P I P

[Nerja2012]

Hi, I have PAF and went 10 months without an episode which is normal for me, it lasted 6 hours and I self converted , my GP has never suggested PIP , just told me to double up on Bisoprolol which does nothing to shorten episodes , I take 1.25 Bisoprolol daily. I have read a lot of posts about Flecainide on this site used as a pill in the pocket. I intend to phone my GP on Monday so any feedback would be greatly appreciated. I score 3 on chads purely because of age and gender. Female and 76 with no underlying health conditions. I have just started Apixaban 2.5 recently .I was diagnosed 5 years ago and have visited this sight a lot and I carnt thank you all enough as it's been such a great help in my journey. Many thanks.

[BobD Volunteer]

You should know that here in UK flecainide, like most rhythm control drugs, is normally not permitted to be prescribed initially by a GP. You will need to see a cardiologist or electrophysiologist in order for this drug to be started should they wish you to take it.

Whilst it is good that you are now anticoagulated (a bit late some may say) your AF burden sounds extremely light so you may have problems getting that idea past the medics.

[Nerja2012 in reply to BobD]

Thanks Bob. That saves a phonecall to the Doctors. Its all a bit clearer now.

[Hidden]

Flecainide as a Pill in the Pocket can be very successful for stopping episodes but it I think it usually needs to be prescribed by a specialist rather than a GP. When first used, it is supposed to be taken in a clinical environment and the patient is monitored for an hour or so to ensure there is no adverse reaction. If Flecainide has been taken previously as a regular maintenance dose, this is probably not necessary. If it is prescribed, it is important to follow the prescribed dose.

It will be interesting to hear if anyone here has had it prescribed by their GP, hope this helps.......

[Nerja2012 in reply to Hidden]

It does thank you. As you can guess I dont have much knowledge about AF so asking the forum saved me embarrassing myself with G P.

[Hidden in reply to Nerja2012]

No problem, when I hit the send button I didn’t know Bob had replied. Given what you have told us, it’s probably best avoided for the moment......

[secondtry]

Yes, speak to a cardiologist, you may have to pay privately to get a prompt referral. Your AF burden is currently low but important and further action now would be prudent for a better future. Consider discussing Fleacinide PIP or daily 100mgs/day (low dose) and also consider lifestyle changes & identifying your possible AF triggers if you can.

[Nerja2012 in reply to secondtry]

Hi, Asking to see a cardiolagist is like spitting in wind at my practice. I paid to see an EP when I was diagnosed and he agreed with everything the G P had given me , I haven't seen anybody since. Thanks for reply.

[The_Lord_is_with_Us]

In USA. I've taken Flecainide prophylactically at dosage 50mg twice a day (lowest dose recommended). And, years before that, I used it pill-in-the-pocket 4 to 6 times to convert me out of AFIB quite effectively.

I was going into AFIB 10 years ago 2 to 4 time a week. In emergency spending $$$ and time getting cardioverted regularly. It was then that I discovered Flecainide taken at home at 50mg converted me within 20 minutes, removing the necessity of going into Emergency.

I had a couple of ablations in 2011 and was AFIB free for nearly 10 years, but it came back AUG 2020 with something new: rapid ventricular rate (RVR). I was put on Cardizem 4 x Day to bring the heart rate down from 130 ... and put on Flecainide 50mg 2 x Day to stop AFIB.

Flecainide was so effective at that dosage at keeping me in sinus ... I decided to stop Cardizem experimentally to see if rate was stable at 80 bpm (and it was). Side note: it wasn't clear whether Flecainide early on was working. It took almost 3 weeks for full effect. It was night and day! when it finally kicked in. I even asked Cardiologist if I should up the dosage. He didn't like that idea, said, "It has nasty side effects."

I was ablated in OCT 2020 ... and told to discontinue Flecainide after 60 days (which I did with no problems). I've been taking Apixaban 5mg 2 x Day since one month before recent ablation to present.

I'm going back down to the EP in MAR to have a 'finishing' procedure. They will analyze my Left Atrial Appendage that was ablated to see if it's functional and check if I need any more touch-up ablation or perhaps a WATCHMAN device installed in the LAA (if the previous OCT ablation damaged it functionally).

They told me 60% of patients undergoing my protocol, upon analysis, don't need any ablation or Watchman, so they're sent home AFIB free. End result whichever way it goes ... is no anticoagulants needed for Life ... and free of AFIB.

I don't know if any of this is applicable to your case. You seem to have a light, nuisance AFIB, some EP's call here in America Lone AFIB.

[Nerja2012 in reply to The_Lord_is_with_Us]

Wow that's some journey, thanks for the reply , hope all well in the U S.

