Cardioversion

Triathlon Forum
1

Sorry for another Afib post/question. Every one is different but I’m curious about the experience of others here who have had cardioversion? How long did it last for you before you were back to Afib/flutter? I did do a search but some of the posts are quite old.

I had electric cardioversion done on June 21. It was actually very easy/straightforward, and I had it in the office. Pre conversion, the EKG showed I was in atrial flutter. After conversion, I was normal sinus rhythm (NSR). Flew to Colorado, the next day, and 48 hours after the cardioversion I started hiking in the mountains. Lowest altitude was 8,000ft. Each day, I usually did a 3-4 hour hike and ran 2-3 days (distance of 3-4 miles). No problems with the heart and I stayed in NSR. On purpose, I tried to never let my heart rate get anywhere near anaerobic (so I walked hills while running).

Back home now and I am back running 4-5 miles each day. Again, I try to take it easy and keep these aerobic (HR rarely goes above 140bpm). When I was in flutter (before the conversion), if I was running, my HR would stay in the mid 140s, even if I was running at a very slow shuffle and I would get out of breath very easily. It was frustrating.

As I read about cardioversion, I know it has a high initial success rate but it has a fairly dismal long term success rate. Some people are back in Afib within days or weeks, and others can last a few months (or more). One of my cycling friends had cardioversion over a year ago and is back going as hard as ever. Not sure how long mine will last but I am enjoying NSR while I can (but also trying not to push my luck by pushing too hard).

2

77 year old male, Persistent Afib, Cardioversion last February. Still in NSR, monitor daily with Kardia 6L. Trying to keep bpm 130 or less when training.

Have they put you on any medications?

3

I had a cardioversion back in 2018 after coming down with afib that lasted almost 2 months. Worked and I have never had any relapse of the afib as of today and I’m training as much as before.

4

77 year old male, Persistent Afib, Cardioversion last February. Still in NSR, monitor daily with Kardia 6L. Trying to keep bpm 130 or less when training.

Have they put you on any medications?

I’m glad you are still in NSR.

When I was first diagnosed with Afib/flutter, I was started on Toprol XL and Elliquis. I tried Flecainide but felt terrible with it. Truthfully, I felt like I was going to have a panic attack when my HR elevated. As soon as I quit Flecainide, that feeling went away.

After my successful cardioversion, I am on Elliquis only. I’ll see my EP cardiologist in the next few months and he will have me use a continuous heart monitor for a month to see if I am having more episodes of Afib/flutter. If I’m good then I can stop Elliquis.

5

I had a cardioversion back in 2018 after coming down with afib that lasted almost 2 months. Worked and I have never had any relapse of the afib as of today and I’m training as much as before.

Wow that is super impressive. Are you taking any meds for the Afib? I’ve read where some people are asked to continue Afib meds, even after successful cardioversion

6

Really hard to answer this because there are so many individual factors. I was cardioverted for flutter so that I could have shoulder surgery. The EP recommended once I recover from surgery that I have an ablation to prevent going into further complications of afib which he said was harder to fix. The complicating factor is that when fluttering at 300 beats per minute my ventricle was in the low 30s.

During the ablation I went into afib and was cardioverted out of it. Long story but they also discovered along with an electrical disfunction in my atrial the signal was being blocked to the ventricle (av block 2) causing me to be tired during the day due to lack of proper blood flow. I now have a pacemaker with leads in both the atrials and ventricles to control 1:1 pacing and I am back to full on training.

So the underlying cause of your flutter, can be a deeper individual dive or not.

The purpose of my response is the medication route. When I was in afib they wanted me on eliquis. Luckily I was on vacation in Canada when they recommended it where a one month supply was $20 verses $650 in the USA. I don’t like being on medication long term so when I had my follow up I wanted to know why I was on it. The answer of course was risk of stroke. When I asked them what is the risk verses crashing on my bike and having a brain bleed they told me my risk factors for stroke were very small and was only a 1 out of 5 because of my age 65. I convinced them that I would rather not be on blood thinners and because my only risk factor was age, they agreed.

This is a personal decision but worth reviewing with your doctors and understanding all the risk factors.

7

I had a cardioversion back in 2018 after coming down with afib that lasted almost 2 months. Worked and I have never had any relapse of the afib as of today and I’m training as much as before.

