Advice from your experience please.

[Apple88]

Hello again,

Hope you are all doing okay. I’ve been really helped by the supportive posts that I’ve been able to read on here. Thank you!

I just wanted to ask people’s opinions really. I have a GP consultation in the morning, as I’m still having a lot of issues.

I’ve been on flecainide 2 x 50mg daily for about 6 weeks but after 4 weeks of still having fast AF I was put back on my bisoprolol as well (1.25mg) a day. I had about 8 long episodes lasting a few hours each of 140+. I also take Apixaban.

Since adding back the bisoprolol I have been feeling really unwell again, mainly because of my low heart rate. My resting pulse dropped from 60 to 48 in less than a week after going back on it. My Kardia records bradycardia every day now.

Last night, my pulse was around 46-47 and I could feel an almost kicking sensation in my chest, with some shortness of breath & chest discomfort. Feel a bit better today but I’m not sure what the GP will suggest, if anything so just wanted to hear peoples opinions on my current state.

My feeling is that my AF is not controlled but the bisoprolol is causing more problems. Not due to see cardiologist any time soon as my ablation has been put on hold.

I would just like to find a combination that might help me to cope or feel a bit more normal in these uncertain times. I have been struggling since the start of February.

Thanks in advance for any thoughts, or any questions that you may think of that I could ask my GP.

[Hidden]

Adding the bisoprolol, a betablocker is supposed to slow your heart rate. I guess the question is how is your blood pressure? If it is running too low, that will make you weak, dizzy. I suspect your gp will probably want to increase your flecainide dose as it sounds like 50mg isnt stopping your a fib. Managing the doses on antiarrhythmic drugs and betablockers is a balancing act. Hoping your doc will get you straightened out. Make sure you are staying well hydrated. Do you have a way to check your blood pressure? Hang in there. When I was put on a betablocker, it probably took me a month to get used to it. Let us know how your appointment goes.

[Apple88 in reply to Hidden]

Thanks for replying.

Blood pressure was 94/73 yesterday.

I tried higher dose of flecainide and my AF increased massively! Took150mg for 3 days and was barely out of AF.

I just can’t seem to find an answer. Don’t know if it’s better to be alert & risk AF or be a zombie who is out of breath & lethargic all the time!

[Hidden in reply to Apple88]

Maybe they need to try a diff rhythm drug

[Paulbounce]

Hello Apple.

Maybe just copy and paste your post above (print it out) and let your GP read it !

It's natural to be nervous when you see your doctor - I know I am and often forget to ask things I wanted to mention. Your GP can read it in 'layman's' terms and it might help him (or her) to understand how you are feeling.

Just a suggestion

Paul

[Apple88 in reply to Paulbounce]

Thank you! You are always reassuring in your replies! It a phone consultation so I guess I could read it out!

😊

[jeanjeannie50]

Hi Apple, I'm wondering how long you've had AF and if it's just for the last 6 weeks you mention? If not what did you take before?

Flecainide can cause an abnormal rhythm in some people which is generally offset by adding a beta blocker. I really feel for you with your heart veering high and low. I used to get that at times and it wears you out! Have you tried stopping the Flec and beta blocker and seen if you're better without them? Pills can affect people so differently and what one person can tolerate another can't. Certainly don't accept pills making you feel like a zombie. Digoxin did that to me, but I have a friend who swears it has helped her.

Have you tried supplementing with magnesium? Some people swear that it really reduces symptoms. What helped me more than anything was changing my diet and moving to one more plant based that contained no artificial additives. Artificial sweeteners were a sure trigger for an AF attack.

Jean

[Apple88 in reply to jeanjeannie50]

Hi Jean,

Thanks for your reply. I was diagnosed in a March 2019 and took bisoprolol for almost a year without much incident. Then suddenly in Feb this year it got much worse and I’ve been in A&E a couple of times.

I managed digoxin for 2 weeks and felt terrible on it.

My cardiologist seems to want me to take something regularly rather than as a PIP so I haven’t tried stopping everything.

We decided that drugs were not the way to go for me in the long term and was listed for ablation but now put on hold.

I’ll see what GP says tomorrow. I’m just really fed up of the rates being either very high or very low.

