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Cardioversion question, and recommendation for specialist at Mass General?
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boston_guy_992@yahoo.com
medicine forum beginner


Joined: 06 Jul 2006
Posts: 7

PostPosted: Thu Jul 06, 2006 7:05 pm    Post subject: Cardioversion question, and recommendation for specialist at Mass General? Reply with quote

Hello: I will be getting a cardioversion done at MGH in Boston.

1. I assume it is one of the best hospitals for this type of treatment?
2. Can anyone recommend a good cardiologist who specializes in it?
3. I have Lone/Chronic AFib, and have probably been in it for 2
years....are my odds of success low? (i am in my 30s and have no other
risk factors... i dont even have symptoms).

Thanks for all your help
Frankly, i am terrified of this whole process.
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boston_guy_992@yahoo.com
medicine forum beginner


Joined: 06 Jul 2006
Posts: 7

PostPosted: Thu Jul 06, 2006 7:34 pm    Post subject: Re: Cardioversion question, and recommendation for specialist at Mass General? Reply with quote

boston_guy_992@yahoo.com wrote:
Quote:
3. I have Lone/Chronic AFib, and have probably been in it for 2
years....are my odds of success low? (i am in my 30s and have no other
risk factors... i dont even have symptoms).

One key piece of info....the the left atrium size is below the "cut-off
point", according the cardiologist i had last month.
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Edgar A Pearlstein
medicine forum beginner


Joined: 12 Jun 2005
Posts: 3

PostPosted: Thu Jul 06, 2006 7:49 pm    Post subject: Re: Cardioversion question, and recommendation for specialist at Mass General? Reply with quote

boston_guy_992@yahoo.com wrote:

: Frankly, i am terrified of this whole process.

Based on my experience, I would say there is nothing to be terrified
about. The only discomfort was boredom--I was being monitored for two
hours before the procedure and three hours after. So take plenty of
reading matter. One other piece of advice: If you have hair on your chest
or back, have the nurse shave it before the procedure, as the electrodes
are stuck on to the skin, and with hair there it would hurt when the
electrodes ar removed.
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boston_guy_992@yahoo.com
medicine forum beginner


Joined: 06 Jul 2006
Posts: 7

PostPosted: Thu Jul 06, 2006 7:52 pm    Post subject: Re: Cardioversion question, and recommendation for specialist at Mass General? Reply with quote

Edgar A Pearlstein wrote:
Quote:
Based on my experience, I would say there is nothing to be terrified
about. The only discomfort was boredom--I was being monitored for two
hours before the procedure and three hours after. So take plenty of
reading matter. One other piece of advice: If you have hair on your chest
or back, have the nurse shave it before the procedure, as the electrodes
are stuck on to the skin, and with hair there it would hurt when the
electrodes ar removed.

Thanks Edgar....i will shave and bring plenty of reading material Smile
Hope your procedure was a success.
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listener
medicine forum Guru


Joined: 05 May 2005
Posts: 617

PostPosted: Thu Jul 06, 2006 8:49 pm    Post subject: Re: Cardioversion question, and recommendation for specialist at Mass General? Reply with quote

boston_guy_992@yahoo.com wrote in news:1152212704.255825.131130
@j8g2000cwa.googlegroups.com:

Quote:
Hello: I will be getting a cardioversion done at MGH in Boston.

1. I assume it is one of the best hospitals for this type of treatment?
2. Can anyone recommend a good cardiologist who specializes in it?
3. I have Lone/Chronic AFib, and have probably been in it for 2
years....are my odds of success low? (i am in my 30s and have no other
risk factors... i dont even have symptoms).

Thanks for all your help
Frankly, i am terrified of this whole process.


Cardioversions are done all over and are fairly routine. They are
relatively quick and boring. They do usually restore normal sinus rhythm.
Staying in nsr is another matter.

Teminology can sometimes be confusing. To me Lone AF means from time to
time and self-converting whereas Chronic AF means in it all the time,
unable to self-convert. (To others they may mean something else.) If you've
had Lone for 2 years your chances of converting and maintaining are
probably good. If you've been Chronic for two years it could be trickier
because of remodeling.

There's no reason to be terrified. Anxious, yes, of course but it really is
a straightforward procedure.

L.
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boston_guy_992@yahoo.com
medicine forum beginner


Joined: 06 Jul 2006
Posts: 7

PostPosted: Thu Jul 06, 2006 9:11 pm    Post subject: Re: Cardioversion question, and recommendation for specialist at Mass General? Reply with quote

listener wrote:
Quote:
Teminology can sometimes be confusing. To me Lone AF means from time to
time and self-converting whereas Chronic AF means in it all the time,
unable to self-convert. (To others they may mean something else.) If you've
had Lone for 2 years your chances of converting and maintaining are
probably good. If you've been Chronic for two years it could be trickier
because of remodeling.