Wow that is super impressive. Are you taking any meds for the Afib? I’ve read where some people are asked to continue Afib meds, even after successful cardioversion

I had an ablation, not cardioversion, but was kept on my meds for 5 months afterwards. After that, I was given the all clear and taken off everything…

8

Back in the mid 80’s I was a paramedic in upstate NY. One afternoon I was called to a grocery store. When we arrived there was an elderly woman on the floor in the checkout line. Eyes open but unresponsive with very shallow breathing. Back then we carried LifePak-5 portable defibrators. Completely manual except these things had Synchronized Electro- Cardioversion, and paramedics were authorized to do it without contacting medical control first. I had only been told how to do it, I had never done it or seen it done. By this time I was a well seasoned paramedic and these type of calls didn’t excite me. I gelled the paddles and did a quick look - course V-Fib. I pushed record on the tape drive, flipped the dial to conversion, positioned the paddles, and pressed the 2 red buttons. Nothing happened for a moment, then the device shocked. I looked down and had NSR on the screen. I’m thinking “damn, it worked like the book says.” The woman reached up and grabbed my arm and said “Don’t ever do that to me again. Just let me die next time.” Apparently it is not pleasant.

The good old days when MAST were used for shock, and Verapamil was still given in the field.

9

I remember those days with MAST for shock victims when I was an EMT prior to med school…

yeah, 200 Joules is about as hard as a very strong punch in the chest as an analogy
(and defib is ~200>300>360 J)

I was doing CPR on a guy who had collapsed due to CHB and woke up and told me to ‘get off him!’
Argued with me about going to the hospital for his PPM at the time…alive now 30 yrs later-

so many stories…

10

I had a cardioversion back in 2018 after coming down with afib that lasted almost 2 months. Worked and I have never had any relapse of the afib as of today and I’m training as much as before.

Wow that is super impressive. Are you taking any meds for the Afib? I’ve read where some people are asked to continue Afib meds, even after successful cardioversion

No, I was back to normal training right away with no meds. That was why I went down the Cardioversion route. I didn’t want to dick around trying meds for months or staying on them. I went to an electro cardiologist knowing full well they are “hammer sees a nail” kind of docs and don’t mess around. LOL! My cardiologist made the referral knowing my desire to get fixed ASAP. I knew it was 90% effective for afib. I also wanted to avoid procedures such as ablation. I knew I ran the risk of recurrence but it never happened, knock on wood.

11

I remember those days with MAST for shock victims when I was an EMT prior to med school…

yeah, 200 Joules is about as hard as a very strong punch in the chest as an analogy
(and defib is ~200>300>360 J)

I was doing CPR on a guy who had collapsed due to CHB and woke up and told me to ‘get off him!’
Argued with me about going to the hospital for his PPM at the time…alive now 30 yrs later-

so many stories…

I’m way too busy (and probably too old) to get back into it, but I stopped by the local fire house a while back and they were very interested in how " it used to be" in the field. Stretchers that had to be lifted by 2 or 3 people into and out of the ambulance, blood pressure was taken manually (while moving with sirens running), Epi that had to be given IV (or IM in some cases) because putting it down the ET tube wasn’t a thing yet. You had to read the rhythm off of a 2 green screen, or run a strip and then read it. Talking to the hospital of a VHF radio right out of the show Emergency. Having a 3-ring binder full of hand drawn maps and a street index that you could cross to a page to find the call location.

As far as not going to the hospital, I’ve had my share of those, usually after I gave them Narcan (again, IV - before the quad muscle injectors).

I’m starting to feel old.

12

Sorry for another Afib post/question. Every one is different but I’m curious about the experience of others here who have had cardioversion? How long did it last for you before you were back to Afib/flutter? I did do a search but some of the posts are quite old.

I had electric cardioversion done on June 21. It was actually very easy/straightforward, and I had it in the office. Pre conversion, the EKG showed I was in atrial flutter. After conversion, I was normal sinus rhythm (NSR). Flew to Colorado, the next day, and 48 hours after the cardioversion I started hiking in the mountains. Lowest altitude was 8,000ft. Each day, I usually did a 3-4 hour hike and ran 2-3 days (distance of 3-4 miles). No problems with the heart and I stayed in NSR. On purpose, I tried to never let my heart rate get anywhere near anaerobic (so I walked hills while running).

