Waiting period for cardioversion?

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Hi - have been in persistent AF now for  the first time ever- previously paroxysmal - for over 8 weeks - when in hospital  initially I was told would need to be on anticoagulant for 4 weeks prior to cardioversion- was put on warfarin then but due to problems with getting and staying in INR required levels - above 2.0  - which i know now but did not know then- I  asked to be swtiched to a NOAC - Eliquis which was done nearly 3 weeks ago- was told then would have to wait a further 4 weeks - as effectively back to square one with the Eliquis- though this was  still better than waiting for the warfarin which had still not reached the required INR after 5 weeks  and was so "hit and miss"and variable  - at least with the Eliquis I was "guaranteed" to be OK to have the cardioversion in 4 weeks - was also assured then - because of the issues and delays with the warfarin - basically the info I was given at the start heavily encouraged warfarin and discouraged a NOAC - which is the reverse  of what the consultant would have recommended had they been involved then -and what I now know-  that I would get the cardioversion in 4 weeks - have been heavily symptomatic over the past 8 weeks and affected  all aspects of my life so really keen to get the cardioversion done urgently - have tried to chase the appointment for this up with the hospital by phone/ e mail / messages left  etc but can not get any info or speak to anyone to confirm when this will be done or what is happening  - has anyone else experienced this issue with delays and communication re dates for cardioversion in the UK and if so any ways to chase this up? - how does the process work and are there any waiting lists for cardioversion or other issues with budgets etc for this? Even if  I get a date shortly it looks like I will have been in AF for at least 10 weeks by the time this is done and am worried how this may affect the outcome of the cardioversion and even if I get back to NSR  this may reduce how long it "lasts" and whether the heart has / will start to "remodel" permanently - how quickly have others got their cardioversions done? Thanks 

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  • Posted

    In East Sussex the twice I needed a cardoversion it was a 12 to 14 week wait. However that was much better than my wait to have my aortic valve replaced. That was 54 weeks while a friend in America was diagnosed and operated on in three weeks.

    I was in NSR for 15 months after the first one and 10 months after the second. I might have stayed in NSR  but for having two procedures that stimulated my vagus nerve and put me back into AF.

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    • Posted

      Thanks Derek - was that 12 weeks from first diagnosis or from finshing anti coagulation and how long ago was this ie what years did you have the cardioversions please?

      Assume you were anticoagulated for more than 4 weeks - dont know if you were on warfarin or a NOAC- and could have had the cardioversion ealrier had you been given an earlier  appointment - ie it was just a "wating list " situation rather than you not being ready able and willing to have it?

      If so did you know (were you told ) there was a waiting list? I am assuming that was the only reason for the delay?

      I have struggled to get any information - or indeed to speak to anyone who knows what is happening 

      On a postive note it sounds like they "lasted" a reasonable time re NSR when they were done though did you wonder if you may have had an even  better outcome if they had been done earlier?

      Some of the Americans on other forums seem to have cardioversions done pretty well straight away as soon as they are ready or anticoagulated 

      Thanks 

       

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    • Posted

      I first went into AF after heart surgery in 2012 and had a cardioversion that failed during the first week. I was then put on the waiting list and was told that it was an eight week minimum to be on warfarin and amiodarone but it stretched to 14 weeks. My INR was kept over 3.0 from week eight to be ready. I stayed on warfarin and amiodarone for three months after the cardioversion. That was what my surgeon said was enough although the cardiologist wanted me on them for life.

      I see no reason that I would not have stayed in NSR but I had a colonoscopy in December 2013 and it stimulated my vagus nerve. Suddenly my BP dropped to 40/29 and heart rate 30 and I went back into AF. This was at a private hospital so I phoned my NHS cardiology secretary and asked for an urgent appointment hoping as newly into AF they would do a cardioversion more or less right away. It seems that the NHS is not geared up for that. 

      I stayed in NSR for about ten months until this time a DRE by a urologist again stimulated my vagus nerve. I realised it as soon as I got home and checked my BP that had dropped but not so dramatically and then noticed my irregular heartbeat. I phoned NHS 111 and they got me an appointment with the Out of Hours GP at the hospital. He gave me the choice of sitting for hours at A&E or seeing my GP for an ECG the next day. That seemed as good an option. That was in January 2015 and too long a story to  write in full now but I have not had another cardioversion but have twice been offered different types of ablation that for various reasons I turned down. I did have a pacemaker fitted in July 2015. I might have a cardioversion combined with a cryoablation in the future but although now in permanent AF I mostly don’t notice it. It won’t cause a stroke as to stop taking warfarin or a NOAC I privately had an Amplatzer Amulet ( a sort of very expensive mesh filter) fitted in my left atrial appendage where clots form.   

