[Jay-Jay]

My husband had an appt. with his cardiologist today. She found he was in atrial flutter with a heart rate of about 150. He's on TWO beta blockers, so the meds just aren't doing their job. She did a rush job on getting the paperwork/tests done that are required for cardioversion (to take place tomorrow). Unfortunately, there was no time to ask her questions, so I'm turning to my nursing buddies here!

What are the dangers/risks of this procedure?

What are the dangers if it's NOT done? Understandably, he's frightened (heck, make that BOTH of us~), and says his HR was extra high today due to stress. He's on coumadin therapy, as well as digoxin, Cardizem, monocor and metoprolol. He had a pacemaker put in several weeks ago, to control tachy-brady syndrome (long pauses in the heartbeat as it converted from tachycardia/a-fib to sinus rhythm.) Unfortunatly, the doc. who inserted the pacemaker went AGAINST his cardio's wishes, and inserted a single-lead pacemaker. She explained that a double lead pacer would be able to control the rhythm somewhat better. "I asked for a Cadillac, and they gave you a Ford!" she explained.

Needless to say, we're a bit stressed out here tonight. Help, please!

[Dinith88]

JayJay, i wish you and your husband well!

As far as elective cardioversion is concerned, the WORST thing that can happen is ventricular standstill (asystole) from defribilator induced 'myocardial stunning'. HOWEVER, if this very rare side-effect were to occur, the treatment is pacing...and your husband already has a pacer! Should be no problem whatsoever.

The other issue is that there's a high incidence of recurrent atrial arrythmias in people who've had the problem for a long time. As you said, your husband gets long pauses as he converts to sinus...then will flip back into a-fib/flutter. Seems his problem is 'paroxysmal' arrythmia, and i wouldn't be surprised if he goes back into an a-fib/flutter down the road.

As far as not having an elective cardioversion and staying on meds, it'd depend on how well his rates are controlled and whether or not he's properly anticoagulated. If the current medications aren't working, have you, your husband, and the Doc discussed cordarone? Especially if his rates are refractory to all that other stuff?

Good Luck again to you both, and keep us posted!

[BarbPick]

Jay Jay,

If it doesn't work, your husband can be elected President. George Hurbert Walker Bush had atrial arrythmias his entire presidency, and still does today.
The fact that they didn't keep him and admit him right then should tell you they felt it could wait.
I also agree, no amiodarone?

Barbara

[Jay-Jay]

My husband asked me to research amiodarone for him, and what I found scared the daylights out of him. Would you want to take a drug that has a 50% rate of side effects? Also, his opthamologist said, "I wouldn't take it if I were you. It builds up in the cornea, and can damage your eyesight."

He spent most of the day in hospital today. He's still in a-fib, but they got the rate down to the 60's-70's, using Rhythmol, plus a few other drugs.

The beeping of the machines, plus the nurses standing at the nursing station, gossiping, and TOTALLY ignoring him when he had an angina attack finally got to him. He signed himself out, and called me to come and take him home! I didn't try to convince him otherwise. If this can be controlled with drugs, that's FINE by me!

[efiebke]

Jay-Jay:

So sorry to read about your husband's situation (both cardiac and hospital experience!)

Just want to wish your husband and you warm wishes as you tackle the a-fib problem together.

Understand I'm not an expert cardiac nurse. I learn more by reading this particular forum and rarely I contribute to it, sadly.

But I've never seen any one treatment work best for people who develop a-fib/flutter. This included electric cardioversion, beta-blockers, amiodarone (sp?), etc. Patients either convert and stay in sinus (if they convert at all), or convert and revert back to a-fib/flutter at some point in time. What I usually see, more often than not, is an attempt to convert back to sinus the patient who is a newly a-fib/flutter within a short period of time (< 24 or so hours), OR control the rate and start anti-coagulation therapy if newly a-fib/flutter but for an unknown time and then possibly attempt cardioversion once therapeutically anticoagulated for a while. Again, no treatment for cardioversion (chemically or electrically) seems to stand out to work the best in my mind. . . well maybe electrically (but it doesn't always seem to last).

Usually . . . if it's realized that a person will probably be a "chronic a-fiber" the goal is rate control and therapeutic anti-coagulation.

And. . . people do convert on their own sometimes. Let's just hope that they've been adequately anti-coagulated during that time!