[cuore in reply to The_Lord_is_with_Us]

I am a little confused with your journey. You say "I've been taking Apixaban 5mg 2 x Day since one month before recent ablation to present.." but you also say 10 years ago you were cardioverted which means you had gone persistent. Did you not have to be on anti-coagulants to be cardioverted or were you on a different NOAC-- 10 year ago you must have been on Warafin? Also, what does OCT stand for?

[The_Lord_is_with_Us in reply to cuore]

Sorry. Let me clear that up.

You don't have to be persistent to get cardioverted (as defined in USA). Cardioversion is only a means of getting out of AFIB and back into sinus rhythmn, which is usually performed by medication or shock paddles. Of course, some people stay in sinus for quite a while, while others (like myself) might go back into AFIB after conversion within a day or so. That's when decision time comes ... do I medicate to try and fend it off or do I ablate (or other form of surgery).

You don't have to be on anticoagulants to be cardioverted. I probably went through many without it. When it progressed ... and became more persistent, that's when I went on warfarin. At that time, I was probably scheduling my first ablation for Atrial Flutter (at least that's what my initial EP said it was. The hospital that cardioverted me had diagnosed AFIB, so I was a little surprised when the EP said she thought it was 'flutter').

OCT ........ october.

[cuore in reply to The_Lord_is_with_Us]

Of course, but it seems that, in a social health system like UK and Canada, the system waits until the patient is persistent before cardioversion is offered. So I forgot about the US. In Canada, and persistent , I had to be anti-coagulated for a few weeks. I have read that if a cardioversion is performed in less than 48 hours, a patient does not have to be on anticoagulants. I am surprised that once you got AF, you were not placed on daily anati-coagulants right away. That seems to be the treatment both in the UK and Canada.

If you were cardioverted after 48 hours did you not have to have a TEE?

The one time I landed in a hospital nothing was done. I had to stay there about 8 hours and then I was sent home. . Although I felt better, I do not know if I was still in arrhythmia or not.

The reverse happened to me for my first ECG. The MD who interpreted it at the lab said it was flutter. So, I downplayed my research thinking I was not a serious case. But, I could not fine any ECG similar to mine that was flutter. I was frustrated in not being able to locate a similar ECG, so I asked my EP about two years later to find out it was AF.

My case was one medical blunder after another so I went to Bordeaux to get straightened out.

[The_Lord_is_with_Us in reply to cuore]

Oh ... yes. I remember your harrowing experience.

I don't know a lot about Canada and UK medical, but from what I've read on this forum ... I'm glad I'm getting treatment here in the USA.

It's not perfect ... nothing is, but wait times seem less and world class treatments and options are readily available. Yours is an exceptionally distressing series of blunders.

Originally I had sporadic Lone AFIB ... 55-years-old ... had no health problems ... somewhat active and exercising. So my low CHAD score enabled me to forgo warfarin. However, it progressed rather rapidly to where I couldn't ignore it any longer.

Although my AFIB was hitting 2 or 3 time a month ... then a couple times per week ... I don't recall that I ever let it go for more than 24 hours. I went right in for cardioversion. Never had TEE or any followup, really. Except Emergency told me to follow up with my Cardiologist.

I straightaway scheduled ablation. So I had ATRIAL flutter ablation in 2010, two AFIB ablations in 2011, an AFIB ablation in OCT 2020, and I'll return for a small 'finishing' procedure that might include minor ablation and installation of a Watchman Device around MAR 2021.

[SirBeatalot]

I've had a AF gap of 10 months ( Feb 2020 to December 2020) and am on 1.25mg of Bisoporol, but I have heart disease (bypass March 2017)I have never been offered a PIP but I am on a waiting list for an ablation.

I am 65.

Not sure if knowing this helps you in anyway!

[Nerja2012 in reply to SirBeatalot]

Abalation has never been mentioned ither. Its food for thought so thank you. I woder if it would still be an option at my age.

[The_Lord_is_with_Us in reply to Nerja2012]

My EP does ablations for teenagers all the way to several in 90's. I think his core average age for bulk of his ablations is nearing mid_70's. Lots and lots of ablation patients in their 80's.

[Nerja2012 in reply to The_Lord_is_with_Us]

Thank you

[lacolyn]

Hi, nice to meet you. My really bad episodes were 6 years apart! But I had an ablation about 5 years ago. Very occasionally I get a bit of afib. More likely is a bizarre feeling that surrounds an episode but actually isn't one. Either way I have taken the PiP and it's helped. It's takes a few hours but works. Good luck my friend.

[Nerja2012 in reply to lacolyn]

Thanks for that.