Thanks Listener...i appreciate the words of support. I thought Lone AF
just meant AF without signs of heart disease. And that there were 3
"subsets" of Lone AF - isolated, recurrent, and chronic.

In any event, my AFib is continuous ... the concern of the cardiologist
was that we dont know how long ive been in AFib, since i dont have
symptoms and havent seen a doc in years. Although 2 years ago, one of
those mobile clinics told me i did have an irregular heartbeat. That's
why i say i've had AFib for (at least) 2 years. I assume continuous
means the same as chronic.

According to him, the left atrium is sized normally.... does that mean
it's less likely there has been a lot of "remodeling" ? Thanks!
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John
medicine forum Guru Wannabe


Joined: 28 Apr 2005
Posts: 144

PostPosted: Thu Jul 06, 2006 10:16 pm    Post subject: Re: Cardioversion question, and recommendation for specialist at Mass General? Reply with quote

On 6 Jul 2006 14:11:54 -0700, boston_guy_992@yahoo.com wrote:

Quote:
listener wrote:
Teminology can sometimes be confusing. To me Lone AF means from time to
time and self-converting whereas Chronic AF means in it all the time,
unable to self-convert. (To others they may mean something else.) If you've
had Lone for 2 years your chances of converting and maintaining are
probably good. If you've been Chronic for two years it could be trickier
because of remodeling.

Thanks Listener...i appreciate the words of support. I thought Lone AF
just meant AF without signs of heart disease. And that there were 3
"subsets" of Lone AF - isolated, recurrent, and chronic.

Lone AF means even more than this, I believe. It means you have NO
other medical condition that sometimes causes AF, including such
things as a thyroid problem. Also, sometimes mitral valve prolapse or
other valve issues can cause AF. I was diagnosed with "lone AF", but
mine was paroxysmal (sort of). Paroxysmal means that it quits on its
own. Mine started out that way, but then I was prescribed Rythmol to
take when the AF started. It performed as a "chemical cardioversion"
and put me back into sinus rhythm, usually within about 3-4 hours and
never more than 12 hours. As long as I remained in sinus rhythm, I
didn't need to take the medication.

Quote:
In any event, my AFib is continuous ... the concern of the cardiologist
was that we dont know how long ive been in AFib, since i dont have
symptoms and havent seen a doc in years. Although 2 years ago, one of
those mobile clinics told me i did have an irregular heartbeat. That's
why i say i've had AFib for (at least) 2 years. I assume continuous
means the same as chronic.

Continuous means you have it all the time. Chronic might mean you
have it "most" of the time.

Quote:
According to him, the left atrium is sized normally.... does that mean
it's less likely there has been a lot of "remodeling" ? Thanks!

This is a good thing.

Hopefully, your heart will remain in sinus rhythm after your
cardioversion. If not, your cardiologist ought to suggest trying some
medications (such as Rythmol or Flecanide) to help maintain (or
restore) sinus rhythm. It's not unusual for these medications to work
well for a few years but then to gradually lose effectiveness. That's
what happened in my case. There are then invasive procedures such as
catheter ablations and surgical "maze" procedures that have pretty
good success at obtaining a cure. I had a so called "mini-maze"
procedure a year ago which has apparently cured me in that I've had no
AF at all since the procedure. You can't beat that!

Your docs also might want you to be on Coumadin to reduce the chance
of suffering a stroke. While in AF, blood tends to form clots in the
left atrial appendage, a little bag of useless tissue on the left
atrium, and these clots may become dislodged and travel to the brain
causing a stroke. Depending on whether you or not you engage in
active sports or motorcycling, etc, which have a chance of sustaining
trauma, you may want to be careful with coumadin as it can cause brain
bleeding to occur which may well be worse than a stroke. The AHA
guidelines for coumadin recommend it for people over 65 but some
doctors seem to enthusiastically recommend it for everyone suffering
AF. In my case, I avoided using it because I'm an active skier, fly
aerobatic airplanes and ride motorcycles. Also, I was always able to
immediately detect when AF started and Rythmol stopped it quickly, not
given blood clots much chance to form.

You might take a look at
http://health.groups.yahoo.com/group/AFIBsupport/. This discussion
group focuses on AF. Lots of activity and all of it "on topic".

You'll be in my prayers.

