Medical Question

[FJRay]

Anybody out there been through this and if so whats it like??? I am scheduled for this Friday and was wondering what to expect. I am told it is safe and efective but the doctors get paid to tell you that.

 

[bikerskier]

No clue, but good luck with. Can I have your bike if.....

 

[FJRay]

No clue, but good luck with. Can I have your bike if.....

If in one hand and **** in the other one and see which one fills up. You wouldn't want a dirty old 03 anyway.

Thanks for the support.

 

[vandy]

Maybe we don't know the procedure by name.. describe it please

 

[FJRay]

Maybe we don't know the procedure by name.. describe it please

I have Atrial Fibrillation. Also known as congestive heart failure. That means that the heart isn't beating with a normal rythm and makes you more likely for a stroke or heart attack. The procedure momentarily stops the heart and when it is restarted it is supposed to maintain normal rythm. It is a short outpaitient procedure and then they send me home. From what I understand there are millions of people with this condition and some just live with it.

I deal with the VA for medical and they want to fix it so that is fine with me. If it doesn't work then I guess I get to live with it.

 

[xharleyrider]

Maybe we don't know the procedure by name.. describe it please

I have Atrial Fibrillation. Also known as congestive heart failure. That means that the heart isn't beating with a normal rythm and makes you more likely for a stroke or heart attack. The procedure momentarily stops the heart and when it is restarted it is supposed to maintain normal rythm. It is a short outpaitient procedure and then they send me home. From what I understand there are millions of people with this condition and some just live with it.

I deal with the VA for medical and they want to fix it so that is fine with me. If it doesn't work then I guess I get to live with it.

You should not feel any pain! They are going to sedate you first (conscience sediation ) then they are going to add the Defibulator paddles or pads to your chest and give you a low voltage shock. That should convert you to normal sinus rhythm. If not they will increase the voltage and try again until converted.

I use to work in the ICU. Seen it a million times. If that does not work, they may consider an internal defibulator. Good luck! FYI, atrial fibulation and congestive faliture are two different heart problems.

 

[docsulivan]

You should not feel any pain! They are going to sedate you first (conscience sediation ) then they are going to add the Defibulator paddles or pads to your chest and give you a low voltage shock. That should convert you to normal sinus rhythm. If not they will increase the voltage and try again until converted.

I use to work in the ICU. Seen it a million times. If that does not work, they may consider an internal defibulator. Good luck! FYI, atrial fibulation and congestive faliture are two different heart problems.

1+ As noted, they will sedate you, likely give you a med caled versed, which also has retrograde amnestic properties. Which means you likely won't even remember the cardioversion event even if you have some discomfort. Hopefully they have figured out what is causing your A-fib - possibly a dilated "floppy" upper chamber of the heart? I would guess you are already on a blood thinner (coumadin) to prevent clot formation. If so, you likely shouldn't be riding while on it as you will be at a higher risk for internal bleeding or bleeding in the brain if you have an accident or fall. Talk to your doctor about any riding. You probably need other rate controlling meds as well.

 

[vandy]

Ok now I recognize the procedure..

One of the people I work with had that done.

No complications and no missed work if i remember right.

Straight forward and pretty safe.

 

[DE OPPRESSO LIBER]

I'm an ER/ICU/OR nurse so, have seen it/done it a ton. You will be started off by getting an IV, being placed on oxygen, a monitor to measure your heart/oxygen/blood pressure. You will get Versed to relax you like Valium with the added benefit of having you not recall the procedure even if you experience any discomfort during the procedure as well as Fentanyl, a powerful narcotic that is short acting but very effective (If they do it right !!

When they feel you are sedated properly, they will defibrilate you at the lowest setting and see if you convert back to a normal rhythm. If not, they'll turn up the dial just a bit and repeat. The good news is that nowadays, they have gone to better technology that requires less energy (joules) by delivering it in a biphasic shock insted of mono. You should be reassured that this procedure is 'relatively' safe and is done probably tens of thousands of times each year with good results. Your cardiologist should explain all of the procedure to you along with the possible risks, outcomes, and benefits. There are no guarantees that the procedure will work or that if it does, that the problem will not recur. If possible, they should attempt to identify any possible causes that can be treated to prevent it from happening again.

You should talk to your doctor about congestive heart failure and the difference between it and A-fib. You can develop similar symptoms of CHF if your Afib is not controlled.

This response is only opinion based on my experience and is NOT intended to serve as legal medical advice for you since I have no medical information regarding your specific case. Good luck, hope it all works out well for you.

