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Forum Name: Arrhythmias

Question: Cardioversion For Atrial Fibrillation


 dizzygirl - Thu Oct 15, 2009 4:36 pm

I am asking about my husband. He is 31 years old, smoker, not on any meds. He went to a cardiologist this week and found out that he has constant atrial fibrillation. The doctors are suggesting he gets cardioversion done within the next few weeks. I was very surprised they wanted to do this as a first line of treatment without trying medication or anything first. My husband believes this came on from being electrocuted when he was 18, and his heart has had a funny rhythm as long as I've known him. I am just wondering if cardioversion is a normal first line of treatment, or should we seek a second opinion from a heart rhythm specialist? I am very worried about him, and the thought of shocking his heart is quite frightning. We don't know much about this procedure, and the doctor did not explain it to us. From what I've read the longer you've been in AFib, the less successful cardioversion is. Is that correct? Any advice or suggestions would be greatly appreciated. Thanks!
 John Kenyon, CNA - Wed Oct 28, 2009 11:56 pm

User avatar Hello -- Cardioversion is a relatively innocuous procedure that sometimes works (probably 75% of the time) and sometimes has to be repeated or loses its ability to effect change about half the time. Still, for certain selected groups it is very effective and may resolve the problem. It's nothing at all like the defibrillation scenes one sees on television involving patients in cardiac arrest; it's pretty dull, actually. The fact your husband was struck by lightning does make sense as a possible cause of his A-fib, especially since he is so young and otherwise healthy. Whatever the cause, cardioversion is usually the first line of therapy, because treating this with medication, which is the second choice, is far more complex, involving both something to subdue the arrhythmia and often an anticoagulant if the arrhythmia won't completely go away. It can be a nuisance, although this is often necessary.

There is also sometimes the hope of curing the problem permanently with radio frequency (RF) ablation, which usually takes (including prep and recovery time) the better part of a day, but when it works it usually is for good. Some people for various reasons are not considered candidates for this, but it's worth asking about.

The reason cardioversion is especially important in your husband's case is because it is the quickest way to return him to normal sinus rhythm while a long-term management plan is formulated, and can result sometimes in permanent cure. A-fib is, in itself, not life-threatening but, as I'm sure has been explained, the potential complication of stroke is always lurking in the background (clots form in the upper chambers of the heart where the blood isn't moving steadily and forcefully, which allows the clots to form, then eventually be expelled, where they then find their way to the brain). So it's important to restore a regular rhythm and then see if it holds up. If not, medication or ablation are the next steps.

Hope this helps. Good luck to you both and please follow up here with any further questions.

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