Cardioversion Question

[Guest guest]

,

The whole topic of electrocardioversion is really interesting. I would bet a

very large percentage of people in the afib group here have had at least one

cardiovert and many have had several. But if you ask them how many remained

in NSR without other treatment, i.e., antiarrhythmic meds or ablation...the

answer might not be so encouraging.

The " success " rate for conversion seems to be very high initially - I have

read percentages at 75-85% or higher for successful conversion to NSR upon a

cardioversion. The problem seems to arise over staying in NSR. After 1 year,

75-80% of people who have had a cardioversion are no longer in NSR. For those

who ARE in NSR, most have to also be on an antiarrhythmic drug to maintain

NSR.

So knowing how long you will stay in NSR is anyone's guess. I didn't have a

lot of high hopes, because I was in persistent afib for more than three months

before my cardiovert. But I have done well so far.

Do not fear an electrocardioversion...it is an easy procedure to have and

very safe. Does your doctor plan to put you on an antiarrhythmic drug or wait

and see how you do?

Lil

n a message dated 5/7/2006 6:34:51 P.M. Pacific Standard Time,

stevep7171@... writes:

I have a cardioversion (my first one ever) coming up in 2-3 weeks

(after the coumadin takes full effect)and I am nervous about it. Since

I stayed in A-fib so long this time, does that pretty much mean I can

forget about ever popping back into NSR on my own either this time or

ever in the future when it happens again>?

[Guest guest]

Good! I agree with your doctor. My EP was great, also. He agreed to do a

cardiovert without putting me on antiarrhythmics. Sometimes I wonder if doctors

put us on the antiarrhythmics too quickly, or automatically, instead of

waiting to see if our hearts will go back into NSR and stay there with drugs

such

as beta blockers.

Lil

In a message dated 5/7/2006 8:14:30 P.M. Pacific Standard Time,

stevep7171@... writes:

He wants to hold off Anti-arrythmic drugs until absolutely needed. He

wants to do the cardioversion and since I have gone years at a time in

NSR (with the exception of this time ) without going into A-Fib, he

wants me to see how this first cardioversion goes. (I have been in A-

Fib 4 times in the last 12+ years, and this is the only time it lasted

more than 18 hours). He said depending how fast I go back into A-Fib

after the cardioversion, he wants me to see an EP and then see from

there. It sounds like good advice. I just get nervous and I am not a

patient person. I guess I will have to learn to be !

[Guest guest]

Hi everyone.

I am still in A-Fib. The rate has been controlled but it's been

almost a month now. I was wondering if the longer I stay in A-Fib, the

more your heart " gets used " to it? I dont know if I am explaining

myself right.

I have a cardioversion (my first one ever) coming up in 2-3 weeks

(after the coumadin takes full effect)and I am nervous about it. Since

I stayed in A-fib so long this time, does that pretty much mean I can

forget about ever popping back into NSR on my own either this time or

ever in the future when it happens again>?

Thanks,

[Guest guest]

First, in a way yes....the longer one is in a-fib, the less bothersome the

symptoms... however, if at all possible, it is most important to be converted to

NSR to avoid the consequences such as hypertrophy of the heart which may lead to

heart failure.

Second, the cardioversion isn't anything to fear. You will be sedated, and

hopefully you'll be converted w/o a problem.....

Good luck and don't worry!

...christine

Stefano stevep7171@...> wrote:

Hi everyone.

I am still in A-Fib. The rate has been controlled but it's been

almost a month now. I was wondering if the longer I stay in A-Fib, the

more your heart " gets used " to it? I dont know if I am explaining

myself right.

I have a cardioversion (my first one ever) coming up in 2-3 weeks

(after the coumadin takes full effect)and I am nervous about it. Since

I stayed in A-fib so long this time, does that pretty much mean I can

forget about ever popping back into NSR on my own either this time or

ever in the future when it happens again>?

Thanks,

Web Page - http://www.afibsupport.com

List owner: AFIBsupport-owner

For help on how to use the group, including how to drive it via email,

send a blank email to AFIBsupport-help

Nothing in this message should be considered as medical advice, or should be

acted upon without consultation with one's physician.

[Guest guest]

Thanks .

Is Heart failure something that can happen at my age (35) after a

month in A-Fib ?? That is scary. My Dr. is very thorough but should i

push him to convert me sooner? He wants me on Coumadin for 4+ weeks

before he converts me. He said if I wanted he would do it sooner

(doing an TEE) if I wanted.