P.S. Let us know what it's like getting juiced "just in case" those meds don't work!! just joking, you'll do fine. Hopefully there are a few people here who have firsthand knowledge to support this and tell you it's nothing to worry about. Good luck.

 

[Docholiday]

1+ As noted, they will sedate you, likely give you a med caled versed, which also has retrograde amnestic properties. Which means you likely won't even remember the cardioversion event even if you have some discomfort. Hopefully they have figured out what is causing your A-fib - possibly a dilated "floppy" upper chamber of the heart? I would guess you are already on a blood thinner (coumadin) to prevent clot formation. If so, you likely shouldn't be riding while on it as you will be at a higher risk for internal bleeding or bleeding in the brain if you have an accident or fall. Talk to your doctor about any riding. You probably need other rate controlling meds as well.

Agree with Docsullivan. Procedure has been around for a long time and is usually performed under some type of sedation. It is usually but not always successful. The bigger question is why you have the problem in the first place and what are your docs going to do to keep it from coming back. A Fib does increase your risk for strokes and blood clots if you are not on a blood thinner like coumadin. The coumadin makes crashes on the bike much more serious. Don't be afraid to ask your doctor questions. Don't forget to mention riding the bike in your discussions.

 

[FJR_pig]

Good luck, Ray. Let us know you're feelin' okay when you get back home.

El Piggo

 

[bikerskier]

Yeah, Ray, I was just kidding about wanting your bike.... I really want your pickup. Listen, if some guy comes in snapping a rubber glove on his hand, you need to stay clear headed enough to tell him that he wants the guy in the next room.

 

[FJR_pig]

Listen, if some guy named Ponyfool comes in snapping a rubber glove on his hand, you need to stay clear headed enough to tell him that he wants the guy in the next room named Ralph.

Fixed it for you.

 

[FJRay]

As usual there is a wealth of knowlege and no lack of humor here on the forum. I will update Friday afternoon and I won't worry about Ponyfool unless he has rubber gloves and handcuffs.

 

[BobbyBlue]

Versed gooood...Coumadin Baaaaad. Its a routine thing Ray and electrical heart problems are corrected relatively easily these days. Worst case is getting a pacer/defib...I've had mine for 4 years and I spank the chit outa my FJR as often as possible. Everything IS possible brother, approach life like every day it is your last, one day you'll even get to be right ! Stay well and give us an update. Sounds like you are in excellent hands and stay positive...its easier on the batteries :clapping: !!!

Blessed ( and Ballistic ),

Bobby

 

[Silver Penguin]

I'm an ER/ICU/OR nurse so, have seen it/done it a ton. You will be started off by getting an IV, being placed on oxygen, a monitor to measure your heart/oxygen/blood pressure. You will get Versed to relax you like Valium with the added benefit of having you not recall the procedure even if you experience any discomfort during the procedure as well as Fentanyl, a powerful narcotic that is short acting but very effective (If they do it right !!When they feel you are sedated properly, they will defibrilate you at the lowest setting and see if you convert back to a normal rhythm. If not, they'll turn up the dial just a bit and repeat. The good news is that nowadays, they have gone to better technology that requires less energy (joules) by delivering it in a biphasic shock insted of mono. You should be reassured that this procedure is 'relatively' safe and is done probably tens of thousands of times each year with good results. Your cardiologist should explain all of the procedure to you along with the possible risks, outcomes, and benefits. There are no guarantees that the procedure will work or that if it does, that the problem will not recur. If possible, they should attempt to identify any possible causes that can be treated to

Seconded, by another ICU nurse. I've seen this done many times to young adults, kids and even little babies. The Versed/Fentanyl goes into the IV. You go away to a happy place. The team does the procedure. You open your eyes and ask if they are going to get started soon. (They're already done). Then you go back to your happy place and sleep there for a while before going home to take a nap.

Wishing you well. Let us know how it goes.

Jill

 

[bikerskier]

I worry about Mr. Pig. I think he really wants to be in the next room listening for the snapping sound.

 

[FJR_pig]

I worry about Mr. Pig. I think he really wants to be in the next room listening for the snapping sound.

Oh, snap! It occurred to me that I shouldn't lay too many funnies down here as Ray has a bad ticker. Sorry Ray! I'm all business from here on out...

