About treatment options for atrial fibrillation

Posted by kyoto @kyoto, Oct 26, 2023

Dear All,

My wife's mother (aged 77) had a severe attack of shortness of breath last week. She has previously had surgery for ASD (atrial septal defect), from which she recovered. However, now the doctors are advising that they can stop her heart to then provide a cardiac stimulus of some sort. She has high blood pressure which may be caused by high level of salt in her blood.
However, they are suggesting that the family should discuss it first. They have explained that there are risks associated with this. These include:
* cerebral hemorrhage
* risk of embolism
etc. We can't find out how high the risk is, and whether we should go ahead with the stopping of the heart or let her come home and continue as she is.
Any advice would be incredibly helpful.
Best regards,
David

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windyshores | @windyshores | Oct 26, 2023

Maybe you could buy a Kardia mobile device that can tell you if there is any heart rhythm problem going on when she is short of breath.

Can she lower the salt level?

I would try everything possible until I felt totally sure that the heart stopping procedure is needed. Is she in danger? Do they know what caused the shortness of breath? Are her lungs okay? Does she have GERD (GERD makes me short of breath)? Etc.

linsie | @linsie | Oct 27, 2023

76 yrold woman, had cardioversion done 2 days ago….worked to create normal rhythm beautifully, no side effects

mllgroom | @mllgroom | Oct 28, 2023

In reply to @windyshores "Maybe you could buy a Kardia mobile device that can tell you if there is any..." + (show)

I got a Kardia device and send my doctor regular results from, it.
I don’t know about the service they offer., but my internist said he can read the results and will refer me to a cardiologist if necessary.

gloaming | @gloaming | Oct 28, 2023

There is minimal risk of thrombosis when the heart is stopped due to a necessary step for cardioversion. If a person is deemed too high a risk for some reason, the physician in charge would almost certainly prescribe an anticoagulant of some kind, Plavix, maybe a small dose of heparin.....all sorts of choices...to reduce the risk. A cardioversion needn't have the heart stilled except in some, a comparatively few, cases. If this is one, they'll get on restarting the heart promptly as soon as it is stopped. There is no need to stand around to see if it will restart itself...that's not the aim of cardioversion. Once they still it, they'll commence the series of shocks to get it back into NSR.

Justin McClanahan, Moderator | @JustinMcClanahan | Nov 2, 2023

Hello @kyoto. You may find this article from the NIH informative, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6453693/. However, this study focused specifically on the use of cardioversion in the Emergency Department so it is not a 100% match to your current situation. Some of the data within the study would have some parallels, however, to your mother's diagnosis. Due to the nature of the procedure and so many differing factors between patients, it is difficult to draw any concrete solutions without your provider's guidance.

@kyoto, it has been a few days since you proposed your question, do you have any updates on your conversations with your mother-in-law's provider? Were you able to share your concerns with them and did they explain more of the risks with you?

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