AFib and Cardioversion

[JoKelly]

My 77 year old husband was in permanent atrial fibrillation for over three years.  It was decided to try a cardioversion and he had his sinus rhythm restored by this procedure on 1st May.  Now some four weeks later, he again went into AF but just for 13 hours and then reverted to sinus spontaneously.  We wonder how come this happened when it never once happened during those three years of AF.  Is this unusual and what could he expect from now on?  Since the permanent condition received no treatment other than anti-coagulation, will he now be treated as paroxysmal?

[JoKelly]

Yes, the comments are right.  The cardioversion failed after almost three months and he enjoyed them.  Now he says he thinks he feels worse in AFib this time than he did all the three years he had it pemanently.  He is opting for a catheter ablation eventually, but first has to have a stent in an artery and is at present awaiting an angiogram.  As for me, I have had my ablation ten days ago, one lone bout of AFib the next day and now so far, so good but just very tired.  Fingers crossed....

I feel it is taking togetherness to extremes for us both to have AFib!!  We happily compare symptoms ....

[Jerry_NJ]

I have undergone several electrocardioversion, all worked, and I took at least a beta blocker after converting to NSR.  Toprolol didn't hold be the time I used that (first time) and I went back into AFib in a couple of months.  The next electrocardioversion saw me on high dose Propafenone, and for two cycles each lasted about 18 months.  I underwent a mini maze in November of 2007, that NSR lasted about a month.  The following electroversion lasted about a week.  I have been in permanent AFib since.  Rate control and an anticoagulant is what I am on now as my AFib symptoms are minor.

My experience says it is necessary to be on a anti arrhythmic medication following electrocardioversion.   I have never used anything more "powerful" than Rhythmol.  Best I can recall I was taking that in the 400 mg range, it didn't hold me in NSR following my last cardioversion.

[JoKelly]

Many thanks, we won't hold high hopes, but reverting spontaneously is a new one for him.  It is likely they will perhaps try anti arrhythmics next if it doesn't hold for very long.

[itdood]

Only time will tell whether he holds normal sinus rhythm (NSR) or goes back into Afib.  Unfortunately he was in afib for a long time before the cardioversion.  One of the predictors for holding NSR after the procedure is how long the patient was in afib before hand.  The long term success rate goes down if the patient has been in afib > 1 year.  Another predictive value is the size of his left atrium.  If it's larger than normal he will have a great propensity to go back into afib.  

Was he placed on an anti arrhythmic before hand?

If he slips back into permanent afib he could try another cardioversion, anti arrhythmic meds, ablation, or one of the mini maze procedures.  The 5 box mini maze has been getting some good results for folks who have been in permanent afib for > 1 year, I'm hearing.  I hope the best for you and your husband.