AF Association
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Persistent eptopics after AF attack.

Hi all, I had a 2 hour AF attack on Friday which stopped about 1pm, its now Monday 6pm and the eptopics/miss beats are showing no signs of stopping. Im getting about 10 per minute, my meds seem to do nothing and the only thing that helps is sitting still and not moving an inch. This is a new development for me. My meds are flecainide x 2 50mg and bisoprolol 7.5mg. Any thoughts or suggestions are warmly welcome. Oh yes my appetite has completely disappeared too, my better half thinks its anxiety related...another great day 🙄

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I’m sorry to hear how anxious you are I know very well how you feel . My advice to you would be go straight to hospital and get checked out , the reason I say this is I too struggled recently and I’m on the same medication, hospital got me sorted out and I’m also seeing an EP consultant soon, it’s sounds drastic to have to go to A and E but it’s the best way and hour anxiety will subside when you know your being checked out .i wish you well .

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Thank you very much for the reply, what treatment did you receive at hospital please?

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I was given flacinide intravenously after cardioversion failed .. I was kept in over night where they upped my medication and booked me in to see an EP .... this is such a procarious condition and so draining when in full AF .... I’ve had a few missed beats just now while messaging you haven’t had them for a while...... but since my stay in hospital I’ve beem ok .... I wouldn’t hesitate to go to hospital again if need be and I’m someone who hates bothering people.... good luck

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Thanks Alison and i hope you keep well 👍

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Hi Dj sounds like you are having a rough spell, I am not a fan of hospitals but I think as this 'thing' has been going on since Friday an ECG would be a good idea just to see what is happening and that this is just ectopics. If it is 'nothing much' well at least it should help to calm your anxiety.

Let us know how things are going when you can...

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Thanks doodle, i have a Kardia and when i take my Ekg even with the miss beats the reading is classed as normal... if they are still happening I will go to A and E in the morning for a check up 👍

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Hi doodle, i went to my GP today and he has increased my bisoprolol from 5mg per day to 10mg per day in the hope that will settle the skipped beats down. Im getting about 10 per minute when moving/walking ect but mainly complete sinus rythum when relaxing so not too scary as long as they disappear. I don't suppose 30c heat is helping either as Im not used to that in the UK... If you have any thoughts Im all ears.. thank you and keep well 👍

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Hi dj :-) I know you posted a video by Dr Gupta the other day well here is another one discussing a paper that was published about a simple breathing exercise for ectopics, I use the same exercise to calm myself when in P-AF

I hope it might help you ....

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Thank you for this Doodle I will certainly give it a try 👍

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Ectopics are a total misery - sorry you are having such a bad time with them. The horrible things are made worse by the anxiety they cause, so it’s a viscious circle.

Have you tried slow, diaphragm breathing - slowing your breathing down to six breaths a minute for at least 5 minutes? I do this for 10 minutes and count as I breathe to help me concentrate. The other thing which has worked for me is magnesium citrate - I take 200mg daily as well as Flecainide and Nebivolol.

Hope you get some relief soon.

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Thank you I wil try that out 👍

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Hi mister,

Gee that sounds word for word like me. Exactly the same. I had two weeks of extreme ectopics. It makes you feel so ill with worry and anxiety. The anxiety stopped me eating too. It then set off my stomach issues which made it worse. My bisoprolol do nothing either. I increased my anxiety meds and it helped although I still get them. Keep smiling

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What anxiety meds are you on? I have selfie anxiety with afib

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Been on escitralopram for about 5 years of varying mg

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Hi all, feeling slightly better after a good nights sleep, going to the doctors this afternoon for a check up. Thanks for your comments 👍

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You have a situation I have been in, and a situation I fear because it is not obvious what to do, and what is the culprit.

I presume there is nothing obvious in your lifestyle you need to address. I know this is often easier said than done. I strongly suspect that uncontrolled 'stupid' anxiety about a move was a major reason why AF hit me. Sometimes, you know you just have to live with who you are, even though the body is protesting.

Next question: what is your heart rate? Is it lower than your normal? You may see this when awake reading the healthunlocked posts -- you are relaxed but alert. You see this best when deeply resting, before the anxious thoughts swing in and confuse the issue. Check it in the middle of the night if you can, or just before getting up. Get someone to check it before you even move since moving means you miss it! Now, compare that to what is normal for you. If the resting pulse is significantly lower than normal, then Bisoprolol is the culprit.

The irregularities are fulfilling their natural biological role in a self-regulating and self-balancing system. Be aware that at 7.5mg you cannot stop and start Bisoprolol, but you could safely reduce the dose for a few days to see any benefits.

I would definitely add a Magnesium supplement, since that has a calming effect.

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Thank you for your comments I will take them on board 👍

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Good answer. My ectopics seem to start after bisoprolol in the morning and after a bigger meal? I think my heart rate drops lower then and it doesn't like it? Although who knows, I am so sick of trying to eliminate possibilities. I defo know that my acid tablets lansoprazole don' help

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Yep. Exactly me for one season. Why did the doctor prescribe Bisoprolol? In my case it was 'routine' and considered almost always helpful. Fortunately in my case it was 1.25mg, the smallest possible dose, so I could stop and start it at will. More than that dose, you have to phase a withdrawal. For you with lansoprazole I would check the drug interactions sites, since a minor side effect can become major in the presence of other meds.

