Cardioversion and Metoprolol

I don't know what the cardiologist knows about you, but maybe he wants the more generic metoprolol so that if you have to change at some point, you can try the diltiazem for benefit. Many patients find that what they have taken for a few years begins to lose ground to the disorder, and then they are faced with more limited options. This is just a wild guess, unless something about your arrhythmia makes metoprolol a clearly better choice...finally.

As for the cardioversion, AF begets AF. A heart spending a long time in AF tends to be resistant to interventions of a kind, certainly the 'easiest and earliest' ones. This includes a cardioversion. Or so I thought. Then, my BIL, who was found to have been in AF for three or four years, as far as anyone can tell, was given a cardioversion last spring and his heart happily converted and has been in NSR ever since. Go figger!
I don't know how much you have learned about AF, but left too long it can cause poorly reversible changes to the myocardium, and even cause prolapse of the mitral valve. Eventually, some patients end up with heart failure. It could be that your cardiologist is now sufficiently worried about your brand of AF, it probably being long-term persistent at least, that he wants to do a last ditch attempt, via cardioversion, to see if you might be due some magic. And, he may feel that, this late in the game, an ablation might not help you because it would involved a horrendous amount of lesions in order to block the signal.
This is all conjecture. Again, I know next to nothing about you, and I'm very much just a curious layman.

I had a cardioversion about 3 months ago. My cardiologist switched from Xarelto (@20 mg) to Eliquis (@10mg). He informed me that Afib would return and recommended Watchman. I have seem msgs here that people who had cardioversion had gone 5 years without afib returning.
Good Luck

Thanks for the reply. Cardioversion is the only procedure that is available in my local area so for now that is the best option. I am getting setup with a hospital (that is a plane ride away) that can provide the pulse field ablation procedure and if warranted, the insertion of a Watchman. Hopefully the cardioversion will keep my out of Afib until I can get other procedures set up.

I have had 3 successful cardio versions however the 4th one failed. Two of the three worked for about 6 months or so. The other was 9 months. There were time gaps in between per waiting for various appointments, wearing monitors after each experience and the like to cross check the afib status. I am now in a search for the next step phase. It's been my understanding that the cardioversion duration varies highly from person to person.

I have always thought of cardioversion as a short-term intervention for atrial fibrillation (Afib), as it restores normal sinus rhythm but does not necessarily prevent Afib from recurring or address any underlying issues. Since I was first diagnosed with Afib in 2017, I’ve had probably a dozen cardioversions. Initially, they seemed to work well, but the last three only lasted about a week each, and the last one didn’t work at all. I am on both Diltiazem and Metoprolol, as well as Xarelto, and I have tolerated them all well. Have they discussed any long-term plans, such as antiarrhythmic medications, if Afib returns? Antiarrhythmic medications worked for me initially, but after seven years, I ultimately underwent an ablation at an academic medical center with a top-notch electrophysiologist. I have been Afib-free now for 604 days. Wishing you the best of health.

I just forwarded a comment to the prior person about cardioversions and noted I am now in the what's next phase per the 4th cardioversion failing. I didn't note that two different cardio MDs recommended radically different "next steps". I also live a place requiring long travel requirements for the best care. Would appreciate it if you could let us know which medical facility you found that offers pulse field ablation? Ot how you found that option. Per the above I found that some medical facilities still don't offer that option yet.

I went to the ER with an episode of Afib (paroxysmal Afib). After a couple of hours of trying to get me back to NSR with IV meds, they suggested Cardioversion, which instantly flipped me back to NSR. I had another Afib episode six weeks later, which lasted about four hours. So based on my experience, I would say that Cardioversion may not a long-term fix for everyone. A little over 6 weeks ago I had a PF ablation procedure...so far so good.

"And, he may feel that, this late in the game, an ablation might not help you because it would involved a horrendous amount of lesions in order to block the signal.
This is all conjecture. "
You are darn correct that this is all conjecture. This is a step too far to suggest to someone when you are not a medical professional and should not be writing words like "horrendous amounts of lesions". These are not the words of anything I have ever read in a medical journal. This is not sound medical advice.

Look at the Cleveland Clinic for Pulsed Field Ablation. They have numerous facilities around the nation. I also tried Mayo; they do them but are very difficult to get an appointment. Also go to https://www.bostonscientific.com/. They make the PFA equipment and list the doctors who do Pulsed Field Ablations around the country.

I am in SW Colorado, so my options are either the Phoenix or Denver area. Both a long drive or a short flight. I chose Denver because it has better airline service then Phoenix. I also still have over 200,000 frequent flight miles from United that are left over from my previous life and United flies to Denver from my local airport.

In Phoenix the two biggest hospitals that do PFA are Mayo and Banner. In Denver there are multiple, but the best that I could determine is University of Colorado Medical Center.

Another plus for UC Health is that they do virtual video appointments which saves me from having to make a flight for a short appointment.