Blessings,
John
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nospam7@heartmdphd.com
medicine forum Guru


Joined: 27 Dec 2005
Posts: 470

PostPosted: Thu Jul 06, 2006 10:30 pm    Post subject: Re: Cardioversion question, and recommendation for specialist at Mass General? Reply with quote

boston_guy_992@yahoo.com wrote:
Quote:
listener wrote:
Teminology can sometimes be confusing. To me Lone AF means from time to
time and self-converting whereas Chronic AF means in it all the time,
unable to self-convert. (To others they may mean something else.) If you've
had Lone for 2 years your chances of converting and maintaining are
probably good. If you've been Chronic for two years it could be trickier
because of remodeling.

Thanks Listener...i appreciate the words of support. I thought Lone AF
just meant AF without signs of heart disease. And that there were 3
"subsets" of Lone AF - isolated, recurrent, and chronic.

Lone atrial fibrillation does mean atrial fibrillation without any
evidence of any other contributing factors (alcohol or thyroid disease
for example) especially structural heart disease.

Quote:
In any event, my AFib is continuous ... the concern of the cardiologist
was that we dont know how long ive been in AFib, since i dont have
symptoms and havent seen a doc in years. Although 2 years ago, one of
those mobile clinics told me i did have an irregular heartbeat. That's
why i say i've had AFib for (at least) 2 years. I assume continuous
means the same as chronic.

According to him, the left atrium is sized normally.... does that mean
it's less likely there has been a lot of "remodeling" ?

No. The "remodeling" is electrophysiological rather than
physical/anatomical.

Quote:
Thanks!

You are welcome.

All thanks and praises belong to GOD, Whom I love with all my heart,
soul, mind, and strength.

Prayerfully in Christ's amazing love,

Andrew B. Chung
Cardiologist, Atlanta, Georgia, USA
http://HeartMDPhD.com/TheLife
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listener
medicine forum Guru


Joined: 05 May 2005
Posts: 617

PostPosted: Thu Jul 06, 2006 10:33 pm    Post subject: Re: Cardioversion question, and recommendation for specialist at Mass General? Reply with quote

boston_guy_992@yahoo.com wrote in news:1152220314.319414.156240
@p79g2000cwp.googlegroups.com:

Quote:
listener wrote:
Teminology can sometimes be confusing. To me Lone AF means from time to
time and self-converting whereas Chronic AF means in it all the time,
unable to self-convert. (To others they may mean something else.) If
you've
had Lone for 2 years your chances of converting and maintaining are
probably good. If you've been Chronic for two years it could be trickier
because of remodeling.

Thanks Listener...i appreciate the words of support. I thought Lone AF
just meant AF without signs of heart disease. And that there were 3
"subsets" of Lone AF - isolated, recurrent, and chronic.

In any event, my AFib is continuous ... the concern of the cardiologist
was that we dont know how long ive been in AFib, since i dont have
symptoms and havent seen a doc in years. Although 2 years ago, one of
those mobile clinics told me i did have an irregular heartbeat. That's
why i say i've had AFib for (at least) 2 years. I assume continuous
means the same as chronic.

According to him, the left atrium is sized normally.... does that mean
it's less likely there has been a lot of "remodeling" ? Thanks!



Why don't you head over to the moderated Yahoo Support Group for afib:

http://health.groups.yahoo.com/group/AFIBsupport/

There are a lot of good people there (now over 2700 members!), including
myself (under a different moniker of course). Post a message introducing
yourself and your situation and you're bound to get some good information
and support.

L.
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boston_guy_992@yahoo.com
medicine forum beginner


Joined: 06 Jul 2006
Posts: 7

PostPosted: Thu Jul 06, 2006 11:23 pm    Post subject: Re: Cardioversion question, and recommendation for specialist at Mass General? Reply with quote

John wrote:
Quote:
Continuous means you have it all the time. Chronic might mean you
have it "most" of the time.

According to him, the left atrium is sized normally.... does that mean
it's less likely there has been a lot of "remodeling" ? Thanks!

This is a good thing.

Hopefully, your heart will remain in sinus rhythm after your
cardioversion. If not, your cardiologist ought to suggest trying some
medications (such as Rythmol or Flecanide) to help maintain (or
restore) sinus rhythm. It's not unusual for these medications to work
well for a few years but then to gradually lose effectiveness. That's
what happened in my case. There are then invasive procedures such as
catheter ablations and surgical "maze" procedures that have pretty
good success at obtaining a cure. I had a so called "mini-maze"
procedure a year ago which has apparently cured me in that I've had no
AF at all since the procedure. You can't beat that!

I've heard of this... thanks for the tip.... i will look into it some
more.