I now only take bisoprolol if my heart rate gets stuck. If after a long day and some helpful exercise I get home and stop, rehydrate, relax in the glow of feeling good due feeling gorgeously hot and bathed in a decent sweat, I notice that the heart rate has not gone down from walking rate to sitting rate, I take it as PIP.

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Hi, I was on propranaol for 13 years which was given initially as I had an irregular heartbeat but they kept me on it for palps and ectopics. Stopped working last year so cardio swopped me.

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I think I have found the potential problem. I checked four different drug interactions sites. Only one of them flagged this, with explanation. drugs.com/drug_interactions... and type in the three meds you mentioned. Read the patient view, then the professional view. I suggest you print it all, highlight your concerns, and show it to a doctor. Ask if you can come off/reduce a medicine, especially the anxiety medicine. Having studied them, I am favourable to the view that in many people anxiety meds 'work' by producing symptoms -- the placebo effect in action.

"Talk to your doctor before using escitalopram together with lansoprazole. Combining these medications may increase the blood levels and effects of escitalopram. You may have an increased risk of developing side effects, including irregular heart rhythm". I hope this helps.

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Wow thanks for that. Really kind of you. I have stopped taking lansoprazole and take ranitidine which helps a little. I was on a very low dose of my anxiety meds but after the last bought of terrible ectopics I increased them which again helped. If I try coming off the anxiety meds my heart goes berserk

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Fascinating, reducing anxiety meds leads to increased ectopics. Excellent observation. A brief search of google scholar and pubmed returned very little. What I found though was significant. You are taking an SSRI. The key reference, old, not followed up on, is Shirayama T, Sakamoto T, Sakatani T, Mani H, Yamamoto T, Matsubara H. Usefulness of paroxetine in depressed men with paroxysmal atrial fibrillation. Am J Cardiol 2006;97:1749-51. Paroxetine is in the same class. Here is the Abstract.

"The occurrence and the duration of paroxysmal atrial fibrillation (AF) are influenced by vagal tone. Paroxetine, an antidepressant, can modulate vagal tone at the level of the mid-brain and inhibit the vasovagal reflex. In this study, oral paroxetine 10 mg/day was administered to patients with multidrug-resistant paroxysmal AF. Nine consecutive men responded favorably to the drug. In 3 patients, AF resolved completely. One patient could not tolerate the drug because of nausea and nervousness. These preliminary results suggest that paroxetine could be a choice in the pharmacologic treatment of paroxysmal AF."

It seems that SSRI meds can have a beneficial effect on the heart. In addition, I noticed that TCAs have anti-irregularities properties.

"TCAs suppress arrhythmias, functioning in a similar manner as Class I antiarrhythmic drugs. TCAs prolong interventricular conduction secondary to sodium channel blockade, which results in a decrease in the frequency of premature ventricular contractions .....

Later research demonstrated that TCAs decrease all component measures of heart rate variability and increase QT variability,

heartmindjournal.org/articl...

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Thanks, very interesting.

Escitralopram goes up to a maximum dose of 20mg a day. I am currently on 15mg. I was down to 1.5mg in Feb. Then I had all sorts of problems with ectopics and SVT.

I tried raising the dose to 10mg but it didn't help till I got to 15mg. I know I was totally stressed out and didn' feel better until I increased my dose. One thing I did wonder. At one point in an uneventful 3 years. I was on 10mg of escitralopram and 40mg of proprananol. I believe proprananol acts to relieve anxiety as well as my heart. So in effect, I was getting 2 meds for anxiety? And hardly any ectopics! Then I reduced the escit right down and swopped onto bisoprolol. Which made a right mess, which has taken months to steady down. I really don't feel bisoprolol stops the ectopics at all. I wonder if there is a better med that is not hard core as I don't believe my heart is that bad. I believe it has got reliant on the anxiety and hearts meds which I should never have been left on and now am stuck on.

Meant to also say. At the moment caffeine is a big trigger. I have just had a can of coke and the ectopics have kicked off. Same with coffee. However, When I feel ok and they are negligible I can drink coke and caffene without issue. It seems at the moment everything upsets it. Its so frustrating

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Beta blockers such as bisoprolol are prescribed, off-label, for anxiety symptoms. But its major effect is to reduce the heart rate. Other medicines exist which mainly influence the rhythm. I say mainly, because sometimes they do both. A common one to calm the irregularities is flecainide, which has an excellent safety profile when you are not taking other medicines, though you need to check renal function and electrolytes, and it can only be prescribed initially by a hospital cardiologist, and usually as an in-patient, especially in your case because their is a rare but really dangerous possible interaction to do with the QT interval.

The safe option is magnesium. Loads of threads on that.

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My echo is normal, but my ep said I should have a more current nuclear stress test (last one was 7 years ago) before taking Flecanide for safety reasons. Do you think this is more prudent than an in-patient trial or the other way around. Not taking any other meds. I am 71.

Jim

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I have noticed an increase in ectopics (PACs) since my afib episode last November that I naturally cardioverted out of. Ectopics are harmless by themselves, however for the past two months they have been triggering SVT episodes. No meds so far but working on diet, exercise and sleep positions.

Jim

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Thanks for your reply Jim and i hope you have success in self treating 👍

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Thanks djb, I am working with an ep and everything is on the table, including meds and ablation. Just taking it one step at a time.

Jim

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