AF Association
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verapamil

Has anyone been given verapamil to use as a pill in the pocket to either stop tachycardia or stop pvc's ?

I was at the ER a couple of days ago with tachycardia that lasted almost four hours. 100ml of Flecainide didn't stop it so they did a chemical cardioversion and it stopped it straight away.

I'm always out of breath recently especially walking up hill or up flights of stairs so I was given a coronary angiogram test yesterday in hospital where a catheter is inserted into an artery in the wrist then up into the heart to see if you have angina or blocked arteries. The test was clear and I have no coronary heat problems but an electrical problem.

the EP wants to try verapamil either as a pill in the pocket at a full dose which is released immediately, or a slow release tablet which I would take every day to try and reduce the tachy events happening.

Jeannie if you read this post, I hope you are still in NSR after your tooth extraction ! xx

Thanks, Trish

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Hi Trish

About 10 years ago, I was given Verapamil but unfortunately it didn't stop my AF. Saying that, we are all so different so it could very well work for you. Flecainide was the only pill that really helped me.

The symptoms you are describing are exactly how I used to feel and I know just how tiring that can be. I'm really hoping that you will soon find a cure.

Yes, I'm still AF free after having my tooth extracted and that's 19 weeks of feeling normal now! Life is good.

Jean

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I was soooo hoping you would say that !! I was almost afraid to ask you in case you'd gone back into afib. I'm so happy for you and really hope it lasts. There is no reason why it shouldn't. It stands to reason that if you have a bad tooth it is bound to affect the rest of your body including your heart.

I think I have tachycardia jonctionelle in French which is the same as Bouveret Hoffman disease in English. It is more complicated to ablate as far as I can make out because it is near the node and I could end up with a pacemaker if anything goes wrong. I'm hoping the verapamil works so I won't need an ablation. Someone else has written that diltiazem works better for them. I'll ask my ep about that, too.

Anyway, hope you stay afib free for ever !!!!

Trish xx

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Hi, I'm on verapamil 240mg SR for SVT.

I have no further episodes palpitations or side affects of the SVT after starting it.

The drug makes me quite sluggish though, I'm in a fast paced job and I can feel it working against me when I'm walking. Which I supposed is good.

I had gone through weeks and weeks of pounding heart and pounding head before I was put on it so it was great to be symptom free. But it does give me insomnia I believes so I'm speaking with my EP about possibly reducing the dose.

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Reebe, glad to hear you have no symptoms now. I have to take a tablet of 120mg if I have another bout to stop it, so it is being used as PIP but I think I would prefer the slow release tablets every day to stop the palpitation that often are a sign I'm going to have a tachycardia episode. 120mg doesn't seem a lot to stop a bout once it starts

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I used to be on Verapamil but its effect wears off so now I am on another drug but have verapamil as a pill in the pocket, with the warning that I have to let the other drug wear off first before taking it.

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Hi Mike, thanks for the reply. What dose do you have to take as PIP? It's strange you have to wait before taking it because the idea is to take it straight away to stop the SVT before it takes hold.

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2 or 3 80mg non slow-release tablets. But you can't mix beta blockers (nebivolol) and verapamil as the blood pressure would collapse so they're more a 'fix it later instead of going to A&E' rather than a 'pill in the pocket' and I have to take one at a time and check my BP regularly. Hence I suspect most consultants won't advise this course of action unless they have complete confidence you can self-medicate like this.

But it did work the one time I've needed it so far.

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I'm not on a beta blocker but I was wondering if I could take verapamil with Flecainide as pip. I really want to try the verapamil slow release every day. It seems a bit early to talk about ablation yet ( see reply to ILowe below).

glad it's working for you.

Trish

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I've never been allowed Flecainide due to another heart condition, but that sounds like something a consultant might consider, provided you're not taking the PIP regularly. Best to ask him/her and see what they say.

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Have you any idea what they did to you for the chemical cardioversion? Did they inject you with something, intravenous?

A few months ago, my PIP -- bisoprolol + Flecainine, worked on Friday, I stayed on this as prophylaxis, then SVT kicked in again on Sunday. At that point I gave up with self treatment. A british cardiologist told me a few weeks ago I could have tried an additional dose (max 200mg Flecainide daily for me, cos I am thin). Anyway, on the Monday, the French trained doctor treated me with Amiodarone as PIP, which seems to be an unknown as a method in the English speaking world, and that worked.

Since then I have been on 1.25mg Bisoprolol + 100mg Flecainide as prophylaxis. In the past, as long as I was on low dose Flecainide, I never had SVT.

Maybe your doctor is thinking. Flecainide has not worked as prophylaxis, so let's try Verapamil, at least for a few months, until your heart re-learns some good habits.

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I started the tachycardia at 11.30PM and tried everything to stop it at home including 100mg flecainide. I eventually called the ambulance and at the ER they injected stryadine (Adenosine). It stopped it straight away and this time it didn't put me into Afib which it did last time (a year ago).

I asked the Rythmo if I should have taken 200mg Flec instead of only 100mg and he said no. He's now given me Verapamil 120mg in case of another bout but I can't see it working if the Flecainide didn't work. He says if it doesn't work he can ablate the part of the heart where it is starting but I'd need a pacemaker if the op went wrong.

Over here it is called Tachycardia jonctionelle or Bouveret Hoffman disease.

