HomeAnswersCardiologyelectrical cardioversionI suffer from atrial fibrillation. Will cardioversion be detrimental if one is in sinus rhythm?

Is cardioversion a high risk procedure for atrial fibrillation patients?

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The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.

Medically reviewed by

Dr. K. Shobana

Published At June 2, 2023
Reviewed AtSeptember 14, 2023

Patient's Query

Hello doctor,

I have been on Atenolol 50 milligrams twice daily to treat atrial fibrillation for the past few days. But when I drank a glass of cold water, it appeared to trigger atrial fibrillation. Why so? Also, will cardioversion be detrimental if one is in sinus rhythm? Please help.

Thanks.

Hello,

Welcome to icliniq.com.

I understand your concern.

Cardioversion will not be more detrimental if one is in sinus rhythm, but its benefits are doubtful. Cardioversion is for conversion to sinus rhythm but will not help significantly maintain atrial fibrillation. Maintenance will depend on medications or ablation. Antiarrhythmics need to be adjusted, and Atenolol is for rate control and has minimal effect on rhythm control. Vagal stimulation, like drinking cold water, tends to precipitate atrial fibrillation in your case. You can consider ablation if you do not want to stay on medications and anticoagulants.

I hope this information will help you.

Thanks.

Patient's Query

Hello doctor,

Thanks for the reply.

It appears my atrial fibrillation episodes are becoming fewer. I have a blood blister on one of my toes. I have lost weight, and my stress levels have also increased. Please help.

Thanks.

Hello,

Welcome back to icliniq.com.

I understand your concern.

Since your atrial fibrillation recurred, it caused an increase in your stress levels. Besides, undergoing ablation or being on antiarrhythmics does not guarantee that thrombotic and embolic complications will not occur. Because short spells of atrial fibrillation still may occur and may lead to the formation of blood clots.

I hope this information will help you.

Thanks.

Patient's Query

Hello doctor,

Thank you for the response.

My frequency of atrial fibrillation is decreasing; however, when atrial fibrillation occurs, my pulse is in the low 80s. But when I am not in atrial fibrillation, my pulse dips into the low to mid-40s. I do not have any apparent symptoms, but yesterday I did not take 50 mg of Atenolol. I took 50 mg plus 25 mg. Today, my pulse is 50 beats per minute late at night. Hence, I will only be taking 50 mg. My thyroid hormones are almost normal. I remain at 50 mg of Flecainide. If I do not remain in persistent atrial fibrillation, I shall skip the cardioconversion. However, I shall now consider ablation if I can find an electrophysiologist in this stressed land. I do hope my atrial fibrillation will diminish further. I have lost 25 lbs and will still aim for another 15 lbs. Also, can too slow of a pulse, caused by the level of beta-blocker being too much, cause an irregular rhythm on the other spectrum? I woke up with an atrial fibrillation pulse of 83 beats per minute. I will try to balance this with 50 mg plus 25 mg of Atenolol. But there were still events even with the 50 mg plus 50 mg. As you might recall, I had briefly taken 50 mg of Flecainide four times daily, and atrial fibrillation persisted. That was still at a much higher thyroid hormone level. The cardiologist became all dramatic, though. My only symptom is interference with sleep. Please help.

Thank you.

Hello,

Welcome back to icliniq.com.

I understand your concern.

As the heart rate decreases, the risk of atrial fibrillation increases slightly. However, bradycardia-induced atrial fibrillation is less predominant in your case than Atenolol-induced atrial fibrillation suppression, as you had atrial fibrillation recurrence this morning when you reduced the beta blockers dose. Although you had no symptoms during bradycardia, I suggest reducing the beta blockers dose and increasing the Flecainide dose. However, it would help if you followed the advice of a treating cardiologist. Reducing the amount of the beta blocker alone may lead to atrial fibrillation recurrence.

I hope this information will help you.

Thanks.

Patient's Query

Hi doctor,

Thanks for the reply.

My atrial fibrillation has been in remission now for about six weeks. The Atenolol was weaned from 100 mg to 25 mg by my cardiologist. As my pulse continued to drop in the 40s, I reduced the Atenolol to 12.5 mg daily and still 50 mg Flecainide. My pulse is in 50 to 60s now. I have gone from a hyperthyroid state to what appears now floating into a hypothyroid condition. Both my t3 and t4 are in the acceptable low range limit, but my TSH has increased in those two weeks from .49 to 5.63 mIU/L. I have a 70 percent chance that I have permanent damage to the thyroid and will need indefinite supplements.

I hope this information will help you.

Thanks.

Hello,

Welcome back to icliniq.com.

I understand your concern.

You may continue with Atenolol 25 mg as 12.5 mg is too low to have any significant effect, especially if you are asymptomatic. External thyroid supplements are not given until TSH (thyroid stimulating hormone) goes above 10 mIU/mL unless one is symptomatic. The exact course will take time.

I hope this information will help you.

Thanks.

Same symptoms don't mean you have the same problem. Consult a doctor now!

Dr. Sagar Ramesh Makode
Dr. Sagar Ramesh Makode

Cardiology

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