 

[BrunDog]

Ray,

There are some solid points here. To clarify and add my 2 cents:

Atrial Fibrillation and CHF are technically two distinct conditions, yet one tends to precipitate/exacerbate the other. A-Fib is a dysrrhythmia of the "top" part of your heart, where your natural pacemaker is being overdriven by many multiple "backup pacemaker" sites. It is a very common condition, afflicting a good portion of the elderly population. It can drive people nuts because it will often cause a high and/or erratic heart rate. The erratic rate is especially annoying because your heart squeezes with varying amounts of blood in it - one beat is fine, the next is quick and the heart is "empty", the next is "full" again, etc.

The main concern of a-fib is that there is a significant risk of a embolic stroke if you are not anti-coagulated. This occurs because blood pools in the atria, expecially the left appendage, and clots using it's natural system. That clot can break free, then bad things happen. Anti-coagulation must be Warfarin (Coumadin), which is a slightly tricky med to manage, because it requires regular evaluation of its efficacy: too little and it is not therapeutic, too much and you risk internal bleeding. Management requires compliance: office visits, administering on schedule, and dietary interactions. As far as I know, there are no acceptable substitutes. Aspirin and Plavix are sometimes surrogates but I do not think they provide the same level of protection. If you are not persistently in a-fib, your doctor may allow you to come off the coumadin - but I think that is not easily agreed to. Better safe than sorry in their mind.

As far as treatment is concerned - there are several approaches, and different doctors will have varying levels of aggressive or conservative treament plans. The cardioversion is as described above, though in my experience they may not mess around with lower energy deliveries - one 360 Joule shock often does the trick. Multiple deliveries can leave the skin under the pads a little "burnt". One thing that was not mentioned, was before they cardiovert you, depending on how long you have been in the dysrrhythmia, they will likely perform a TEE - Trans-Esophogeal Echocardiogram. This is a sonography probe that they put down your esophogus, which runs right behind the heart, to look for any clots. The clots must be dissolved before cardioversion - normal sinus rhythm could break any clots loose. Again, coumadin is the fix here.

Another common frontline therapy are anti-arrhythmic medications, like Amiodarone, but these are high-powered drugs with their own potential serious side effects.

The possibility is reasonable that after the cardioversion, you will end up back in a-fib again in the future. If it becomes habitual, another possible therapy that is becoming more common, depending on your age and other risk factors, is an Atrial Fibrillation Ablation. This is a somewhat complex procedure that can be done surgically, or more likely, via catheters. There have been many advances in this treatment recently, but you will find that only a subset of skilled cardiac electrophysiologists perform these procedures.

Having atrial fibrillation does not necessarily mean you need an internal pacemaker or defibrillator. First, having paroxysmal (on and off briefly) or persistent (on for longer periods) a-fib alone does not indicate you for a defibrillator at all. And you would only be indicated for a pacemaker if your heart rate were slow and it made you dizzy, even as a result of medication (beta blockers, which I will bet you are on, etc.) or your heart rate did not increase with exertion. If they could not control your rate and/or rhythm, they may opt for an Atrioventricular Node Ablation and pacemaker implant. This effectively breaks the communication channel between your natural pacemaker(s) and the pumping part of your heart (ventricles), and replaces it with an artificial pacemaker, which could be either a standard or bi-ventricular device (which has two lead wires implanted in the bottom part of your heart). At that point, the rate would be very regular and controlled. Again, this is after other attempts at management have not yielded acceptable results.

CHF (Congestive Heart Failure) is a bucket of symptoms related to poor heart pumping performance. Fluid tends to build on either side of the heart's periphery due to its inefficiency. Unfortunately, this condition, inadequately managed, can be a downward spiral. The body's own self defense system can actually worsen the condition in the long term. Having a-fib can make CHF worse, too, and it is common for CHF patients to be in chronic a-fib. CHF should be medically managed with several cornerstone medications. If your CHF is in advanced stages (does not sound like it), you could be indicated for a bi-ventricular pacemaker or defibrillator mentioned above. If you have structural heart disease, either by ischemic (heart attack) or non-ischemic (hypertension, viral effects, etc) affect, it is critically important to try to manage it and halt the progression of the condition.

A quick look at your profile revealed you are < 60 yrs old. These are fairly serious conditions at that age in my opinion. My guess is you probably had a heart attack or two along the way. Do what you can to take care of yourself now. Listen intently to your doctors and ask a lot of questions. Do not settle for anything short of careful management - you want to ride that '03 into the gound before you go yourself!

Anyhow, sorry to ramble on - I would not sweat the procedure. It is low risk and you will do great. I wish you the best - let me know if I can answer any questions at all.

-BD