Cardioversion Failure



J

Jerome R. Long

Guest
This is a serious post for which I request serious responses. To some extent this post is also my
test to see if this newsgroup still has any serious value. So TROLLS go away!!!! Here is my problem.

I recently had a DC cardioversion that failed to last but a few hours.Now I am on 7.5 mg/day
coumadin with no noticeable symptoms of my atrial flutter, but wondering what is next and if the
condition is going to lead to heart enlargement and if I will ever be able to get off of daily
coumadin. OK, that was the short version what follows is the history.

During my most recent 6 months visit to my cardiologist for a stress echo test (which I passed very
well) we noticed that my normally low resting pulse of about 55 was up to about 95 and that my
electrocardiogram trace had many irregular QRS pulses with missing p-waves. This was diagnosed as
atrial flutter. My cardiologist recommended cardioversion. I am 68 years old and in generally
excellent health, but have a coronary stent which was put in three years ago after some bouts of
mild angina. I have had no angina since the stents. The stress echo was for the purpose of checking
the stents for any re-stenosis. The cardiologist took me off my daily aspirin and put me on coumadin
with weekly protime tests and dose adjustments until my INR stabiliized at 2.6. Then I went into the
hospital with a Holter and a 24 hour IV of Amiodarone. The Amiodarone did not convert me to normal
sinus rhythm, so I was wired up and anesthetized for DC electro cardioversion. This restored normal
sinus rhythm and p-waves and I was released from the hospital later the same day. By bedtime, the
beeps from my home blood pressure cuff told me the arrhythmia had returned. When I returned to my
cardiologist a week after the DC electro-conversion I still had the arrhythmia. My cardiologist
asked me, "When did this start?" I told him it happened within a few hours of the conversion. He
responded that new attempts after a first failure were almost never successful, so he took me off
the 50 mg daily of amiodarone and put me back on 7.5 mg daily of warfarin. He said to come back from
time to time to check the INR to make sure my blood would not form clots in the right atrium and put
me at risk of stroke. Then he said to come back in four months for a re-evaluation. I have no
noticeable symptoms of all this. I do not feel missed beat or PACs or PVCs and I can do heavy
sustained work without any problems. I do not understand where my p-waves went or what I should not
expect.One main concern is that this condition could lead to gradual enlargement of my normal sized
heart. The only other prescription drug I take is 40 mg Zocor, which has kept me on a good lipid
profile for over ten years..
 
D

Dr. Andrew B. C

Guest
"Jerome R. Long" wrote:

> This is a serious post for which I request serious responses. To some extent this post is also my
> test to see if this newsgroup still has any serious value. So TROLLS go away!!!! Here is my
> problem.
>
> I recently had a DC cardioversion that failed to last but a few hours.Now I am on 7.5 mg/day
> coumadin with no noticeable symptoms of my atrial flutter, but wondering what is next and if the
> condition is going to lead to heart enlargement

If your heart rate is well controlled (less than 100 bpm), it shouldn't.

> and if I will ever be able to get off of daily coumadin.

There are alternatives to coumadin in the works.

> OK, that was the short version what follows is the history.
>
> During my most recent 6 months visit to my cardiologist for a stress echo test (which I passed
> very well) we noticed that my normally low resting pulse of about 55 was up to about 95 and that
> my electrocardiogram trace had many irregular QRS pulses with missing p-waves. This was diagnosed
> as atrial flutter. My cardiologist recommended cardioversion. I am 68 years old and in generally
> excellent health, but have a coronary stent which was put in three years ago after some bouts of
> mild angina. I have had no angina since the stents. The stress echo was for the purpose of
> checking the stents for any re-stenosis. The cardiologist took me off my daily aspirin and put me
> on coumadin with weekly protime tests and dose adjustments until my INR stabiliized at 2.6.

Coumadin will not prevent heart attacks as well as aspirin.

> Then I went into the hospital with a Holter and a 24 hour IV of Amiodarone. The Amiodarone did not
> convert me to normal sinus rhythm, so I was wired up and anesthetized for DC electro
> cardioversion. This restored normal sinus rhythm and p-waves and I was released from the hospital
> later the same day. By bedtime, the beeps from my home blood pressure cuff told me the arrhythmia
> had returned. When I returned to my cardiologist a week after the DC electro-conversion I still
> had the arrhythmia. My cardiologist asked me, "When did this start?" I told him it happened within
> a few hours of the conversion. He responded that new attempts after a first failure were almost
> never successful, so he took me off the 50 mg daily of amiodarone

Maintenance amiodarone doses are typically 200 mg.

> and put me back on 7.5 mg daily of warfarin. He said to come back from time to time to check the
> INR to make sure my blood would not form clots in the right atrium and put me at risk of stroke.
> Then he said to come back in four months for a re-evaluation. I have no noticeable symptoms of
> all this. I do not feel missed beat or PACs or PVCs and I can do heavy sustained work without
> any problems. I do not understand where my p-waves went or what I should not expect.One main
> concern is that this condition could lead to gradual enlargement of my normal sized heart. The
> only other prescription drug I take is 40 mg Zocor, which has kept me on a good lipid profile
> for over ten years..