Back home now and I am back running 4-5 miles each day. Again, I try to take it easy and keep these aerobic (HR rarely goes above 140bpm). When I was in flutter (before the conversion), if I was running, my HR would stay in the mid 140s, even if I was running at a very slow shuffle and I would get out of breath very easily. It was frustrating.

As I read about cardioversion, I know it has a high initial success rate but it has a fairly dismal long term success rate. Some people are back in Afib within days or weeks, and others can last a few months (or more). One of my cycling friends had cardioversion over a year ago and is back going as hard as ever. Not sure how long mine will last but I am enjoying NSR while I can (but also trying not to push my luck by pushing too hard).

Ablation is best for long term success in freedom from afib but recurrence rate is about 2% per year.

https://www.heartrhythmjournal.com/cms/attachment/4ab7c6d2-645e-466b-826c-3b20465f5034/fx1.jpg

cardioversion also has excellent short term success- at about 95% but at one year, about 1/4 of patients go back into afib…

a lot depends on why the patient went into it to begin with so all potential causes should be evaluated, and there are many causes

this is actually a good one as it has a video which is quite representative of an actual cardioversion
Cardioversion to Restore Normal Sinus RhythmAtrial Fibrillation: Resources for Patients (a-fib.com)

and unfortunately, many of the meds given can cause fatigue or other issues so a lengthy discussion with your provider can help as to the best plan

as always, LMK if I can help-

13

No, I was back to normal training right away with no meds. That was why I went down the Cardioversion route. I didn’t want to dick around trying meds for months or staying on them. I went to an electro cardiologist knowing full well they are “hammer sees a nail” kind of docs and don’t mess around. LOL! My cardiologist made the referral knowing my desire to get fixed ASAP. I knew it was 90% effective for afib. I also wanted to avoid procedures such as ablation.

Unfortunately, my insurance carrier didn’t give me an option. My cardiologist pushed for ablation from day one, and told me “You’re too young to be on drugs the rest of your life”, but the bean counters felt otherwise. So I spent nearly 9 months on meds that drastically slowed me down but barely kept my condition under control. They finally gave in after 9 months of demonstrating that medication was not the answer. Had the ablation in December of 2017, and aside from an occasional few second blip, everything’s been fine for the last 6.5 years…

14

Were you dx’d with atrial flutter or atrial fibrillation? or some of each?

After a virus in Feb I had the same heart rate issues - any exertion would pop me up to the 140-150 range. My RHR also went up about 10 beats. Had I not been paying close attention to HR I may not have noticed it for a while, but there was definitely a cause/effect thing with the virus. Literally the day before I got sick ran 7 mile trail run HR normal. Every run after had the new issues (and learned all about how and why that happened).

No sign of a fib

EP doc said cardioversion very successful for a flutter, so we opted for that as a first line, especially since there seemed to be an identifiable trigger for it as opposed to a physiological reason (echo showed normal chamber sizes). He said it works every time, just does not always last, and is less effective long term for a fib. Had it May 8, it was more of an ordeal. At the hospital in the short stay ward, had a Transesophageal echo to make sure no stroke inducing clots in the heart. Been NSR since, and swimming and running is coming back (with maybe a little bike). Resting HR also back down to historical norms

Never had to go on meds as I was already on thinners.

I wasn’t right back to training because the flutter had put the kibosh on pretty much all training, and always felt fatigued and like shit. So I took another week off and have slowly worked back towards regular training over the last 8 weeks

15

dtoce, as always, thank you for your input.

I was glad to have the cardioversion done so I could quit taking the meds (except for Elliquis). Being on a beta blocker made me feel tired and my runs were much more limited. Flecainide was awful to me and made me feel like I was going to have a panic attack any time my HR was elevated.

Long term, I know I’m more likely to convert back to an arrhythmia, but right now I am thankful for the NSR the cardioversion has provided. I’ll enjoy it as long as I can.

16

Were you dx’d with atrial flutter or atrial fibrillation? or some of each?

When the arrhythmia first started, I was diagnosed as Afib in the ER. About 5 days later, I saw a cardiologist and he also said Afib. He asked me to try pharmacological cardioversion by taking a big dose of Flecainide to see if that would convert me. About 12 hours later, it did appear to covert me to what I thought was NSR.

