Not too long ago, I underwent Cardioversion. Almost a year had passed between the time the cardiologist diagnosed AFib (Atrial Fibrillation) and recommended Cardioversion, to the time I finally broke down and had it done. To put it quite simply, I was chicken ... scared out of my mind. I should add this fear was based on absolutely nothing. Just something about having electrodes attached to my chest and an electrical charge sent through my heart just didn't seem like something I wanted to do. I put it off and put it off looking for something, anything that would either correct the AFib or provide me with a good excuse for not doing it. Needless to say it was a miserable, anxiety filled year.
Turns out, Cardioversion is pretty much a nonevent; no pain, no recovery, no after effects, not much of anything. I was foolish to put it off as long as I did (easy to say in retrospect). In addition to the year of misery, it turns out some permanent damage was done to my heart; most likely preventable had I taken my doctor's advice and had it done when he suggested.
I have put this web site together to share my experiences from start to finish in the hopes I might help others who find themselves in this situation. During the year prior to Cardioversion, I searched the web continuously for information on the procedure. While there was plenty of information of the mechanics of the process and countless reassurances from doctors on the safety and necessity of the process, I couldn't find a thing on what the experience was like, from a patient's perspective. Does it hurt? Do you regret having it done? Would you do it again? For some reason, I just couldn't find the reassurances I was looking for. Hopefully this web site, in some small way, will fill that void.
[Note: I'd be the first to admit this presentation is rather long and wordy. I've included several graphics along the way to make it a little more palatable. If you want to skip all this background material and go directly to the day of the Cardioversion, click here.]
It all began one evening just before New Years a couple of years ago. I felt lousy. I could feel something was not right, but not sure what it was. I checked my pulse and it was high, around 120 as I remember, and that was at rest. Of course anyone with any common sense would have sought medical attention, but it was late, and a weekend, etc. so I decided to take a "wait and see" approach (not wise).
The next morning I checked my pulse again. It was even higher, around 150 and I felt even worse. Now I was getting scared. I called the doctor, and of course was told to come in immediately.
By this time, I had broken out in a sweat and knew I was in serious trouble. The nurse gave me an EKG and found that my heart was in AFib and my pulse was racing. The doctor said that if it had been diagnosed soon after onset, the normal treatment would be to have Cardioversion done immediately, but since I had waited nearly 24 hours, it was too late for that (apparently a chance of blood clots forming in the Atrium if the heart has been in AFib for an extended period of time). The immediate treatment was therefore to slow the heart to a safe rate and deal with the AFib later. (At this time I didn't know enough about AFib or Cardioversion to have much feeling about either, one way or the other).
The nurse wired me up to the EKG and started an IV drip and, as I remember, it took a few hours to get the heart rate back to normal. Finally the doctor was satisfied that my heart rate had stabilized at an acceptable rate and I was able to return home. I was exhausted and damp with sweat, but otherwise felt O.K.
The next day I returned to the doctor's office for another EKG and was told that my heart was now back in normal sinus rhythm. No more AFib! All that remained was a short period of anticoagulant therapy and follow-up EKG's and I'd be home free (wishful thinking as you'll see later).
For the next few months I had to make periodic office visits for Protime tests (a.k.a. PT or prothrombin time). These tests were to measure my blood clotting time and was used by the doctor to determine the appropriate dosage of the anticoagulant medication I was taking. As mentioned earlier, when your heart is in AFib there is a chance that blood clots are formed in the Atrium. The anticoagulant regiment is to help make sure they dissolve before doing any harm. Of course you don't want to over do it and stop the blood clotting all together or you would be in pretty bad shape if you cut yourself (actually people on anticoagulant therapy are advised not to use shave with a blade razor for just that reason). As you can see, though inconvenient, Protime tests are very important and the testing schedule should be adhered to diligently.
There were periodic EKG's to make sure my heart my heart was still behaving itself. For 4 months, my heart remained in normal sinus rhythm. I thought for sure I was out of the woods and AFib was a thing of the past.
