Hi all, went into AF at around 4.30 UK time
At 5.30 took 2.5mg of bisoprosol and 300mg of flecaninde as suggested by EP as pill in the pocket solution.
I have yet to revert back to sinus and was wondering when I should go to casualty(a&e). As I am abroad and not sure what to do next or how long to give it.
Thanks
A
Hello Andyt36, Depends partly on where you are abroad I think. Also your own history. In my case I can't take a 'pill in the pocket' solution because of other heart problems, but I typically self revert between 3 and 7 hours, sometimes quicker. I only get checked out at A&E now if my heart rate stays above 150bpm for a while. I'm travelling too at the moment - in Asia - so I'm hoping I don't have any bad events 
I hope you come good soon, or get some help if you feel you need it. Only you can make that judgement, and usually A&E are understanding if it's a short lived event that they can't help with.
Sometimes it's best to go to A&E so you get an ECG recording. That can be useful in a better assessment of your AF.
I am not medically qualified and comment as a PAF sufferer.
300Mg is a large dose and the maximum recommended in 24 hours. I had raised eyebrows when I told my EP I had taken 300Mg at once. I also felt really bad when I did. I no longer take such a high dose as PiP and make 200Mg the max at one time.
Having said that you have now taken that dose and if it is going to work my experience is that if PiP is to work it will be within 1 - 10 hours.
Regarding going to A&E(ER) it depends on your symptoms and where in the world you are right now.
If your symptoms are bearable and you do not revert to NSR you might,if you are soon to return home, wait to take advice from your EP consultant.
Hope you feel better soon.
Pete
Agree that it depends upon which country you are in and your health insurance details. Personally, unless I felt very ill, had syncope (fainting), chest pain or HR over 200 or thereabouts for more than 4-5 hours I would just sit it out.
AF is not really an emergency, although it can sometimes feel like it!
PS - if you have taken the full daily dose of Flec - 300mg - whatever you do, do not take any more for 48 hours.
AF is neither an accident nor an emergency it is a chronic condition so A an E is not really appropriate UNLESS you have syncope or chest pain in which case there is no argument. Whilst I agree that in the early days or whilst trying to obtain a diagnosis an ECG from A and E may be useful that does not sound to be the case for you. Remember that many people are in AF all the time so it is really only about symptoms and quality of life. 300mg Flecainide is the max dose permitted in 24 hours as has been mentioned and is what I was given as pill in pocket when i took it many years ago pre ablation.
Flec does not reach maximum power until about 6 hours sometimes it takes longer - I have been told unless HR150+ try and read a book etc - when I was admitted they gave me a saline drip .. and more Flec. if after 18 hours not resolved and you have rehyrdrated you better get to AndE.
Hi
My instructions are to take 150mg flecainide after 15 minutes and then 150mg after an hour. If I hAve chest pain to go to A&E. If my heart rate stays high to go to A&E if not resolved after 2 hours.
Not 100% sure what high means but I think probably above 150bpm.
300mg flec on my instructions are the maximum you can take in 24 hours.
Hope u aee feeling better by now.
Elsie xx
Hi I echo much of what has been said. Until I had my ablation, I always felt more vulnerable abroad, through change of routine, diet, maybe an extra drink or two, so AF episodes were sadly not unusual for me. So much depends on your personal medical history, and how you normally handle AF episodes. As the other Bob says, people can be in permanent AF and are managing the condition. If, like me, you were on anticoagualants, BP meds, statins etc, I didn't see much to gain from going to an A&E abroad. Again, it depends when you are due to come back to the UK, and what facilities are like where you are if you did seek help. My AF rarely lasted more than 24 hours without reverting, and after that I usually became a bit more concerned. I was admitted to a Tenerife hospital once after my AF went over my comfort threshold, and found myself in an ambulance with a flashing blue light and admitted for 24 hours until I did eventually revert to NSR. I suspect I would have reverted anyway as I was only being monitored when I was there, although the Spanish doctors told me they were going to do a cardioversion if I had lasted more than another day in AF. My last experience abroad was an AF episode which did not revert and lasted 5 days. My cardiologist did not advise me to go to hospital but to get back to the UK as reasonably quickly as possible. 2 days after I got back I had a cardio version, and 6 weeks later an ablation. There is no single rule to follow here. I am tempted to say follow your heart, but in my case not really a good idea! Seriously, I hope you get well soon. Never great being ill away from home.
