My Cardioversion

[JoAnna]

Hi Everyone, well I had my cardioversion on Thursday. So far I feel really good. I have my energy back, and I haven't had any sob so far. But I can't help but feel cautiously optimistic. I just feel like it's too good to be true, and I am afraid the Afib is going to come back. I think I will be more and more confident as time goes on. I feel a little more secure than I did yesterday. The first night after the CV I felt what I thought were heart palpitations when I was laying down. I'd never felt that before. It wasn't uncomfortable, just weird. It was as though I could feel my heart beating in my chest. Maybe it was just my heart beating normally again that I was getting used to? And I was burned on my chest and back where they put the patches for the CV. Has anyone else experienced that? Also it seems like I am not retaining water anymore, let's put it this way, the diuretics are really working all of a sudden. Does anyone know why that may be? I am making sure I drink a lot of water so I don't get dehydrated since my doctor thinks getting dehydrated may have caused the afib in the first place. I am going to check with my doctor on whether or not I still need to be on the diuretics. So anyway, I'm taking it easy, and also told myself to look at this as an experience to help me appreciate my health more. It certainly opened my eyes to the fact that I do have a real heart condition, and I do need to take good care of myself.... and not sweat the small stuff so much anymore.
JoAnna

[Reenie]

I don't have any answers for you but I want to say how happy I am that you are feeling better!

Reenie

[Laoshur]

This is great! Glad you are feeling better.

I am not sure exactly why either but my doctor has frequently told me that afib leads to fluid retention.

Rhoda

[Toogoofy317]

As far as the burns from the patches. You can call your doc and tell them and they can give you a script for an ointment to help the healing. Mine were pretty bad had blisters. I was having an EP study and was shocked while awake. LOOONG Story. What a feeling.


I hope this helps!

Mary S.

[progers]

Joanna,

I am so relieved for you - finally you are back in sinus. I felt the same way - that every palpitation was going to be a-fib and that it would come back at any time. But you are right, the more that time passes the more confident you become that you will be alright.

Just remember to insist on getting cardioverted if it comes back. Yes, some people can live with a-fib (Sarah is an example of this). But some of us with HCM rely heavily on the atrium for our cardiac output. A-fib basically takes away 30+ % of your heart's function. In addition, the longer you leave it, the more chance there is that it will come back.

So, please insist on being cardioverted within 24 hours if it happens again. You should also be on warfarin, which is a pain in the a**s, but may save you from having a stroke, which would be devastating. I am only 35 and feel absolutely robbed of my peak years by this damn disease. But it could be worse so I now take warfarin to make sure I am not in a nursing home for the rest of my life - or even worse, dead!

Take care and keep us posted.

Paul

[Largehearted]

Joanna.

I am very glad you are back in sync! The debilitating feeling that goes along with highly symptomatic a-fib is just plain bad! May you have many years of steady, plodding, boring, normal heartbeats!

Peace,

Leon

[cynthia]

Joanna,

Glad to hear you're feeling better! I always feel SO good after I've been cardioverted. As far as feeling your heart lying down....most of us can't lay down on our left side (I think a doctor told me once that I feel the thumps more on that side because your heart is on its side in that position). I even experience it lying down on my back...I have to sleep on my right side or stomach. Also, I would hazard a guess that AFIB could lead to fluid retention. One more thing, I've been cardioverted twice and never had any "burn" marks...how are they performing the CV for someone to actually get burn marks?? :shock:

[Toogoofy317]

Cynthia,

The burn marks usually result from the pads not being laid completly flat on the chest and back. You need to be careful about placing it one end at a time and then rubbing it down flat. What happns is when the electrical charge is applied there are spaces in the pad and it creates an arc and that is what causes the burn.

The pads are a lot safer than the paddles I've seen an Arc with those and you can literally see the electricity jump from one paddle to another. That causes severe burns. It also puts the health care people at a higher risk when that happens.