I have stopped drinking alcohol completely and eat generally healthily. I haven’t tried magnesium. Would I need to check with the doctor before trying that with all the medication I’m on?

Thanks again for taking the time to answer. It means a lot. 😊

[Hidden in reply to Apple88]

Hi

I am on exactly same drugs as you and take magnesium had no problems with it so maybe worth a try.

Andy

[jeanjeannie50]

I've not heard of anyone not being able to take magnesium alongside heart medication, but yes you could ask your GP, though I suspect he may know nothing about how it helps with AF.

Here is a link to a talk by Dr Sanjay Gupta who works in the cardiology dept in York hospital U.K.. All explained very clearly.

youtube.com/watch?v=Ckdcr-c...(Not working as expected?)

[Apple88 in reply to jeanjeannie50]

Thank you. I will look into this.

[Apple88 in reply to jeanjeannie50]

Jean, do you know if magnesium and vitamin d supplements combined would be any good?

I have a vitamin d deficiency anyway and take a daily supplement so wondered if I could try taking one with both in.

Maybe anyone else has done this?

[Apple88 in reply to Apple88]

Scrap that. Just watched the video again. He said no!

[Buffafly]

I take an alternative to Bisoprolol which is Diltiazem, not sure if your GP could change you over or not. It might not slow your HR so much at the lowest dose. You don't say what your HR would without Bisoprolol when in sinus rhythm?

[Apple88 in reply to Buffafly]

It’s usually around 60 when in normal resting rhythm. I could ask about alternatives.

I think I just don’t want it to be this low so I’m hoping she offers to do something that might help. Not sure how much she’ll be willing to change without the say so of the cardiologist though.

Thank you for replying.

[Gowers]

I have been in exactly same situ as yourself - after my 1st ablation 6months ago two of the cardiologists said Bisop + Flec are the standard meds after ablation. But! The Flec sent me into Atrial flutter & I felt really ill after 1st ablation - sick feeling etc + af meant I had to stay in hospital & have cardioversion next day & couldn't go home. I was on lowest dose of Flec & it was a while before Cardiologist realised I was one of those who couldn't tolerate the Flec or Bisop. (Actually, I was already off the Bisop as like you I felt very poorly on even a low dose - heavy feeling in chest, heavy feeling in legs & very weak, hr = 40-47.)

Following a 2nd cardioversion 2months later i was still in af with hr of 150-180 most days for over a month. I was exhausted! So, I was put on low dose Digoxin & I am still on it + Diltiazam 300mg once a day (which i was already on) i had a 2nd ablation 3 months ago & doing better but still early days & still few days of af. I was told Digoxin slows the rate & Diltiazam the rhythm.

It is interesting to read up on what various heart meds are prescribed for.

But - as you will see we are all very different & even now on the advice of my cardio nurse I am tweaking the meds. Do let us know how you get on

[Apple88 in reply to Gowers]

Thanks for replying. It really does go to show what different experiences we can all have doesn’t it?

My interpretation of what the cardiologist said was that I thought I’d be able to stop the medication after the ablation.

I really struggles with digoxin. To be honest, I seem to struggle with them all now. I know that people seem to get on with much higher doses of things but I feel like any slight change has a bit effect on me.

Thank you for sharing your experience with me. All the best with finding what’s right for you.

[Gowers]

Getting the meds right has been & is an ongoing thing for many of us. I had hoped Flec would help especially as a pip

[Hammerboy]

Hi I have a lowish resting heart rate and after my ablation was put on 1.25 mg of Bisoprolol by my EP. I found my HR went quickly down to the low 40's at rest which made me tired and lethargic. I persevered for around 6 weeks but decided to stop taking it as it had no effect on my having the occasional AF episode. I've been off it for a few weeks now and I feel much better and more energetic but still continue to have the odd short lasting AF which appears to be random. I have been sent a 7 day Carnation Ambulatory Monitor which is hopefully going to more inform my EP of my progress since the ablation. I think this beta blocker affects people in different ways so it's very individual and personally I would discuss alternatives with your cardiologist. Good luck and stay safe 👍

[Apple88]

Thank you for your reply. Reading people’s experiences has been really useful. 😊

[Clarrie]

I had the same problem with Flecainide and Bisoprolol and my heart rate was in the low 30's so was put back onto Sotalol.

