Pill in the pocket

[Slattery]

I have read many articles about a pill in the pocket approach. I get Afib and so far it goes away on its own. The longest episode was 24 hours. Should I ask my doctor for a pill in the pocket to stop the event or let it stop on let's own. Is the pill in the pocket better for my heart?

[hertz]

Hi Slattery,

My doc suggested I try Fleacinide (Flec for short on this forum) as PiP

He said I could go up to maximum of 2 x 100mg but only in bad cases but normally 1 x 100mg should suffice.

Tried both, neither ever worked for me. only thing that reduced (but not stopped) the events was 2 x 100mg Flec per day continuously.

Two PVIs and 6 Months later I am "cured" so no more Flec needed . If this is a constant for you? Why not go for PVI treatment?

[Slattery in reply to hertz]

What does PVI mean?

[hertz in reply to Slattery]

Pulmonary Vein Isolation (PVI)

AKA Pulmonary Vein Ablation (PVA)

AKA Pulmonary Vein Antrum Isolation or (PVAI)

What they do is either freezing (cryo) or burning a ring around the area where the veins from your lungs (the Pulmonary Veins, or PVs) come back into your heart's atrium.

This isolates the atrium electrically from the PVs (scar tissue is a bad electric conductor) thus stopping electric impulses from reaching your heart from the ends of the pulmonary veins.

This is an engineer explaining it not a doctor.

They can either blow a little balloon up where the veins open into the atrium and freeze/burn a ring by freezing/heating the balloon. Gives a nice round scar and is simple to manipulate. Or nowadays they can burn points in a larger circle around both PVs (a bit like spot welding with ultrasonic pulse to keep the energy levels in check - if you have ever seem a solar cell manufacturing with aluminium strip bonding - its the same physics)

They don't want to use too much heat (energy) because that area is very close to your esophagus and thus can cause untold damage if overheated.

Hence you take a proton blocker pill for a while after treatment to avoid any ulcers forming from the heating. Also this reason to be so careful is a cause that the isolation is often not perfect on first attempt.

They can't really weld like crazy that close to the esophagus for fear of damage.

So; either too careful and the treatment is not successful on first attempt or too enthusiastic and you end up with secondary damage. Catch 22 for the specialists here and this is where the docs with the most experience and the best "feel" get the best results.

During the procedure they can see on a monitor a computer graphic that visualizes the degree of isolation achieved (by showing the heart with colour areas - purple being the isolated part red the conducting etc) so that tells them to do more or less and where to go. Its not one person but a whole team that works on you. Scar tissue forms over a period, so second PVI is usually more successful than first time as they can "see" whats left to be done and don't need so much heat to fix the gaps compared to the first time.

Hope this explains in simple terms what is going on.

[secondtry in reply to hertz]

Great explanation thanks.

[Slattery]

Hertz,

Thank you for this detailed information.

[Rellim296]

I'd like an answer to your last question too, Slattery. I had AF yesterday and was back in normal rhythm by six in the evening, having woken in the night with my heart off the rails. I have flecainide but I've not been using it and last time the AF only lasted a short time. It always reverts to NSR eventually. My day usually goes much as it would anyway as AF doesn't bother me too much but perhaps I would do better to zap it. However, my heart seems to be doing well enough and its long term health is not at the top of my list of priorities.