I was diagnosed with atrial fibrillation in January 2012. I am aware of when it comes by how I feel — a little out of sorts, but no shortness of breath, chest pain or light-headedness. Consulting with my app on my smart watch confirms the same. I am taking bisoprolol and rivaroxaban. Occasionally, I get an episode, which lasts anywhere from one to four hours. It subsides, and I’m over it. But last time, it lasted nearly 12 hours before it subsided. At the time of diagnosis, the cardiologist suggested that should an episode persist, I need to get to an emergency room and undergo a mild shock treatment to correct my heart’s beating. My question is this: How long do I wait? — R.B.

Answer:

Atrial fibrillation, an electrical abnormality of the heart causing an irregular heartbeat, can persist, or it can come and go. There are two goals when treating Afib: treating symptoms and preventing stroke. Both of these are usually done with medication when necessary, but it may also be done with electricity, giving a shock to the heart to “reset” the electrical system.

Emergency treatment with a shock (“cardioversion”) is indicated when a person is unstable, such as a person with very low blood pressure, causing the brain or heart to lack enough blood flow. That’s not you. People can have Afib for decades, but no additional treatment may be necessary as long as their heart rate is under control (bisoprolol, a beta blocker, is good at keeping the heart rate from going too fast) and they are doing what they should to prevent stroke (rivaroxaban, a direct-acting oral coagulant, reduces stroke risk).

Sometimes, a person with Afib undergoes cardioversion in an attempt to return their heart to its normal rhythm. This is usually done in a person to keep them at a normal rhythm permanently. However, there are some cardiologists who recommend what yours has, to use electricity in case you don’t go back into normal rhythm spontaneously.

In one study I read, participants were instructed to go to the ER if their symptoms hadn’t gotten better in six to eight hours, but you should certainly get an answer from your cardiologist.