Cardioversion Failure

This is a serious post for which I request serious responses. To some extent

So TROLLS go away!!!! Here is my problem.

I recently had a DC cardioversion that failed to last but a few hours.Now I am on 7.5 mg/day coumadin with no noticeable symptoms of my atrial flutter, but wondering what is next and if the condition is going to lead to heart enlargement and if I will ever be able to get off of daily coumadin. OK, that was the short version what follows is the history.

During my most recent 6 months visit to my cardiologist for a stress echo test (which I passed very well) we noticed that my normally low resting pulse of about 55 was up to about 95 and that my electrocardiogram trace had many irregular QRS pulses with missing p-waves. This was diagnosed as atrial flutter. My cardiologist recommended cardioversion. I am 68 years old and in generally excellent health, but have a coronary stent which was put in three years ago after some bouts of mild angina. I have had no angina since the stents. The stress echo was for the purpose of checking the stents for any re-stenosis. The cardiologist took me off my daily aspirin and put me on coumadin with weekly protime tests and dose adjustments until my INR stabiliized at 2.6. Then I went into the hospital with a Holter and a 24 hour
IV of Amiodarone. The Amiodarone did not convert me to normal sinus rhythm, so I was wired up and anesthetized for DC electro cardioversion. This restored normal sinus rhythm and p-waves and I was released from the hospital later the same day. By bedtime, the beeps from my home blood pressure cuff told me the arrhythmia had returned. When I returned to my cardiologist a week after the DC electro-conversion I still had the arrhythmia. My cardiologist asked me, "When did this start?" I told him it happened within a few hours of the conversion. He responded that new attempts after a first failure were almost never successful, so he took me off the 50 mg daily of amiodarone and put me back on 7.5 mg daily of warfarin. He said to come back from time to time to check the INR to make sure my blood would not form clots in the right atrium and put me at risk of stroke. Then he said to come back in four months for a re-evaluation.
I have no noticeable symptoms of all this. I do not feel missed beat or PACs or PVCs and I can do heavy sustained work without any problems.
I do not understand where my p-waves went or what I should not expect.One main concern is that this condition could lead to gradual enlargement of my normal sized heart. The only other prescription drug I take is 40 mg Zocor, which has kept me on a good lipid profile for over ten years..

This is how I understand it. Generally, the atria are responsible for ten to fifteen percent of your cardiac output. When your atria and your ventricles do not work in tandem, you lose what they call your 'atrial kick'. Most people are okay with this. For some folks, it results in fatigue, fainting, etc. Being without symptoms is a good thing.

The other risk with A-flutter or A-fib is that blood could stagnate in the atria causing a blood clot leading to a stroke. That is why you are currently taking coumadin.

Enlargement of the heart occurs when it is not strong enough to meet current demands. With an arrhythmia problem, this usually occurs because the heart beats too fast. Many patients take digoxin and lopressor. Are you on any meds other than the ones you mentioned?

Does being on coumadin bother you? Do you have frequent side effects?
Generally speaking, it is a harmless drug as long as you are well monitored and avoid opportunities for serious injuries.

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