Quote:
Your docs also might want you to be on Coumadin to reduce the chance
of suffering a stroke. While in AF, blood tends to form clots in the
left atrial appendage, a little bag of useless tissue on the left
atrium, and these clots may become dislodged and travel to the brain
causing a stroke. Depending on whether you or not you engage in
active sports or motorcycling, etc, which have a chance of sustaining
trauma, you may want to be careful with coumadin as it can cause brain
bleeding to occur which may well be worse than a stroke. The AHA
guidelines for coumadin recommend it for people over 65 but some
doctors seem to enthusiastically recommend it for everyone suffering
AF. In my case, I avoided using it because I'm an active skier, fly
aerobatic airplanes and ride motorcycles. Also, I was always able to
immediately detect when AF started and Rythmol stopped it quickly, not
given blood clots much chance to form.

You might take a look at
http://health.groups.yahoo.com/group/AFIBsupport/. This discussion
group focuses on AF. Lots of activity and all of it "on topic".

You'll be in my prayers.

Blessings,
John

Thank You John. I appreciate the kind words and the info. This is all
new to me, and to be honest, ive had very bad experiences with doctors,
so i'm researching things pretty thoroughly. Again, thanks!
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boston_guy_992@yahoo.com
medicine forum beginner


Joined: 06 Jul 2006
Posts: 7

PostPosted: Thu Jul 06, 2006 11:34 pm    Post subject: Re: Cardioversion question, and recommendation for specialist at Mass General? Reply with quote

Andrew B. Chung, MD/PhD wrote:
Quote:
According to him, the left atrium is sized normally.... does that mean
it's less likely there has been a lot of "remodeling" ?

No. The "remodeling" is electrophysiological rather than
physical/anatomical.

Andrew - i am confused. This site seems to say there are 5 physical
factors. Can you please explain? (this is not a flame - I've read, and
respect your advice in this newsgroup, and am interested in your
views):

http://www.a-fib.com/BostonA-FibSymposium2006.htm#WilberLeftAtrialRemodeling

Dr. Wilber's presentation focused on the structural and mechanical
changes that affect the heart in A-Fib, and whether any of these
remodeling effects can be reversed by eliminating patients' A-Fib.
Some of the remodeling effects associated with A-Fib are:
a) Increased left atrial size
b) Decreased left atrial contractual and reservoir function
(reservoir function refers to the capacity of the left atrium to expand
and accept blood flow)
c) Pulmonary Vein expansion
d) Atrial fibrosis (the formation of fibrous tissue) and scarring
e) Increase in Left Ventricle size, decrease in LV Systolic and
Diastolic function.
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Andrew B. Chung, MD/PhD
medicine forum Guru


Joined: 25 Mar 2005
Posts: 8540

PostPosted: Fri Jul 07, 2006 12:37 am    Post subject: Re: Cardioversion question, and recommendation for specialist at Mass General? Reply with quote

boston_guy_992@yahoo.com wrote:
Quote:
Andrew B. Chung, MD/PhD wrote:
According to him, the left atrium is sized normally.... does that mean
it's less likely there has been a lot of "remodeling" ?

No. The "remodeling" is electrophysiological rather than
physical/anatomical.

Andrew - i am confused. This site seems to say there are 5 physical
factors. Can you please explain? (this is not a flame - I've read, and
respect your advice in this newsgroup, and am interested in your
views):

http://www.a-fib.com/BostonA-FibSymposium2006.htm#WilberLeftAtrialRemodeling

Dr. Wilber's presentation focused on the structural and mechanical
changes that affect the heart in A-Fib, and whether any of these
remodeling effects can be reversed by eliminating patients' A-Fib.
Some of the remodeling effects associated with A-Fib are:
a) Increased left atrial size
b) Decreased left atrial contractual and reservoir function
(reservoir function refers to the capacity of the left atrium to expand
and accept blood flow)
c) Pulmonary Vein expansion
d) Atrial fibrosis (the formation of fibrous tissue) and scarring
e) Increase in Left Ventricle size, decrease in LV Systolic and
Diastolic function.

It is clear from Dr. Wilber's presentation that he recognizes that
there is a disconnect between the structural and mechanical changes
that arises with chronic atrial fibrillation and whether the heart will
remain in sinus rhythm after cardioversion. The example cited of the
left atrium remaining structurally abnormal after an invasive MAZE
procedure "curing" atrial fibrillation draws the distinction between
the two kinds of remodeling.

IOW, the remodeling behind lone atrial fibrillation that makes AF
chronic is electrophysiological and not structural/mechanical.

