Cardioversion Failure

Jerome R. Long said:

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.

Quoted message said:

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

There are alternatives to coumadin in the works.

Quoted message said:

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.

Quoted message said:

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.

Quoted message said:

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
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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 hidden]> wrote in message "]news:[email hidden]...

Quoted message said:

This is a serious post for which I request serious responses. To some

extent

Quoted message said:

this post is also my test to see if this newsgroup still has any serious

value.

Quoted message said:

So TROLLS go away!!!! Here is my problem.

I recently had a DC cardioversion that failed to last but a few hours.Now

I

Quoted message said:

am on 7.5 mg/day coumadin with no noticeable symptoms of my atrial

flutter,

Quoted message said:

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

Quoted message said:

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

Quoted message said:

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

Quoted message said:

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

Quoted message said:

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

Quoted message said:

IV of Amiodarone. The Amiodarone did not convert me to normal sinus

rhythm,

Quoted message said:

so I was wired up and anesthetized for DC electro cardioversion. This

restored

Quoted message said:

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

Quoted message said:

the arrhythmia had returned. When I returned to my cardiologist a week

after

Quoted message said:

the DC electro-conversion I still had the arrhythmia. My cardiologist

asked

Quoted message said:

me, "When did this start?" I told him it happened within a few hours of

the

Quoted message said:

conversion. He responded that new attempts after a first failure were

almost

Quoted message said:

never successful, so he took me off the 50 mg daily of amiodarone and put

me

Quoted message said:

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

Quoted message said:

for a re-evaluation. I have no noticeable symptoms of all this. I do not feel missed beat or

PACs

Quoted message said:

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

Quoted message said:

normal sized heart. The only other prescription drug I take is 40 mg

Zocor,

Quoted message said:

which has kept me on a good lipid profile for over ten years..

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

Jerome R. Long said:

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.