Post Cardioversion and Back in Atrial Fibrillation: Next Steps

Patient Expert

I've been sharing in real time what's been happening since late January, when I woke up one morning after 9 years  in normal sinus rhythm and noticed that my chest and possibly heartbeat felt a little strange. I attributed it to  indigestion, figuring if I just got up and started moving around that I would feel better, but I didn't.   I brewed a nice, hot cup of tea, which often seems to solve all kinds of troubles. However, it didn't do much, and after taking care of a few chores around the house and keeping an appointment, I called my cardiologist's office and went in for an EKG.

I learned that I was indeed in atrial fibrillation, and was immediately put on one of the new blood thinner drugs that do not require regular testing, and on more beta blockers to control the heart rate. My cardiologist said I would get a cardioversion in three weeks, which actually turned into four, because I came down with a pretty nasty case of sore throat/laryngitis and we postponed.

So, about nine days ago, I got a cardioversion, which worked immediately and, with one jolt, it put me back into NSR (Normal Sinus Rhythm.) I waited at the hospital for an hour, and then a friend took me home. And, two days later, I was back in atrial fibrillation again.

I was pretty disappointed, but not terribly surprised. Even though I had an excellent response to my first cardioversion (I had one jolt, slipped easily into NSR and remained there, sans any kind of antiarrhythmic medications for nine years) several things were different this time around:

1. The most obvious change was I was nearly a decade older. Increasing age is one of atrial fibrillation's best friends.

2. I had surgery on my mitral valve in 2008, and while this cut back on some mitral regurgitation, the fact remains that scar tissue and possibly a larger left atrium (structural changes)  can contribute to change in electrical impulses and the presence of afib.

3. Stress, life changes, moves, some weight gain, not enough exercise ... all of these factors may have been peripheral contributors to the return of atrial fibrillation.

But the bottom line...why do we get atrial fibrillation? Why do some of us get this miserable condition, and some do not? It's often anybody's guess.

So here I am, about a month after the appearance of my "new and improved" afib. (It really isn't improved. It's the same old demoralizing, tiresome, unpleasant and upsetting condition.) And, I have had a conversation with my cardiologist's assistant. We have gone through the possibilities of where we go, and what we can  do, from here:

1. We can continue to use beta blockers to slow the rate. The afib is well controlled with the beta blockers. And, I can decide to live my life in afib, and put up with some of the tiredness and discomfort but mostly just live with it. Many people who have afib do just this. Sometimes they need more than just beta blocker. They might use channel blockers or even some kind of anti-arrhythmics. The physician assistant reminded me that as we grow older, afib is likely to return, and studies have shown that controlling the rate is possible with relatively safe medications.

I can attempt to recapture a sinus rhythm. We can  do what they call a "pre-load" with an anti-arrhythmic medication such as Amiodarone, for about one month, then have another cardioversion, hopefully converting to NSR, and remain on Amiodarone for two more months to "hold" the NSR in place, then stop taking the Amiodarone and see if we can remain in NSR. The Amiodarone, like other anti-arrhythmic medications, has toxic properties and can cause serious side effects. The side effects are less likely if you don't take the drug very long, but that does not mean you are entirely safe. And there is no guarantee I will remain in NSR, that the afib won't come back. This is true of all anti-arrhythmic drugs, whether you convert chemically, or with an electrical cardioversion. There are risks to anti-arrhythmics.

I can explore surgical treatments for afib, from various types of ablations to a mini or full Cox Maze. These, too, have possibly harmful side effects and do not always work, or require repeat surgeries, and there is no guarantee the afib won't come back.

Regardless of what I decide, I need to do it soon. The longer one's heart remains in persistent afib, or goes in and out of it frequently in what is called paroxysmal afib, the more likely it is to stay in afib. ("Afib begets afib.")   And, no matter what I do, and despite the fact that I am one of the "lucky" afib sufferers who has had her atrial appendage removed/pinned back, thus reducing the likelihood of stroke, I will most likely take blood thinner medication for the rest of my life, whether or not I am in afib.

At this point, it is pretty much up to me to do my homework, explore my options, talk to various physicians who are knowledgeable and experienced and make my own decision.

I'll continue to explore all of these issues with you in my afib chronicles. See you next time.