By the way, is a TEE an invasive or painful test?

>

[Guest guest]

I believe it makes sense that the heart muscle will condition itself to

the AFIB rhythm after a while, but a " while " may be longer than just one

month. Everyone is different. I my case, I was in AFIB for several

months before diagnosis, the coumadin wait, and cardioversion. Didn't

" stick " for me for more than six weeks, at first. Now I am on

flecainide, and it was five months before I had an episode, and an extra

dose of flecainide help me convert back on my own.

I don't fear electro cardioversion any more. Amongst the many risks we

manage in our lives, cardioversion has a pretty low rank, and it feels

so good to see that sinus rhythm on the monitor after it is done.

This is just my " AFIB noir " story. There's a million of 'em out there....

All the best,

--

Clay, 75 mg Flecainide x 2, no electrocardioversion since August '05.

Stefano wrote:

> Hi everyone.

>

> I am still in A-Fib. The rate has been controlled but it's been

> almost a month now. I was wondering if the longer I stay in A-Fib, the

> more your heart " gets used " to it? I dont know if I am explaining

> myself right.

> I have a cardioversion (my first one ever) coming up in 2-3 weeks

> (after the coumadin takes full effect)and I am nervous about it. Since

> I stayed in A-fib so long this time, does that pretty much mean I can

> forget about ever popping back into NSR on my own either this time or

> ever in the future when it happens again>?

>

>

> Thanks,

>

>

>

>

>

>

>

>

> Web Page - http://www.afibsupport.com

> List owner: AFIBsupport-owner

> For help on how to use the group, including how to drive it via email,

> send a blank email to AFIBsupport-help

>

> Nothing in this message should be considered as medical advice, or should be

acted upon without consultation with one's physician.

>

[Guest guest]

A TEE is an echocardiogram done by placing the transducer into the esophogus.

The patient's throat is " numbed " first with a spray or mist, then the patient is

sedated with IV medications. It is not painful. The above is done to prevent

the unpleasant gagging.

It is not dangerous either.

Your cardiologist seems a bit over precautious. The standard is three

consecutive weeks with documented INR between 2-3.

....christine

Stefano stevep7171@...> wrote:

Thanks .

Is Heart failure something that can happen at my age (35) after a

month in A-Fib ?? That is scary. My Dr. is very thorough but should i

push him to convert me sooner? He wants me on Coumadin for 4+ weeks

before he converts me. He said if I wanted he would do it sooner

(doing an TEE) if I wanted.

By the way, is a TEE an invasive or painful test?

>

Web Page - http://www.afibsupport.com

List owner: AFIBsupport-owner

For help on how to use the group, including how to drive it via email,

send a blank email to AFIBsupport-help

Nothing in this message should be considered as medical advice, or should be

acted upon without consultation with one's physician.

[Guest guest]

thank you. i feel better about the TEE and the cardioversion. What

about the heart failure question and if its still possible to convert

on your own after a month of A-Fib? Thanks. You are so helpful. I can

not tell you how much I apprecaite this. I am so afraid. (I know, guys

are babies when it comes to medical stuff)

>

[Guest guest]

My husband was in atrial fibrillation at least 10 weeks before his cardioversion

(due to careless instruction on maintaining INR and a delay due to changing

doctors). After the cardioversion, he was in normal sinus rhythm for 10 days

and then went into atrial fibrillation today reaching over and picking up a

heavy box.

The cardioversion worked very well and he went to normal sinus rhythm very

quickly, according to the nurse. Yet he could not hold it well enough, and I

sensed that the 10+ weeks delay made him take longer healing then they realized.

My message sent about the time yours was sent: " Atrial fibrillation for more

than 6 weeks, then after cardioversion, up to 3 weeks for full atrial function "

including a report on research discusses that recovery takes longer when more

time has passed since atrial fibrillation began.

Jo Anne

Cardioversion Question

Hi everyone.

I am still in A-Fib. The rate has been controlled but it's been

almost a month now. I was wondering if the longer I stay in A-Fib, the

more your heart " gets used " to it? I dont know if I am explaining

myself right.

I have a cardioversion (my first one ever) coming up in 2-3 weeks

(after the coumadin takes full effect)and I am nervous about it. Since

I stayed in A-fib so long this time, does that pretty much mean I can

forget about ever popping back into NSR on my own either this time or

ever in the future when it happens again>?