Mary S.

[fausto.freire]

Joanna: Excellent news!!

Yes the first few hours hours (days…) are very special (Paul explain it very well). After my first cardioversions I was afraid for a few hours (days…) of checking my hearth rhythm, thinking that afib could be back again.

I wish you a long time, preferably for ever, without a.fib.

Mary: thank you for the electric arc explanation. It makes sense and I have never though about it. I always got burn marks. From my own experience, burn marks depend on the number of chocks you get, the level of energy used and finally the type of device (monophasic or biphasic defibrillators). The biphasic are more efficient and require less energy, and they must be the used ones... always

Fausto

[Toogoofy317]

Fausto:

Thanks for covering the other aspects of burns too! Mind isn't firing on all cylinders right now. Got a lot on my mind.

I am curious when you talk about monophasic and biphasic. I guess the only equipment I've ever worked with as an EMT is biphasic. Could you give me an explanation on the differences please!

Mary S.

[fausto.freire]

Hi Mary:
Electric shocks given by defibrillators can use a monophasic shock waveform or a biphasic waveform. Old defibrillators were monophasic. Modern ones are biphasic.

Just a question before I continue. What means EMT? I remember reading in one of your posts that you were studying something related with health care… but I don’t remember what exactly?

In my first cardioversion (a few years ago) the doctors used a monophasic one. In my next cardioversions, they always used biphasic defibrillators. The main difference is that the biphasic needs less energy to do the same job. A second and perhaps more important difference is that biphasic defibrillators have a higher success rate in restoring sinus rhythm in patients with atrial fibrillation. More details below in an abstract from this article: Gurevitz et al. (2005) Comparative efficacy of monophasic and biphasic waveforms for transthoracic cardioversion of atrial fibrillation and atrial flutter. Am Heart J. 2005 Feb;149(2):316-21.

BACKGROUND: Transthoracic cardioversion fails to restore sinus rhythm in 6% to 33% of patients with atrial fibrillation. This study sought to determine the relative efficacy of biphasic waveforms compared with monophasic waveforms in the treatment of atrial arrhythmias. METHODS: A total of 912 patients underwent 1022 transthoracic cardioversions between May 2000 and December 2001. A monophasic damped sine waveform was used in the first 304 cases, and a rectilinear biphasic defibrillator was used in the next 718 cases. RESULTS: Use of a biphasic waveform was associated with 94% success in conversion to sinus rhythm compared with 84% with a monophasic waveform (P < .001). The cumulative energy required to restore sinus rhythm was lower with biphasic shocks in both atrial fibrillation and atrial flutter groups (554 +/- 413 J for monophasic vs 199 +/- 216 J for biphasic shocks in the atrial fibrillation group, P < .001; 251 +/- 302 J vs 108 +/- 184 J, respectively, in the atrial flutter group, P < .001). In a multivariate analysis, use of a biphasic shock was associated with a 3.9-fold increase in success of cardioversion. CONCLUSION: When used to cardiovert atrial arrhythmias, the rectilinear biphasic waveform was associated with higher success rates and lower cumulative energies than the monophasic damped sine waveform.

[Toogoofy317]

Fausto,

An EMT is an Emergency Medical Techncian. You typically find this type of person working on an ambulance. There are three levels of EMT. EMT-B, EMT-I, and EMT-P. EMT-B is Basic which is what I am, job duties of the Basic are BLS or basic life support measures. We can defibrillate. In most counties it is with an AED and from my knowledge they are biphasic. Using a manual defib requires extensive knowledge in EKG interpretation which most EMT-B do not get training for. In the state of Florida to get an EMT-B liscense you have to complete 11 college level hours of class and 100 hours on clinical ride time before you can apply to take the boards. In my class we started out with 33 students only 13 made it through the entire year and only 4 of us passed the national boards the first time. So, to say it is a rigourus coarse. EMT-I is the intermediate level and they do more advanced airways and they can start an IV line. This only takes a few more hours of training. I've gotten the training just never took the examination because very few areas in Fl. use EMT-I. An EMT-P is the paramedic level and they can do anything that a doctor will allow them too some areas are more liberal than other in their practice. An EMT practices under a doctor's liscense since in my area we were very short on paramedics so we could also do some advanced arways such as LMAs and combitubes. Since, those are pretty fail safe airways. Paramedics may also push medications and do endotracheal intubations, This level requires an Associate in Science degree as well as I think is like over 500 contact hours. Then you may sit for the boards.