Unfortunately, roughly 4 months after the first bout of AFib it happened again. Because I was already taking medication to control the heart rate, the symptoms were far less severe than the first time around. In fact, if it hadn't shown up in an EKG I probably wouldn't have known it happened.
Since I had been on anticoagulants for 4 months the doctor felt the appropriate treatment this time was to have Cardioversion done as soon as possible. He proceeded to tell me what the process was and what I might expect. I think it was some place around "we place electrodes on your chest and back and pass an electrical current through your ..." (it was about then I decided I didn't want to hear any more of this). One thing for sure, this wasn't something I was going to do! After all, I felt OK. So what if my heart was in AFib? Why mess around? Why take a risk, regardless of how small? In retrospect I am sure my doctor had answers for all of these questions and more, but by now I had my metaphorical fingers in my ears and was silently chanting my mantra "No, no, no..." as though that would some how make all this go away.
Against my cardiologist's best advice, I decided against having the Cardioversion. I thought of a million excuses: "I don't have time.", or "I'm feeling OK the way things are, why mess with it?", or "It went away once on its own, probably will again...". I scanned the Internet for countless hours trying to find alternative, or at least new excuses for not having it done. I took ever herbal supplement that seemed even remotely to have anything to do with cardiac health. I was over weight and thought if I lost a few pounds that might fix it (actually I lost 60 pounds, but that's another story). I started exercising more, watching my diet, and of course taking all the doctors magic potions, all in the hopes that some how, some day I'd wake up and once again my heart would be beating with a normal sinus rhythm.
The days turned into weeks and weeks into months and still my heart was in AFib. The good doctor was patient and understanding through all of this, but with each visit he was more adamant about having the Cardioversion done, and soon. When my last Echo Cardiogram showed a significant increase in the size of my heart resulting from the extended period in AFib ... well, let's just say it was no more Doctor Niceguy. He drove home the point that I was doing serious damage to my heart with all this procrastination and it was time to get on with it. What really drove it home was when he looked me straight in the eye and said: "Don't let your fear stand in the way of common sense!" Of course he was right, that was exactly what I was doing. I decided that moment to schedule the Cardioversion and get it over with, and just hope my foolishness hadn't done too much permanent damage.
I don't know if it is always the case, but my Cardioversion was to be done in the hospital. It was therefore necessary to register prior to admittance. If you find yourself in this situation, I recommend you the day before allow plenty of time (it took me 2 hours, mostly waiting to be called). It might be a good idea to bring along a friend or family member to help fill out the forms. In my case I was so nervous, I couldn't even remember my birthday!
Well needless to say I didn't get much sleep the night before, so it was no problem in meeting the 7:30 AM check-in time. Actually I got there around 7:00 as I remember. It turns out that was a wise decision in that, even though I had pre-registered the day before, there was yet more paperwork to be done.
Fortunately, admitting was a lot faster that registration (turns out it was smart to get that over with in advance). Here again, it is a good idea if you can have someone with your for moral support if nothing else. By this stage I was a nervous wreck.
Yet one more stop in the administrative paper trail. Fortunately this is the last. The ward nurse takes all of the paperwork heaped on you at Admitting, fastens your ID bracelet, and let's you know what's going to happen. I'm sure there was more, but by now I'm pretty much out of it; i.e. taking notes was the last thing on my mind.
The next step is to undress, put on your surgical gown and climb into bed. The aids then prepare you for surgery. They clean what needs cleaning and shave what needs shaving and, in general, take very good care you. These guys quickly became my best friends. Of course hospitals are very busy places and you don't see much of the doctors and nurses during this time. These guys are therefore your primary interface with the hospital; a job which they do extremely well.
Well the time finally came. Time to be put on the gurney and wheeled to the Cath Lab. Let me tell you this was the longest trip of my life. Even though I had spent almost a year researching Cardioversion and even though my cardiologist had explained the whole procedure to me in detail, at that moment I felt like I was being wheeled into oblivion; I was just plain scared.