Hi Andy
I have been to A&E so many times when my AF continued for over an hour, and when I am there, waiting HOURS! it eventually subsides. However, I am given ECGs (2), blood is taken (5 tubes), and other things (including x-rays) and the doctors find that I am so fit and healthy, nothing else is wrong and my heart gets back eventually so sinus rhythm, often when they are finally able to do the ECG! I now feel it is not worth going to A&E - but - they say you should - just in case you have a stroke and to check nothing really bad is going on (it feels bad enough!). I had an episode when in the States last Christmas, at the airport and luckily the medical staff decided I was ok to fly. If you are abroad and go into hospital it will be very expensive.
The good thing about going to A&E (casualty) is that (for me anyway!), it makes me feel safe, and looked after and I always calm down! With AF, it eventually subsides, but if you have the symptomatic type, which I do, it is scary, and like a panic attack. If you can afford hospital I would go, just to feel safe!
I hope this is of some help?!!
Agreed: do not take any more flecainide for at least 24 hours. Stay hydrated. Slow walking can help. There are three things you can probably do:
1. Take some more bisoprolol. The 2.5mg is quite low. I agree with the advice to mainly take flecainide to hit the AF, but, maybe it is the type that responds to bisoprolol.
2. After 24 hours start a daily dose of flecainide at say 100mg, perhaps divided morning and evening. Flecainide is known to be good for keeping the lid on AF restarting, and some take it as prophylaxis. My personal experience is that even when AF stops, it trys to restart the next day, therefore, a few days of flecainide keeps the lid on it.
3. My experience is that it is easier to handle AF when abroad, since I am paying, and, depending where you are, this can be quite reasonable. Doctors abroad are more willing to accept medicine as doing a job, doing what the customer wants. Therefore, if you have good reason to believe that a cardioversion is a good idea (assuming you are anticoagulated -- the main thing that concerns medics) then go for a CV. Then keep the lid on it for with a few months of flecainide. My British cardiologist actually said that the best results are when the CV is done within 48 hours of starting, and I had an advantage abroad because I could walk in to almost any emergency unit, and demand a CV. I cannot imagine the NHS being so obliging.
I assume you are already on a regimen of anticoagulants. If not, I would recommend starting some asap. You are still (barely) in the window where they will likely cardiovert without having to wait for weeks to clear possible clots. Hope you are already back in nsr and this is irrelevant.
Dave
Guys thank u all for your feedback, reverted after 15 hours. Being kept in for observation for one night all good though. Thanks all, the reason I asked the question initially is that my EP said if I do not revert after 2 hours I should consider going to A& e. Thank u all V much.
Hi Andy,
My cardiologist suggested to go to A&E after 14-18 hours. Are you taking anticoagulants?
When I had permanent AF I never went to A and E as some say I lived with it sometimes when very high heart rate I sat or lay down till it calmed a bit. My GP said call ambulance but hospital would only tell me what I knew. Had I had pain or really feeling very faint I would have of course. I get AF and other arrythmias now but again stay at home .
Hi guys to add some clarity for all and I hope it helps.
I have PAF, with a chads vads of 0, and I have a pill in the pocket 2.5 mg bisoprosol and ,300 mg flecaninde.
I took them, and waited 12 hours,(EP said in. His letter, if I do not revert in 2 hours should consider a&e) as I had not reverted and read there was a 48 hour window for cardio version that is when I made the decision to go to the a&e unit. I feel it was the right decision and yes it cost in terms on money as I am abroad but well worth it as I reverted within 3 hours of getting to a&e, had some tests done all good which helps put the mind at ease as well. And I wanted to say thanks to all for their feedback. Hope my post helps😀
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