       

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  • Posted

    Hi Peter, it is preferable to be cardioverted back into sinus rhythm sooner rather than later (for the reasons you suggest). When I first had AF/heart failure in Dec 2014, I wasn't cardioverted for six weeks (I think this was partially due to Xmas and the doctors taking time off)!

    I, like you, was also very anxious to get zapped back into rhythm, but the more I read about AF, the more irealised that 6 weeks wasn't a huge wait (In AF terms at least). What I read suggested that if you had been in AF for many months/years, cardioversions tended to be less effective, but 6-8 weeks is not that big a deal (apparently??)

    If you ever go back into AF again in the future, and can get to an emergency room within 24hrs, they will usually cardiovert you straight away(as it is unlikely that any blood clots will have developed in your atrium). Well, here in Australia they will, don't know about the UK?

    I can certainly relate to how you feel right now though, good luck with it all.

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    • Posted

      Simon- thanks for this - yes I think the rules here are if it is within 48 hours of onset of AF or if you are continuously anti coagulated - as I would be even after the cardioversion as they continue this - sometimes for a  period and sometimes indefinitely afterwards - then I think you could have another cardioversion pretty well straight away - if of course that was the agreed strategy and if there is no waiting list issue.

      There is also chemical cardioversion with drugs but they seem less keen on this 

      Thanks for your input and best wishes - hoepfully I will get sorted soon.......

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  • Posted

    I think I am also..No one ever suggested a cardioversion. Have you had an ablation? I  wonder if my heart is remodeling..I have been on eliquis for a long time. years..What symptoms have you had I so far have the silent afib...Live in US so different from UK. 
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    • Posted

      Betty -thanks - assume you were diagnosed a good while ago as being in |AF anf they put you on Eliquis as an anti coagulant to limit the potential stroke risk caused by any clotting which is standard practice as far as i am aware  and the main concern for people in AF - I know that many people who have AF and are not  even aware of it - some just being discovered at a  normal check uo or the like and there are also  others who are in AF and  do not have any symptoms and for those people - who presuably are not that bothered if they are in AF or NSR that they will not always recommend a cardioversion -I did have an ablation for SVT in 2010 which worked well and this current episode is the first time I have been in "persistent" AF - ie my "normal"! state is NSR and if in the past \I have gone into AF it has always gone back into NSR itself within a few days or a week but that is not the case this time - so as I want to get back into NSR the options are cardioversion - either electrical - which I am awaiting a date for - or chemical - I dont like being in AF at all as  this restricts what I can do - cant do any sport which I like and also affects me around the stomach and causes anxiety - many people are asymptomatic however or have different symptoms and no two people are the same so not everyone wants to get back to NSR -some people get breathless or feel the palpitations - from what I know the same principles will apply inthe USA as here and I know they do cardioversion there as well on a regular basis - however as to whether you need -or want one- is something you should discuss with your doctor or  I think they are EPs? in the USA to see if it is the right thing for you - remember a cardioversion is not a "cure" for AF it is simply a short term "fix" and a way of resetting the heart back into sinus rhythm and is not always successful in that and even when it is there is no guarantee it will stay in sinus or for how long - good luck! Your doctor / EP can doubtless also advise you  if you have any longer term risks/ remodelling etc  of you staying in AF etc 

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    • Posted

      Thank you for a very thorough explanation. I have been told to "risk" it for a very long time and have not done it. Been very frightened for some reason even thought I have had surgeries before. Trying to work with my mental state to gather courage. Makes no sense as gets worse as time goes by. I know that Thank you for explaining cardioverion as a "fix". Yes on anticoagulants to prevent stroke and that does not always work. Guess life is a roll of a dice but we can take actions to possibly help ourselves. I know that. Thank you again. 

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    • Posted

      Thanks Betty - know what you mean about anxiety that can be the curse of AF regardless of what you do - or dont do- about it! I know it is for me . Some people are lucky enought to live with it and never give it much of a thought and it does not affect them physically.There are no easy "right" or "wrong" solutions - some people favour ablations others medication, others minerals and natural remedies and lifestyle changes or more commonly a mixture of the above......and some doing nothing or as litle as possible - you can only take advice from your doctors see what the various options are and decide what feels best for you weighing everything up re "risk" and "reward" ie of taking or not taking some action. Good luck 

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