had the same experience as LIl. I have had three cardioversions.

I have never had a TEE, but they did monitor my INR.

No, a pacemaker was never mentioned. They told me there is always a

chance of a problem during a cardioversion, but that is why ots done

in the hospital setting. They said they were equiped to handle any

problem that may come up. They evern fitten me for a throat tube

before doing the cardioversion. They said under the conditions it

was a very safe procedure.

Kathy

>

>

>

> I did not have a TEE when I had my cardioversion. I had to have an

INR of

> between 2 and 3 consistently for 6 weeks -obviously was tested

weekly--and then

> went in for the cardiovert. I think they also drew blood that

morning when I

> was in the hospital. For me-- this was the easiest procedure I

have ever had.

> Lil

>

> <

jakarasek@... writes:

>

> My husband's cardiologist also said that some people's hearts stop

and won't

> start with cardioversion (obviously a very low percentage), so

they implant

> a pacemaker then and there. Has this happened to anyone here?

>

> For those who have had the TEE, would they recommend it as a hedge

against

> death by blood clot with cardioversion? What ways can injury to

the esophagus

> be protected against, other than getting a great surgeon?

>

>

>

>

>

>

>

>

[Guest guest]

ine,

Yes, each of the cardioversions were about 6 months a part. I

was in NSR in between episodes.

Kathy

> >

> >

> >

> > I did not have a TEE when I had my cardioversion. I had to have

an

> INR of

> > between 2 and 3 consistently for 6 weeks -obviously was tested

> weekly--and then

> > went in for the cardiovert. I think they also drew blood that

> morning when I

> > was in the hospital. For me-- this was the easiest procedure I

> have ever had.

> > Lil

> >

> > <

> jakarasek@ writes:

> >

> > My husband's cardiologist also said that some people's hearts

stop

> and won't

> > start with cardioversion (obviously a very low percentage), so

> they implant

> > a pacemaker then and there. Has this happened to anyone here?

> >

> > For those who have had the TEE, would they recommend it as a

hedge

> against

> > death by blood clot with cardioversion? What ways can injury to

> the esophagus

> > be protected against, other than getting a great surgeon?

> >

> >

> >

> >

> >

> >

> >

> >

[Guest guest]

If your husband has been in afib for any time over 48 hours, he needs to

be theraputically anti-coagulated for several weeks prior to the

cardioversion AND still have a TEE to check for clots. The two are

rather minor in comparison to a catastrophic stroke.

I've had 9 cardioversions (7 in the first two months of this year!) and

3 TEE's. The worst thing that has happened during a cardioversion is

that I once had " shallow " breathing upon awakening and had to be

bagged.. that's from the anesthesia, and not the cardioversion. The

worst problem with a TEE, is that I had to have two in a row (not

recommended), since the first machine broke, and on the second my throat

was already swollen, and they bruised my larynx... so I croaked like a

sore frog for a couple days and had a raspy voice for a couple weeks..

but that's it!

I have never heard of, or met anyone personally who has had a negative

complication from either a cardioversion or a TEE. Both are worth the

very small risk.

No offense, but your cardiologist sounds like he's still in the dark

ages...

_____

From: AFIBsupport [mailto:AFIBsupport ]

On Behalf Of J

Sent: Saturday, April 01, 2006 10:05 AM

To: AFIBsupport

Subject: Cardioversion, TEE and pacemaker

Clear DayCardioversion of my husband is being planned. I asked his

cardiologist about ways to reduce the risks of death (less than 1% I

have read), which includes releasing blood clots. He said that the

trans-esophageal echocardiogram (TEE) could find blood clots better than

the trans-thoracic echocardiogram), but that the cardiologist with other

doctors decided that the TEE was a draw, considering his stated risks to

the esophagus and vocal cords with the TEE. Risks to the esophagus and

vocal cords are not as serious as risk of death, so I think my husband

should have been offered the choice without having to ask.

My husband's cardiologist also said that some people's hearts stop and

won't start with cardioversion (obviously a very low percentage), so

they implant a pacemaker then and there. Has this happened to anyone

here?

For those who have had the TEE, would they recommend it as a hedge

against death by blood clot with cardioversion? What ways can injury to

the esophagus be protected against, other than getting a great surgeon?

Jo Anne

[Guest guest]

Stefanie, I agree. I suspected there were serious problems, so I was checking

out his advice, especially about having a cardioconversion with only one week of

INR in the 2-3 range.

We are getting a different doctor now.

Thank you,

Jo Anne

RE: Cardioversion, TEE and pacemaker

. . .

No offense, but your cardiologist sounds like he's still in the dark

ages...