The Amiodarone you are talking about is used a lot in France but it is unpopular with patients because of the long term side effects. I had to take a very heavy dose last year when Afib was brought on by the injection they gave me to stop the SVT.

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Thanks for the French. I have a temporary job in Tunis, so use French frequently with the doctors.

OK. Without trying to find the research papers, I seem to remember there are several ways of trying to limit the rate of a heart, particularly when it gets above 150. These are usually intravenous, but all of them have their own problems, including over-reaction, (eg very low HR, and/or very low BP). If I remember right, they usually try to inject you quickly: the idea is, to provide a chemical shock to the heart. Une boule.

Verapamil is a Calcium channel blocker, and is considered to be a rate controller. It is used mainly when beta blockers are not tolerated.

Flecainide is considered to be a rhythm controller.

There are two basic issues: 1. How to reset the heart. 2. How to stop SVT or AF developing.

I view rhythm and rate like two children. Sometimes they squabble, and things escalate. Irregs increase, so HR increases in order to calm down the irregs. Have you ever noticed how regular SVT is? Then sometimes, the irregs increase in an attempt to tame the high HR of SVT, and this means you have AF. I have seen this battle in myself. I even have ECG traces to record the switch between SVT and AF and back again.

The basic approach to PIP is to hit both -- like separating boxers in a ring. Then there are five broad options:

1. Straight jacket the irregularities. flecainide

2. Straight jacket the HR: betablocker or Verapamil etc

3. Straight jacket them both, though perhaps with reduced doses

4. Do nothing

5. Change between these options, according to need.

You have to decide, who started it? Who is most likely to start it in the future. Then straight jacket them. I say you, not your doctor, because only you know your case history in detail. Only you have memory (with differing degrees of accuracy) of how it started in the past, and what it feels like just before the crisis hits.

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Exactly. Well said! I know the last time it was definitely the tachy that started it but it was because of the injection used to stop it and it put me in afib. Fortunately the injection used this time, Krenosin, just stopped the tachy and didn't start another arrhythmia. I know I've woken up in afib once and the doctor said he was sure it was afib but it wasn't documented. I have palpitations and feel hot and then I know I'm going to have something come on so I should really take a fllecainide to stop it coming on but I think the 150mg slow release the doctor gave me was too high, I had tinnitus and a heavy feeling in the chest. They gave me a coronary angiogram test and it came back all clear, the doc said it's nothing like coronary disease, it is really a question of rhythm. I have read somewhere that Verapamil can start off afib, have you heard that?

I think options 3 and 5 above are good but can you use Flec and Verapamil together?

The cardio who did the angiogram said he'd touched the heart with the probe and it fibrillated immediately. He says it is very sensitive but I'd like to know what exactly so I can stay away from the triggers.

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Verapamil starting AF? I need to look into that some more. But, according to the British National Formulary number 70, year 2016 which I have, I do not see this under the list of possible side effects. The main side effect seems to be constipation -- which is why a similar drug, diltiazem is usually used instead.

But, I found some interesting information. page 161

Ventricular rate can be controlled with a standard beta-blocker (not sotalol hydrochloride p. 93) or a rate-limiting calcium channel blocker such as diltiazem hydrochloride

..., or verapamil hydrochloride as monotherapy. Choice of drug should be based on individual symptoms, heart rate, comorbidities, and patient preference.

Interesting, that here in the BNF, which has high authority, patient preference is mentioned.

=======

Verapamil hydrochloride is usually effective for supraventricular tachycardias.

(important: serious beta-blocker interaction hazard) may

be followed by oral treatment; hypotension may occur with large doses. It should not be used for tachyarrhythmias where the QRS complex is wide (i.e. broad complex) unless a supraventricular origin has been established beyond

reasonable doubt. It is also contra-indicated in atrial fibrillation or atrial flutter associated with accessory conducting pathways (e.g. Wolff-Parkinson-White syndrome) p86

So that may be the main nuance. Verapamil is good against SVT. Exactly my situation. It was SVT that led to AF. I am primarily in the business of avoiding an unstoppable SVT. Most people and most doctors focus on the AF.

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holy cow-no one ever said my svt could lead to afib--my MD insinuated it could go into vtech - i guess because my pulse was 230--highbpressure too170 ish--but cardiologist said svt is more of a nuisance--now if it can lead to these things-it sounds more seriuos.!! So I have a question regarding diltiazem-has anyone felt wierd in the brain-like its dangerous?like brain wants to dissapear?I cant find 1 case.at first It was making me feel more relaxed(diltiazem er)but it changed .I had adenosine at ER but am afraid of diltiazem now !!You know-i feel like maybe I had afib when I took effexor once-it felt like a motor inside my chest,scary,then i took ambien and went to sleep and was fine.

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I know little about diltiazem. Perhaps best to wait a little then start a new thread.

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yes-I plan to--Im seeing cardiologist soon==but this is the 1st Ive heard of svt-afib relationshipp---so is it common?please tell me all you know so I can have achat with a dr who says its only a nuisance!

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Discussion and evidence concerning SVT versus AF seems rare. My repeated experience is that SVT can lead to AF. I have ecg recordings of a tussle. Another time, when bring chemically cardioverted with a high dose oral bolus of amiodarone I watched on the screen how the battle went. It was the fear that SVT would set in that led the doctor to tell me to see him immediately if I had SVT 3 times in a week.

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