All EMT's are also supposed to maintain their liscenses with ride time hours and class hours. I voulunteer in Polk county Fl. which once a monh we have a class and then can ride with any station in the county. I've not been able to do this for awhile and sorely miss it! EMTs can also work in hospitals I worked as an Advanced Clincal Tech on a surgical oncology floor for a year with it. It is really different than an EMT so I got a really good knwoledge base from it as well.

I am still in school at this point going for an AA in General Studies and the plan on pursing a Bachlors in Health Sciences which I will decide then. If I want to become a physcian assistant or a Medical degree, or a PHD.

Hope this helps!
Mary

[jmurray]

JoAnna,

It is good to hear that you are feeling so much better. Hang in there, I'm sure this will be a longer term fix for you. I truly agree about sweating the small stuff. It's just not worth it - go with the flow girl!

Best wishes,

John

[heather]

JoAnna,

I'm so glad your cardioversion went well. Isn't it a relief when you wake up in normal sinus rhythm?? I know what you mean though, always waiting for the other shoe to drop. I continuously do that!!!

[fausto.freire]

HI Mary
Thank you for all the details. Now I know a little bit more of the USA health system. Good luck for your future professional plans
I have been trying to finish a PhD (unfortunately not on Health Sciences, but on environmental and energy management). It has been very hard to finish it with all the afib problems I have been having lately.

Fausto

[JoAnna]

Hi Everyone, thanks for the good thoughts on my cardioversion. I'm still feeling really good. My burns are all gone. Now that I know what it feels like, you can bet I will be the doctor's office the minute I feel it so I can get cardioverted asap !! It was interesting to read about the different kinds of defibrillators used. I am learning so much about all this. I haven't talked to my doctor since the CV. He was gone the minute I woke up. (Unless he told me something and I don't remember). I left a mssg for him because I'm not sure what I'm suppose to do next. So I am just continuing to take the Coumadin, which I assume I will be on for a long time and my Atenolol, which I have taken forever. I don't know if he plans on putting me on meds for keeping me out of Afib or not. He did tell me earlier that he would like to keep me off those if possible because of side effects. I guess it depends on if I stay out of Afib or not. I also wanted to ask him if it's ok to start exercising. I missed it so much. I want to do some light exercise. I went to my yoga class tonight and it felt so good. And I rode the stationery bike a little yesterday and today just to see how I felt. I felt great. No shortness of breath at all. I made sure I drank plenty of water and stopped after 15 minutes. I felt like I could have gone on for another half hour with no problem. It felt like I have never been away from the gym. My doctor told me before the CV that I should be fine exercising as long as I kept it really low key and did not over do it. So that is what I am doing. I'm just so worried any little thing is going to send me into Afib again. Any thoughts? Thanks again for your thoughts and support.
JoAnna

[progers]

Joanna,

My EP told me not to exercize for a month after my CV because of the 'stunning' that occurs after a-fib. I'm not sure of what it is exactly, but I believe the atria are not quite right for several days after conversion, even though you may be in sinus rhythm. Nevertheless, I've been doing some walking which I'm sure is ok.

Next week I will three months since my myectomy and my surgeon told me it will be ok to go surfing again. I surf all the time normally, so being out of the water for somthing like 13 weeks has been ****. Can't wait....

Cheers,

Paul