Specialist electrophysiology care
Dr Rohan WijesurendraConsultant Cardiologist & Electrophysiologist
1,500+ ablationsPersonally performed catheter ablation procedures
Oxford-based carePrivate care at Nuffield Health The Manor Hospital
NHS practiceAcademic & researchGMC registrationHospital profile
What next if AF comes back after cardioversion?
Electrical cardioversion can restore a normal heart rhythm very effectively, but atrial fibrillation sometimes returns afterwards. For some people this happens after months or years; for others it returns within days or weeks.
This does not necessarily mean that cardioversion was unsuccessful or that nothing more can be done. It may, however, be a useful point at which to reconsider the longer-term rhythm-control strategy.
Why can AF return after cardioversion?
Cardioversion restores the heart rhythm but does not remove the underlying tendency to develop AF. The chance of AF returning varies considerably and can be influenced by the duration and pattern of AF, heart structure, age and other medical conditions.
What are the options?
Depending on your circumstances, options may include:
- accepting AF and controlling the heart rate;
- another cardioversion;
- medication to help maintain normal rhythm;
- addressing factors that may contribute to AF; or
- catheter ablation.
The appropriate choice depends partly on how much AF affects you and what you want treatment to achieve.
When might catheter ablation be worth discussing?
If maintaining normal rhythm makes you feel substantially better but AF repeatedly returns, catheter ablation may be worth discussing. This can be particularly relevant when cardioversion restores normal rhythm but the benefit does not last, or when repeated cardioversions are becoming necessary. Should I have an AF ablation? sets out the broader decision, while the AF ablation page explains the procedure itself.
Ablation is not automatically the right next step. The important question is whether its potential benefits justify the procedure in your individual situation.
Can I ask about ablation instead of another cardioversion?
Yes. Another cardioversion may be entirely appropriate, but asking about ablation does not mean you have decided to undergo it. An electrophysiology consultation can help determine whether repeating cardioversion, using medication, considering ablation or following another strategy makes most sense for you.
Already under a cardiologist?
You do not need to transfer your general cardiology care to obtain a specialist heart rhythm opinion. The discussion can focus on the rhythm-management question, with recommendations shared with your existing cardiologist or GP where appropriate.