Would suggest you ask your cardiologist about adding low-dose beta blockade to keep your heart rate
well controlled in order to prevent the heart enlargement that concerns you. You should also ask
about having aspirin restarted.

Servant to the humblest person in the universe,

Andrew

--
Dr. Andrew B. Chung, MD/PhD
Board-Certified Cardiologist
http://www.heartmdphd.com/

**
Who is the humblest person in the universe?
http://makeashorterlink.com/?W1F522557

What is all this about?
http://makeashorterlink.com/?G1BB12C67

Is this spam?
http://makeashorterlink.com/?N69721867
 
J

Julianne

Guest
This is how I understand it. Generally, the atria are responsible for ten to fifteen percent of your
cardiac output. When your atria and your ventricles do not work in tandem, you lose what they call
your 'atrial kick'. Most people are okay with this. For some folks, it results in fatigue, fainting,
etc. Being without symptoms is a good thing.

The other risk with A-flutter or A-fib is that blood could stagnate in the atria causing a blood
clot leading to a stroke. That is why you are currently taking coumadin.

Enlargement of the heart occurs when it is not strong enough to meet current demands. With an
arrhythmia problem, this usually occurs because the heart beats too fast. Many patients take digoxin
and lopressor. Are you on any meds other than the ones you mentioned?

Does being on coumadin bother you? Do you have frequent side effects? Generally speaking, it is a
harmless drug as long as you are well monitored and avoid opportunities for serious injuries.

j "Jerome R. Long" <[email protected]> wrote in message news:[email protected]...
> This is a serious post for which I request serious responses. To some
extent
> this post is also my test to see if this newsgroup still has any serious
value.
> So TROLLS go away!!!! Here is my problem.
>
> I recently had a DC cardioversion that failed to last but a few hours.Now
I
> am on 7.5 mg/day coumadin with no noticeable symptoms of my atrial
flutter,
> but wondering what is next and if the condition is going to lead to heart enlargement and if I
> will ever be able to get off of daily coumadin. OK,
that
> was the short version what follows is the history.
>
> During my most recent 6 months visit to my cardiologist for a stress echo test (which I passed
> very well) we noticed that my normally low resting
pulse
> of about 55 was up to about 95 and that my electrocardiogram trace had many irregular QRS pulses
> with missing p-waves. This was diagnosed as atrial flutter. My cardiologist recommended
> cardioversion. I am 68 years
old
> and in generally excellent health, but have a coronary stent which was put in three years ago
> after some bouts of mild angina. I have had no angina
since
> the stents. The stress echo was for the purpose of checking the stents for any re-stenosis. The
> cardiologist took me off my daily aspirin and put me on coumadin with weekly protime tests and
> dose adjustments until my INR stabiliized at 2.6. Then I went into the hospital with a Holter
> and a 24
hour
> IV of Amiodarone. The Amiodarone did not convert me to normal sinus
rhythm,
> so I was wired up and anesthetized for DC electro cardioversion. This
restored
> normal sinus rhythm and p-waves and I was released from the hospital later the same day. By
> bedtime, the beeps from my home blood pressure cuff told
me
> the arrhythmia had returned. When I returned to my cardiologist a week
after
> the DC electro-conversion I still had the arrhythmia. My cardiologist
asked
> me, "When did this start?" I told him it happened within a few hours of
the
> conversion. He responded that new attempts after a first failure were
almost
> never successful, so he took me off the 50 mg daily of amiodarone and put
me
> back on 7.5 mg daily of warfarin. He said to come back from time to time to check the INR to make
> sure my blood would not form clots in the right atrium and put me at risk of stroke. Then he said
> to come back in four
months
> for a re-evaluation. I have no noticeable symptoms of all this. I do not feel missed beat or
PACs
> or PVCs and I can do heavy sustained work without any problems. I do not understand where my p-
> waves went or what I should not expect.One main concern is that this condition could lead to
> gradual enlargement of
my
> normal sized heart. The only other prescription drug I take is 40 mg
Zocor,
> which has kept me on a good lipid profile for over ten years..
 
E

Eric

Guest
There's ablation, but since you say you have no noticeable symptoms...

Jerome R. Long wrote:
> This is a serious post for which I request serious responses. To some extent this post is also my
> test to see if this newsgroup still has any serious value. So TROLLS go away!!!! Here is my
> problem.
>
> I recently had a DC cardioversion that failed to last but a few hours.Now I am on 7.5 mg/day
> coumadin with no noticeable symptoms of my atrial flutter, but wondering what is next and if the
> condition is going to lead to heart enlargement and if I will ever be able to get off of daily
> coumadin. OK, that was the short version what follows is the history.