Thanks,

Web Page - http://www.afibsupport.com

List owner: AFIBsupport-owner

For help on how to use the group, including how to drive it via email,

send a blank email to AFIBsupport-help

Nothing in this message should be considered as medical advice, or should be

acted upon without consultation with one's physician.

[Guest guest]

Often (depending on symptoms), they recommend 3 weeks or so normal INR with

warfarin before cardioversion. But a TEE to check for clots, with heparin or

warfarin, can be done instead. A TEE is invasive and more expensive, and has a

small risk. But if your cardioversion can be done sooner because of TEE, that

might speed your recovery. Again, see

http://circ.ahajournals.org/cgi/content/full/98/5/479

(I don't know whether a TEE is painful because I have not had one.)

Most people with newly diagnosed atrial fibrillation do not have heart failure.

I am not a doctor, but I suppose that if the rate was very high or there were

other heart problems, etc., it is possible. The fact that your rate is

controlled is a very good sign.

Jo Anne

Re: Cardioversion Question

Thanks .

Is Heart failure something that can happen at my age (35) after a

month in A-Fib ?? That is scary. My Dr. is very thorough but should i

push him to convert me sooner? He wants me on Coumadin for 4+ weeks

before he converts me. He said if I wanted he would do it sooner

(doing an TEE) if I wanted.

By the way, is a TEE an invasive or painful test?

>

Web Page - http://www.afibsupport.com

List owner: AFIBsupport-owner

For help on how to use the group, including how to drive it via email,

send a blank email to AFIBsupport-help

Nothing in this message should be considered as medical advice, or should be

acted upon without consultation with one's physician.

[Guest guest]

He wants to hold off Anti-arrythmic drugs until absolutely needed. He

wants to do the cardioversion and since I have gone years at a time in

NSR (with the exception of this time ) without going into A-Fib, he

wants me to see how this first cardioversion goes. (I have been in A-

Fib 4 times in the last 12+ years, and this is the only time it lasted

more than 18 hours). He said depending how fast I go back into A-Fib

after the cardioversion, he wants me to see an EP and then see from

there. It sounds like good advice. I just get nervous and I am not a

patient person. I guess I will have to learn to be !

[Guest guest]

I left a post a couple of weeks ago about exactly that. My Dr. almost

choked when the ER cardiologist prescribed Amiodarone within days of

me being in A-Fib, he said a lot of cardiologists nevr give you a

chance and overprescribe Anti-Arrythmics. he said they definitely have

their place and I may have to take them at some point, but in his

opinion, not now.

>

[Guest guest]

>

> I left a post a couple of weeks ago about exactly that. My Dr.

almost

> choked when the ER cardiologist prescribed Amiodarone within days of

> me being in A-Fib, he said a lot of cardiologists nevr give you a

> chance and overprescribe Anti-Arrythmics. he said they definitely

have

> their place and I may have to take them at some point, but in his

> opinion, not now.

>

>

>

: Seems to me the underlying question here is do repeated

cardioversions cause any damage to the heart. I don't have a rational

answer but it seems like the amount of energy used is minimal compared

to other things but OTOH I can't believe that too many of those don't

cause some damage.

I guess ultimately it boils down to the benefit you get from them as

you get more of them and how you assess the potential damage from them

compared to the potential damage from one or other of the drugs

compared to potential damage from long term fib compared to the

downside of having an ablation.

The more physicians you talk with the more opinons you'll get and the

more confused you'll becomes, or at least so I found. The advantage

of talking to several experts about this is that you'll relate better

with one than the others and tend to accept that input more than the

others. If you only talk with one you don't have much to compare to.

I know that there are a lot of genius nerd physicians who have no

bedside manner but I also know to trust my gut when deciding who I

have confidence in vs. who I don't.

Get a couple of second opinions then decide what program you want to

follow. Down deep somewhere you know that neither the drugs nor the

cardioversion is going to solve the problem long term so you have

another tradeoff of buying time vs. improvements in ablations, etc.

What I'm trying to say in summary is that only you can make the

decisons regarding your health. All physicians give ADVICE, not hard

facts so each of us has to take as much input as we can handle then

make the best decision we can to go forward with the program that's

right for us. Nobody ever said it was easy.

Gordon

[Guest guest]

, If your AF is feeling less bothersome it is probably in part due to

the fact that you are taking medication which keeps the ventricular rate under

control. This can make a difference in how it feels. The fact that you are used

to it also helps. You have probably reduced some of the anxiety, which often

attends AF, by learning a lot about the disorder and potential treatments.