Again, warm wishes to your husband.

Ted

[Havin' A Party!]

Agree with Ted.

Latest studies indicate rate control is where it's at (rhythm's not crucial).

Your hubby's right. Amiodarone is super scary.

Of great importance is anticoag treatment. Aspirin, if young (<65) and no outstanding heart / valve issues. Coumadin if older and / or with heart probs.

Another option: If he's symptomatic and wants to stay off meds, look into an ablation.

All the best!

[efiebke]

Originally posted by LarryG
. . . Another option: If he's symptomatic and wants to stay off meds, look into an ablation.

All the best!

Yep! I was thinking the same thing too. But I never see stuff like that in my small, my very, very small. . . my really freakin' very, very small hospital. If an ablation is done to one of our patients, it's after they're shipped to "Teaching Hospital General".

We had one patient specifically transported to one of those "Teaching Hospital General" type facilities for a possible ablation from an uncontrolled rate problem related to WPW thingy. Of course no one really knows what happened to that patient; what type of therapy was provided, outcome, etc.

HIPPA is so not hip. . . .

But that's another topic for another thread for another time.

Ted

Testing edit function

[Dinith88]

An ablation would be an option if this problem were 'ablatable'.
Unfortunatley, a-fib/flutter isnt 'ablatable' because there is no 're-entrant track' to sizzle. The entire atrium/atria are fibrrilating/fluttering...and sizzling the entire atrium would be detrimental to a patient's health

Also, it sounds as though his problem has a sick-sinus-sindrome/tachy-brady component (requiring a pacemeker)> In this circumstance, the problem is a malfunctioning sa-node. Again, sa-node ablations arent done....it'd ruin whatever intrinsic pacemaker a patient has. In fact, even in re-entrant svt, if the 'track' is close to the sa-node, ablation isn't done because of the risk of frying the node.

Ablation is a wonderful option for those who have abalatable problems. Unfortunatelty, not all (the majority) of atrial arryhtmias cant be fixed this way.

The classic rhythms that can be ablated are WPW and SVT's caused by a re-entry track (WPW is ALWAYS caused by a re-entrant track)

[Dinith88]

LarryG,

Just read your comment about being<65 and on aspirin rather than coumadin. That's very bad advice if a patient has a-fib.


The risk for developing a clot is very real in a-fib. Coumadin is a standard treatment for prevention of a-fib associated thrombus.
Aspirin is less effective but will occaisionally be given as a substitute for coumadin in very elderly patients (at increased risk for falls, co-morbidity/bleeding issues, etc.), or those who are unable to tolerate it (for whatever reasons).

A person with a-fib who is less than 65 and is on aspirin rather than coumadin is rolling the dice and flirting with stroke. Although i'm sure the chance of clot would be lessened with aspirin (minimally), coumadin is the treatment of choice and would provide much better protection.

[moonshadeau]

Originally posted by Dinith88
An ablation would be an option if this problem were 'ablatable'.
Unfortunatley, a-fib/flutter isnt 'ablatable' because there is no 're-entrant track' to sizzle. The entire atrium/atria are fibrrilating/fluttering...and sizzling the entire atrium would be detrimental to a patient's health

Also, it sounds as though his problem has a sick-sinus-sindrome/tachy-brady component (requiring a pacemeker)> In this circumstance, the problem is a malfunctioning sa-node. Again, sa-node ablations arent done....it'd ruin whatever intrinsic pacemaker a patient has. In fact, even in re-entrant svt, if the 'track' is close to the sa-node, ablation isn't done because of the risk of frying the node.

Ablation is a wonderful option for those who have abalatable problems. Unfortunatelty, not all (the majority) of atrial arryhtmias cant be fixed this way.

The classic rhythms that can be ablated are WPW and SVT's caused by a re-entry track (WPW is ALWAYS caused by a re-entrant track)

They are doing ablation therapy to both AFib and Flutter now at the Mayo clinic. I have had several patients that were referred to Rochester for persistant Afib despite attempts at Cardioversion, Tikosyn and other anti-rhythmics. Another thing that is big is the MAZE treatment that has a high success rate. I have noticed though that both groups (ablation/MAZE) usually end up with pacers eventually.

http://www.mayoclinic.com/invoke.cfm...B4C9F9BF3C2F9F