Ray: They should have you on a thinner for a few weeks. With Pradaxa they don't monitor it, with Coumadin, I would think they would check it before the procedure and check for clots using some method...

Consider TEE Before Cardioversion of AF

Anticoagulation with warfarin is recommended for 3 weeks before and for 4 weeks after cardioversion of atrial fibrillation (AF) because of increased stroke risk. An alternative strategy is pre-cardioversion transesophageal echocardiography (TEE) to screen for left atrial thrombi, and then 4 weeks of post-cardioversion anticoagulation. In this prospective, multicenter trial, investigators randomized 1222 patients with AF of at least 2 days' duration to either a conventional or a TEE-guided anticoagulation strategy.

Thrombi were detected in 13.8 percent of TEE-guided patients. Rates of the composite endpoint of cerebrovascular accident, transient ischemic attack, or peripheral embolism within 8 weeks of cardioversion were similar in the 2 groups: TEE-guided, 0.8 percent; conventional, 0.5 percent. The 8-week incidence of hemorrhagic events was significantly lower in the TEE-guided group (2.9 percent vs. 5.5 percent). In addition, initial restoration of sinus rhythm was significantly more common among TEE-guided patients (71.1 percent vs. 65.2 percent). However, at 8 weeks, the 2 groups did not differ significantly in mortality incidence (TEE-guided, 2.4 percent; conventional, 1.0 percent) or in maintenance of sinus rhythm (52.7 percent vs. 50.4 percent, respectively).

Comment: These data show that the incidence of thromboembolic complications after cardioversion of AF is similar with a conventional versus a TEE-guided anticoagulation strategy. The potential advantages of the TEE-guided approach -- including shorter time to cardioversion, higher acute cardioversion rate, and lower risk for hemorrhagic complications -- must be weighed against the discomfort, cost, and inconvenience associated with it and against its lack of improvement over the conventional approach in long-term maintenance of sinus rhythm. The low efficacy rate of cardioversion in both groups likely reflects that defibrillators with biphasic waveforms were unavailable at the time of this study.




peteycap

RAY, I've had 6 cardioversions and no one would touch me until I had three weeks of good INRs. It's too risky. Like Petey said it's always followed by 4 weeks of anticoagulation. Don't worry about being hard on him, it's your life and you owe it to yourself to protect yourself as much as possible.

thanks i think i will change my doc he doesnt know my inr numbers just pushing me to get cardioverted.i am on warafin for one year now ,

For paroxsysmal a-fib the risk of clotting goes up after 24-48 hours in a-fib. In the early hours, the risk is much lower. For me, they gave me heparin within the first 24 hours as an anti-coagulant and were planning to do a TEE the next AM to check for clotting prior to the cardioversion. I was lucky and my a-fib self terminated just prior to getting the TEE so I got to skip the whole unpleasant business.
I think that the anti-coagulation approach for cardioversion would be based upon the type of a-fib and duration of your problem.

If you have rare episodes of paroxysmal a-fib, and you know for sure when the Afib episode started, you may consider to do the cardioversion ASAP. Last time I had an episode I was cardioverted within 9 hours, with only a shot of Lovenox and no TEE, although I am only on aspirin.
The problem with waiting many weeks is that you are in afib all this time (unless the afib goes away by itself). This may establish more permanent bad electrical circuits in your heart.
If you have possibly been in Afib more than 24 hours, consider the possibility of a TEE, followed immediately by cardioversion, should the TEE be OK. Keep in mind I am a Afib bozo, but that's the advice of my cardiologist for rare paroxysmal Afib: try to get back in sinus ASAP.

what is a tee , i was diagonesed with a fib in 2011 and i am on rate control med and also on coumedin ,i go for my regular inr check and it is always between 2 and 3 .

i seldom feel anything , once ina while i will feel quivering when i sleep on my left side .other then that not a thing .
i am not getting staright answeres from doc,one says i should go for ablation asap.i see no need since i am also now diabetic.and that to me is a bigger concern.I am still trying to find a doc who can take his time to tell me the right procedure.The doctor who wanted to cardiovert me didnt even ask me regarding my INR .his only question was if i have done a test for heartfailure i guess it is called some kind of hart ultra sound ,THAT WAS NEGATIVE since the guy said he sees no blockage on the atreries.I feel fine being on amoldipine,warafin,digoxin and lisinopril.I feel that docs have yet to figure this baby out .I feel frustrated that even with health insurance i cant find the proper god damn doc who can give me the staright answere.Last doc was too upset saying that i read too much on google and that poeple are screwing with my brain .I guess he was not too happy when i said no to ablation .

sorry this sound like a rant and may be i should stop now .

ray

Ray: Find out if your ejection fraction was measured. That is what he was asking. It is a % like 60% . -petey