[Paulbounce in reply to Clarrie]

Ouch - bottom 30's is very low for HR. Pleased you got it sorted.

Paul

[Flyer2820]

Hi Apple88. It seems that a lot of cardiologists like to put you on bisoprolol. I was on 100mg flechanide three times a day which completely stopped my afib but the cardiologist told me to only take 2 x 100mg of flechanide and bisoprolol. I discussed this with my doctor and we decided to stay on the 300mg flechanide. Later however I was told to do as the cardiologist said by the hospital so I changed to 100mg flechanide twice a day and bisoprolol. Within 3 days I was back in to afib and that same day went in to bradycardia. I was very ill and had to send for the ambulance. I spent a night in hospital with bradycardia and they lowered my dose of bisoprolol which stopped the bradycardia but I still had afib. I've had an ablation since which has worked so am off meds except for anticoagulant. Bisoprolol is designed to lower the heart rate so that is why you are going in to bradycardia. You need to discuss this with the cardiologist as soon as possible. The ep nurse at the hospital told me I could have stayed on the 300mg of flechanide without the bisoprolol. There are different views from different cardiologists and they don't always get it right.

Good luck for the ablation.

Best regards Flyer.

[Apple88 in reply to Flyer2820]

Thank you for your reply. Really useful. Glad to hear your ablation was helpful.

[jeanjeannie50]

Let us know how you get on at the docs this morning.

Jean

[Apple88 in reply to jeanjeannie50]

Hi,

Had my consultation and she wants me to stop the bisoprolol again and see what happens to my rate & symptoms.

I’ve already taken today’s dose so I’ll see whether this makes a difference. She’s calling again at the end of the week.

She seemed concerned about some of my symptoms and made me promise that I would seek emergency help if things worsened. This is something I’ve avoided due to coronavirus but I get the impression that a lot of people are not doing what they would do normally - like calling 111 which is what I have done in the past.

I will see what happens now with just the flecainide again.

Thank you all so much for sharing you experiences. 😊

[Paulbounce in reply to Apple88]

Good luck Apple. I'm sure it will work out well for you

Paul

[goldey]

Do not be afraid to talk to your dr about getting a pacemaker. After I had 4 episodes of cardiac arrest, where my heart stopped completely -- Thank God I was in the ER at the time --- they gave me a pacemaker. Now when I am reading or watching TV, my heart rate also slows to 49-55. But I know that if it goes below 49, the pacemaker will give my heart a little kick and get it up. I AM SO COMFORTED just knowing that my heart is protected in this way. Knowing that I don't have to worry about it going too slow or stopping again.

[Chezz123]

Drugs A to Z

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Drug Interactions between bisoprolol and flecainide

This report displays the potential drug interactions for the following 2 drugs:

bisoprolol

flecainide

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ConsumerProfessional

Interactions between your drugs

Moderate

flecainide bisoprolol

Applies to: flecainide and bisoprolol

Using flecainide together with bisoprolol may have additive effects. Contact your doctor if you experience dizziness, slow or irregular heartbeats, fainting, or palpitations. You may need a dose adjustment or special tests to safely use both medications. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

[Flyer2820]

Hello again Apple88.

Hope all goes well now the cardiologist has taken you off bisoprolol. Just to let you know that bisoprolol on its own did nothing for me, it did not stop my afib. Only flechanide at its highest dose stopped it. Flechanide I was told by the ep nurse also slows the heart rate but not as much as bisoprolol, so the combination of the two in high doses can take you into bradycardia. We are not medically trained but we do know what our bodies respond to, so if you feel bad, take action as the cardiologist has said. Remember we are all different, none of us can tell you what is right for you. Only you will know if things are wrong. Speak out when you need to.

Hope all goes well for you.

Stay safe.

Best wishes Flyer.

[Apple88 in reply to Flyer2820]

Thank you. First day without bisoprolol today. 🤞🏼 Hopefully I’ll start to feel a bit better soon.

All the best.