Urgency of Cardioversion

I'm writing today to ask a doctor this question:  When electrical remodeling of the atria can take place so quickly, it would stand to reason that doctors would inform a fib patients that have intermittent atrial fibrillation that they should go straight the ER for cardioversion if it lasts 24 hours.  If this information was readily provided by M.D.'s  many patients could avoid the risk of falling into permanent A Fib.  Why is this line of thinking not used with patients?  I think this is the most important information a doctor can give to a patient in paroxsmyl A Fib.  In ten years of being occasionally treated for A Fib not one doctor ever mentioned it.  Had they,  I might never have experienced the events described here....

I have had A Fib off and on occasionally since 1990 and had an attack on june  1, 06  that lasted 48 hours or so before i went to the clinic for an opinion. they put me on diltiazem  and warfarin and scheduled for a cardioversion on  8/1/06. Two months elapsed before i was CV'd.  I think that during this two month time period atrial remodeling caused my heart to become very resistant to converting back to sinus.  Then I fell down the "slippery slope".  Another failed cardioversion,  a failed catheter ablation w/ complications of aspiration pneumonia,  another failed ablation with  complication (EJ Fraction dropping from 55 to 30 within 2 days of ablation... they could come up with no explanation))....  then declared that there was nothing more they could do for me... permanent A Fib.  There's more...  the toxic stew of diltiazem, coreg, warfarin, lasix and diovan ( taken for 12 months) caused "ear  poisoning"  (ototoxicity- damage to inner ear) which threw  me into a state of almost constant intense vertigo for six weeks.  The strange thing was that a neurologist, ear specialist, cardiologist and my G.P. had no clue as to the cause of the vertigo..  Three stays  in  the hospital, workups from each specialist,  each specialist saying the cause must lie in the other's domain.  It took a homeopath to figure out that the drugs were causing the problem.  N Acetyl Cesteine cleared it up within 3 days.  I stopped taking diovin, coreg, and lasix (substituted a homeopathic diuretic with good results).  I imagine that there are many other A Fib patients who have similar stories.  I can't help but think that at least some of them could have avoided their A Fib drama by being cardioverted 24 hours into a serious episode.  Why don't doctors inform patients of the importance of catching it early?

Ron
  

[twinbee]

When I first developed a-fib & a-flutter, the first doctor I saw was a cardiologist. He did not seem to think it was anything serious and told me to just go to the hospital if I had chest pain during my a-fib attacks. When I decided to seek help from an EP, she told me that I needed to go to the ER if my a-fib/flutter attacks lasted more than 4 hours and/or go immeditaley if I was having and chest pain or feeling faint.

[jallen0347]

I have been told 2 times in my life that I had a heart murmur, the dentist always insisted I take the antibiotic before any dental work could be done.... I have been told twice that I didn't have a murmur, so I tell the dentist that I have been told twice I had a murmur and I've been told twice that I did not have a murmur.... Dentist wants a signed document stating I don't have a murmur, Primary Care Physician wants an echo cardiogram done to rule out the murmur, results there's nothing to worry bout there's just a slight flutter but there is no murmur.... In preparation for gastric by pass I have to get an EKG signed off, whoops my heart was in A Fib.... Was prescribed Warfarin, took two weeks to get it stabilized, then had to have another electrocardiograph and see the cardiologist who wanted 4 weeks of INR levels at the therapeutic range for 4 weeks, and Metoprolol cause my heart rate was a little fast .... That about knocked me off my feet, so DR put me on Cartia, yesterday I had 5 attempts of Cioversion now I'm on Multaq, waiting and wondering whats next..... Any ideas....

[Jerry_NJ]

My AFib was first ignored by my primary care, he said something like "they" (cardiologist, I assume he meant) put me on blood thinner, but he didn't see any urgency.  I was still a runner, or at lest a jogger and about 50 years old.  At about age 55 my primary care decided, it may be the health insurance program changed and didn't "dig" him for referring me to a specialist, to refer me to a cardiologist.  The cardiologist confirmed I had AFib, not monitor needed I was in Permanent AFib.  We tried Toprol for a few months then he did an electrocardioversion.  I continued to take Toprol and an aspirin.  I was in NSR for about 3 months.  The story goes on too long, suffice it to say I've had periods of more than a year that I was in NSR following an electrocardioversion.  But I always returned to AFib.  I am currently in Permanent AFib and using beta and calcium channel blockers to hold my heart rate below 90 at rest.  I also take Warfarin.  I have been told an ablation is not likely to stop the AFib and therefore not worth taking the risk to find out.  Yes, I've been told the longer one is in AFib the harder it is to convert them.  Still, I have had periods of months in permanent AFib and been successfully converted to NSR that lasted for more than an year.  So, my experience doesn't support any practice that says one should go to ER to get converted or they will not be able to be converted.   A fit more about me, my left atrium was continually enlarging due to a leaky mitral valve, thus making my heart more susceptible to AFib.  This was a known condition, but here the question was: should I try to live with the leaky valve or take the risk of open heart surgery.  The valve answered that question by failing so bad surgery was mandatory.  But, it seems too late to stabilize the left atrium size such that NSR could again be invoked with a shock.