Oddly enough, once in the Cath Lab and on the operating table, I started to feel more at ease. Perhaps I was just numb, or perhaps it was simply resignation; i.e. well I'm pretty much committed now, no sense worrying about it. Actually I completely forgot about what was about to happen and became engrossed in all the gadgets that surrounded me. As strange as it may sound, my most pressing worry at this point was what was I going to do if I had to go to the bathroom (fortunately I never had to find out).
Above me was the fluoroscope used by the doctor to follow the catheter as it is treaded toward the heart. To left was a cluster of CRT displays for the fluoroscope, EKG monitor, etc. Directly in front a glass cubical arrangement (which later I discovered is where a technician sits that monitors the instruments, controls the defibrillator, etc.). To the right was a large tray of instruments: scalpels, syringes, clamps and catheters.
[ In case your doctor didn't mention all this stuff to you, perhaps I should qualify the above. Apparently in many cases Cardioversion is done in the patients room and involves no more than the administering of a light general anesthetic, applying paddles to the chest and delivering the electric shock to the heart. In my case, it was a bit more complicated. I was outfitted with a temporary pacemaker, which required feeding a catheter with the electrodes through a small incision in a leg artery (in the groin) up into the heart. The doctor used the fluoroscope to follow the catheter's progress through the artery.]
OK, my jobs done. Somehow I've managed to make it this far, now it's the doctor's turn. As he goes to work, he explains each step of the process...
"You'll feel a slight pin prick ..." (medical-speak for I'm going to stick you with a sharp object) "... as I administer the local anesthetic". Actually I think there were several hypodermics used, but I didn't feel anything after the first one.
"Next, I'm going to make the incision for the catheter" (all I felt was a slight pulling of the skin, no pain what so ever). Lastly, he slid the catheter though the vein (from what I could see, it looked much like snaking a drain). Of course I couldn't see much since I was flat on the table. As he progressed he slid the fluoroscope along the rail to monitor his progress. The whole process seemed to happen very quickly.
Next step, the anesthesiologist (gas-passer) appears, introduces himself and goes right to work. He puts an oxygen mask on you, injects something into the IV and the said something about you may feel a little warmth...
The next thing I knew, he was gone, most of the surgical staff was gone, and my doctor told me it was all over. "All over? What's all over?" I had no idea what, if anything had just happened. I had no memory of going to sleep or waking up. No headache, no drowsiness', ... no nothing! I had absolutely no sensation of a single second passing between when the anesthesiologist said "... warmth" and when my doctor said "its all over". "That's it?" I asked myself. "I put myself through a year of misery because I was afraid of off that?"
Well needless to say the trip from the Cath Lab back to the room went a lot faster than the trip from the room to the Cath Lab. It was all over and I felt great (though admittedly a little, no make that a lot, foolish for putting it off as long as I did.
Well that's pretty much it. Once back in the room I had to lie still for a while with a small sandbag applying pressure to the area where the catheter incision was made (the catheter had been removed and the wound cauterized closed). I was also outfitted with a wireless EKG which allowed me to get out of bed and move around a bit after a couple of hours.
Not much more to say. After a couple more hours of monitoring and my assurance I felt fine I was allowed to go home. Just to be fair I should add that later that day I felt a little warmth where the electrodes were place; much like a mild sunburn. In addition, my chest muscles were a little sore. All-in-all less discomfort than you'd feel after a day of fun in the sun. No big deal (and this is coming from someone who cringes at the thought of removing a splinter from my finger).
Fortunately, the conclusion is the easiest part:
"Would I do it again if needed?" - "Yes, without hesitation."
"Did it hurt?" - "Just the pin prick, and that was less painful than taking your Protime test"
I'd say that pretty well sums it up. I let my fear (baseless as it turns out) cloud my good judgment, and as a result, have done permanent damage to my heart. I'd hate to see others make the same mistake, thus this web site. Of course, all I can tell you about is my personal experiences. Only you can decide what is right for you. It is my hope however that, after viewing this web site, you are better able to make that decision rationally, based on the facts at hand and simple good judgment. As the good doctor said to me: "Don't let your fear stand in the way of common sense!" Truer words were never spoken!