The problem was, if I exercised, my HR would quickly spike to 130s-140s with very little effort. I needed Toprol XL to help control the rate with these exercise induced spikes in HR. Later, a few hours after my run, I’d check my Kardia device and it would indicate I was back in NSR or say “unclassified” even though my HR was 50s-60s.

I went back to the cardiologist (and then an EP cardiologist) and the EKG was repeated. That is when I was told I was in atrial flutter each time the EKG was done. So, the Kardia would lead me to believe I was in NSR. Even when the EP doc checked my pulse, he was like “you feel like it’s in NSR” but the EKG would always show flutter.

The morning of my cardioversion, I went for a 4 mile run because I wanted to make sure I was in flutter. When the nurse hooked me up to the monitor, she initially said “hmm, you are already in NSR” but she then did the EKG and it showed I was in flutter. After the cardioversion, the EKG showed me in NSR

17

dtoce, as always, thank you for your input.

I was glad to have the cardioversion done so I could quit taking the meds (except for Elliquis). Being on a beta blocker made me feel tired and my runs were much more limited. Flecainide was awful to me and made me feel like I was going to have a panic attack any time my HR was elevated.

Long term, I know I’m more likely to convert back to an arrhythmia, but right now I am thankful for the NSR the cardioversion has provided. I’ll enjoy it as long as I can.

Sinus always feels best and I’m glad you were able to get the actual rhythm problem figured out.
You should have a long discussion with your providers regarding short/long term risks/benefits of anticoagulation.

And I mentioned the success of ablation long term, as if this recurs, that would be the route to push for from the start. You just don’t know if you’re going to get one of the long term success stories with cardioversion only and it can *usually *be arranged pretty quickly–at least, much faster than getting in with one to do an ablation

GL going forward

18

dtoce, as always, thank you for your input.

I was glad to have the cardioversion done so I could quit taking the meds (except for Elliquis). Being on a beta blocker made me feel tired and my runs were much more limited. Flecainide was awful to me and made me feel like I was going to have a panic attack any time my HR was elevated.

Long term, I know I’m more likely to convert back to an arrhythmia, but right now I am thankful for the NSR the cardioversion has provided. I’ll enjoy it as long as I can.

Sinus always feels best and I’m glad you were able to get the actual rhythm problem figured out.
You should have a long discussion with your providers regarding short/long term risks/benefits of anticoagulation.

And I mentioned the success of ablation long term, as if this recurs, that would be the route to push for from the start. You just don’t know if you’re going to get one of the long term success stories with cardioversion only and it can *usually *be arranged pretty quickly–at least, much faster than getting in with one to do an ablation

GL going forward

My EP wants me to wear a Holter Monitor (not sure if that’s what it’s even called anymore) for a month, when I return to him in a few months. He said if this monitoring shows me to consistently be in NSR then I can likely stop the Elliquis. Right now, I am OK taking the Elliquis. I have limited activities that could lead to crashes or falls (group rides, mountain biking, technical trail running). To be honest, it’s kind of a nice break from pushing myself all the time.

My EP did discuss ablation with me as well. He said flutter has an excellent success rate (90% with ablation) whereas Afib is not quite as high long term. If I had been diagnosed with flutter, from the start, instead of Afib, I’d likely have gone straight to ablation. But, the fact that I had Afib diagnosed first, and then all subsequent EKGs show flutter, has me perplexed and more concerned about long term abalation success. This is definitely something I will need to discuss with the EP if I end up needing the ablation.

19

I had atrial flutter in 2017 for the first time, cardiologist did a cardioversion with nsr as result. In 2019 i went in atrial flutter again and they cardioverted me again. In mid 2020 I 'm in atrial flutter and they did an ablation that is good until now. Drugs only the month pre and post cardioversion and ablation.

20

Later, a few hours after my run, I’d check my Kardia device and it would indicate I was back in NSR or say “unclassified” even though my HR was 50s-60s.

I went back to the cardiologist (and then an EP cardiologist) and the EKG was repeated. That is when I was told I was in atrial flutter each time the EKG was done. So, the Kardia would lead me to believe I was in NSR. Even when the EP doc checked my pulse, he was like “you feel like it’s in NSR” but the EKG would always show flutter.

You using the Kardia that uses a finger from each hand and the back of your left knee?