Prayerfully in Christ's amazing love,

Andrew B. Chung
Cardiologist, Atlanta, Georgia, USA
http://HeartMDPhD.com/TheLife
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boston_guy_992@yahoo.com
medicine forum beginner


Joined: 06 Jul 2006
Posts: 7

PostPosted: Fri Jul 07, 2006 2:39 am    Post subject: Re: Cardioversion question, and recommendation for specialist at Mass General? Reply with quote

Andrew B. Chung, MD/PhD wrote:
Quote:
It is clear from Dr. Wilber's presentation that he recognizes that
there is a disconnect between the structural and mechanical changes
that arises with chronic atrial fibrillation and whether the heart will
remain in sinus rhythm after cardioversion. The example cited of the
left atrium remaining structurally abnormal after an invasive MAZE
procedure "curing" atrial fibrillation draws the distinction between
the two kinds of remodeling.

IOW, the remodeling behind lone atrial fibrillation that makes AF
chronic is electrophysiological and not structural/mechanical.

Ok...but i am wondering why my cardiologist said that if my left
atrium's size is below the "cut-off point", cardioversion is more
likely
to be successful?

If not, is there anything i can do to mitigate the electrophysiological
remodeling that may have occurred? (e.g. i've heard that vit C
mitigates
the heart's propensity to "remodel") Can remodeling be measured?

Thank you and God bless
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Andrew B. Chung, MD/PhD
medicine forum Guru


Joined: 25 Mar 2005
Posts: 8540

PostPosted: Fri Jul 07, 2006 5:33 am    Post subject: Re: Cardioversion question, and recommendation for specialist at Mass General? Reply with quote

boston_guy_992@yahoo.com wrote:
Quote:
Andrew B. Chung, MD/PhD wrote:
It is clear from Dr. Wilber's presentation that he recognizes that
there is a disconnect between the structural and mechanical changes
that arises with chronic atrial fibrillation and whether the heart will
remain in sinus rhythm after cardioversion. The example cited of the
left atrium remaining structurally abnormal after an invasive MAZE
procedure "curing" atrial fibrillation draws the distinction between
the two kinds of remodeling.

IOW, the remodeling behind lone atrial fibrillation that makes AF
chronic is electrophysiological and not structural/mechanical.

Ok...but i am wondering why my cardiologist said that if my left
atrium's size is below the "cut-off point", cardioversion is more
likely
to be successful?

An enlarged left atrium is a structural abnormality that is associated
with decreased likelihood of successful cardioversion.

Quote:
If not, is there anything i can do to mitigate the electrophysiological
remodeling that may have occurred? (e.g. i've heard that vit C
mitigates
the heart's propensity to "remodel") Can remodeling be measured?

No.

Quote:
Thank you and God bless

You are welcome :-)

Prayerfully in Christ's amazing love,

Andrew
http://HeartMDPhD.com/TheLife
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Nel
medicine forum beginner


Joined: 24 Mar 2005
Posts: 30

PostPosted: Sun Jul 09, 2006 10:02 pm    Post subject: Re: Cardioversion question, and recommendation for specialist at Mass General? Reply with quote

Hi,
I have Afib and have had it for 7 years. I've also had 6 cardioversions.
Not much to it. I do get nervous but I'm that way..You won't even know
anything..My cardio does mine and I wouldn't want anyone else.
It always puts me back in SR. Seems the only way I convert. I stay in the
hospital trying but I end up having a cardioversion ....take care...Nel
"



Quote:
unable to self-convert. (To others they may mean something else.) If
you've
had Lone for 2 years your chances of converting and maintaining are
probably good. If you've been Chronic for two years it could be trickier
because of remodeling.

Thanks Listener...i appreciate the words of support. I thought Lone AF
just meant AF without signs of heart disease. And that there were 3
"subsets" of Lone AF - isolated, recurrent, and chronic.

In any event, my AFib is continuous ... the concern of the cardiologist
was that we dont know how long ive been in AFib, since i dont have
symptoms and havent seen a doc in years. Although 2 years ago, one of
those mobile clinics told me i did have an irregular heartbeat. That's
why i say i've had AFib for (at least) 2 years. I assume continuous
means the same as chronic.

According to him, the left atrium is sized normally.... does that mean
it's less likely there has been a lot of "remodeling" ? Thanks!



Why don't you head over to the moderated Yahoo Support Group for afib:

http://health.groups.yahoo.com/group/AFIBsupport/

There are a lot of good people there (now over 2700 members!), including
myself (under a different moniker of course). Post a message introducing
yourself and your situation and you're bound to get some good information
and support.

L.
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