It is pretty likely that the cardioversion will put you into NSR. Many of us

then need an antiarrhymic med, such as flecainide, Rhytmol, etc. to keep us in

NSR after converting. It can be very helpful to make sure you have no clots in

your atria by having a transesopogeal echo (TEE) before you are cardioverted.

Of course it is ideal to have an EP to treat lone AF.

I have hopes that things will go well with you. Please keep us posted.

Stefano stevep7171@...> wrote:

Hi everyone.

I am still in A-Fib. The rate has been controlled but it's been

almost a month now. I was wondering if the longer I stay in A-Fib, the

more your heart " gets used " to it? I dont know if I am explaining

myself right.

I have a cardioversion (my first one ever) coming up in 2-3 weeks

(after the coumadin takes full effect)and I am nervous about it. Since

I stayed in A-fib so long this time, does that pretty much mean I can

forget about ever popping back into NSR on my own either this time or

ever in the future when it happens again>?

Thanks,

Web Page - http://www.afibsupport.com

List owner: AFIBsupport-owner

For help on how to use the group, including how to drive it via email,

send a blank email to AFIBsupport-help

Nothing in this message should be considered as medical advice, or should be

acted upon without consultation with one's physician.

[Guest guest]

, I almost forgot, if doc doesn't have luck initially with electrical

cardioversion, he should have better luck then by doing a combination of IV

antiarrhytmic meds + cardioversion, if needed.

Stefano stevep7171@...> wrote: Hi everyone.

I am still in A-Fib. The rate has been controlled but it's been

almost a month now. I was wondering if the longer I stay in A-Fib, the

more your heart " gets used " to it? I dont know if I am explaining

myself right.

I have a cardioversion (my first one ever) coming up in 2-3 weeks

(after the coumadin takes full effect)and I am nervous about it. Since

I stayed in A-fib so long this time, does that pretty much mean I can

forget about ever popping back into NSR on my own either this time or

ever in the future when it happens again>?

Thanks,

Web Page - http://www.afibsupport.com

List owner: AFIBsupport-owner

For help on how to use the group, including how to drive it via email,

send a blank email to AFIBsupport-help

Nothing in this message should be considered as medical advice, or should be

acted upon without consultation with one's physician.

[Guest guest]

, Heart failure means that the ventricles are not pumping blood

adequately to meet all of the body's needs. Your ventricular rate is already

under control with the meds, so you are in no way stressing the ventricles.

Heart failure would only only be a problem with lone AF in the case that the

venticular rate and work was excessive for a long time, or in the case of other

problems such as prolonged hypertension, etc. You have no reason to wory about

heart failure. My wife has been in permanent AF for years but her heart pumps

fine and she has no heart failure whatsoever. This is because her ventricular

rate is controlled with meds and consequently they are not overworked. Heart

failure is all about the ventricles and how they pump, and is not about the

atria.

Of course, It will be helpful to go ahead with your cardioversion because you

do not want to leave your atria in AF any longer than necessary, because AF can

over time cause enlargment of the atria and make them more prone to remaining in

AF. I'm sure you saw the article posted on this issue.

Stefano stevep7171@...> wrote:

thank you. i feel better about the TEE and the cardioversion. What

about the heart failure question and if its still possible to convert

on your own after a month of A-Fib? Thanks. You are so helpful. I can

not tell you how much I apprecaite this. I am so afraid. (I know, guys

are babies when it comes to medical stuff)

>

Web Page - http://www.afibsupport.com

List owner: AFIBsupport-owner

For help on how to use the group, including how to drive it via email,

send a blank email to AFIBsupport-help

Nothing in this message should be considered as medical advice, or should be

acted upon without consultation with one's physician.

[Guest guest]

Thanks ,

I appreciate the explaination. I also appreciate finding this board

more than words can describe. There is something comforting about

other people KNOWING from experience what this is like. I wish I had

more experience so I could help people here because I have been helped

so immensely. One thing for sure, no matter what, even if I never have

another episode of A-Fib after the cardioversion (which I know is

impossible) I will never leave this board. Thanks again to everyone.

[Guest guest]

Regarding the cardioversion, it's not anything to get too nervous

about. I'm about to have my 7th and except for the first one, I never

felt a thing. The first was in an ambulance with my heart rate up in

the 200s so the paramedics were a bit paniced and cardioverted me

before the sedation hit. It was a bit like getting kicked in the chest

but was followed by a great sense of relief as my heart rate went back

to normal.

I am a bit surprised that you haven't been on Coumadin all along. My

cardiologist started me on that as soon as I was diagnosed with A-Fib.

Hope this sets you mind at ease a little...

Garrett

>

> Hi everyone.

>

> I am still in A-Fib. The rate has been controlled but it's been

> almost a month now. I was wondering if the longer I stay in A-Fib, the

> more your heart " gets used " to it? I dont know if I am explaining

> myself right.

> I have a cardioversion (my first one ever) coming up in 2-3 weeks

> (after the coumadin takes full effect)and I am nervous about it. Since

> I stayed in A-fib so long this time, does that pretty much mean I can

> forget about ever popping back into NSR on my own either this time or

> ever in the future when it happens again>?

>

>

> Thanks,

>

>

>

[Guest guest]

While TEEs are very safe, they are not without complication, such as perforation

of the esophogus. This has always been mentioned as a possibility prior to each

TEE I've had (four).

I also had a bruised larynx from one and boy did that smart, and make me croak

like a frog for several days! Better than a stroke, though, so I wouldn't

hesitate to have another one.

stef

Carroll carroll_chris2@...> wrote:

It is not dangerous either.

[Guest guest]

- it's good that you have rate control, and are getting your blood

theraputic.. both are important while waiting for your conversion. They do

say that afib begets afib, so you will want to minimize the amount of time you

do spend in afib, if possible, but being in afib permanently, with good rate

control, is not the end of the world, or your life. My mother has been in

permanent afib since 1967, and managed to raise 4 kids, travel the world, play

tennis every day... etc. IN AFIB the whole time. She has great rate control on

verapamil.

And no, the fact that you are not converting out of this event does not mean

that you will never convert out of another future event. Afib is unpredictable

at best. I had a 6 week afib event in the beginning of 2004 and was

cardioverted for the first time.. I too was afraid, but after having that one

(and 9 more since Aug 05) I have come to view them as blessed relief, and will

ask for one post haste at the local ER when I pop into afib. Prior to my PVI,

but after that long event, I did convert on my own twice.. I know.. you say

twice isn't much, but when every single event ends in the ER and a

cardioversion, twice was a bit of a miracle!

Knowing what I know now, if I were you I'd be looking forward to my

cardioversion! I know that's hard to believe.

Stef

Stefano stevep7171@...> wrote:

Hi everyone.

I am still in A-Fib. The rate has been controlled but it's been

almost a month now. I was wondering if the longer I stay in A-Fib, the

more your heart " gets used " to it? I dont know if I am explaining

myself right.

I have a cardioversion (my first one ever) coming up in 2-3 weeks

(after the coumadin takes full effect)and I am nervous about it. Since

I stayed in A-fib so long this time, does that pretty much mean I can

forget about ever popping back into NSR on my own either this time or

ever in the future when it happens again>?

Thanks,

Web Page - http://www.afibsupport.com

List owner: AFIBsupport-owner

For help on how to use the group, including how to drive it via email,

send a blank email to AFIBsupport-help

Nothing in this message should be considered as medical advice, or should be

acted upon without consultation with one's physician.

[Guest guest]

, Thanks for the good words. The truth is that you are helping all of us.

It is a two way street. When you post about your experience and questions we all

learn. Your posts give us a chance to share and reflect on your experience.

Each question you pose prompts us all to think, and then we all get to view all

of the responses. Think how much you have already learned in a short time.

Your anxiety and concerns have energized you to search for answers here and

elsewhere. Your contribution is appreciated and helpful to us all. As an

electrician you have a tremendous aptitude for learning all about AF. My guess

is that you will continue to be an asset to this group for a long time. Keep us

posted. Thanks,

Stefano stevep7171@...> wrote: Thanks ,

I appreciate the explaination. I also appreciate finding this board

more than words can describe. There is something comforting about

other people KNOWING from experience what this is like. I wish I had

more experience so I could help people here because I have been helped

so immensely. One thing for sure, no matter what, even if I never have

another episode of A-Fib after the cardioversion (which I know is

impossible) I will never leave this board. Thanks again to everyone.

Web Page - http://www.afibsupport.com

List owner: AFIBsupport-owner

For help on how to use the group, including how to drive it via email,

send a blank email to AFIBsupport-help

Nothing in this message should be considered as medical advice, or should be

acted upon without consultation with one's physician.