I’ve deduced I have vagal Afib as all my episodes occur without fail late evening after eating or early morning waking me from my sleep. I take 1.25mg Bisoprolol daily and 50 to 100mg of Flecainide as a pill in pocket. The Flecainide stops Afib in its track usually within one to two hours but I find the daily regime of Bisoprolol, even on such a low dose, regularly reduces my resting heart rate to 45 to 50 BPM. I’ve read that beta blockers are a bad thing for vagal induced Afib episodes as they can enhance bradycardia which often present prior to a vagal Afib attack? I also read however that Flecainide can cause irregular and potentially dangerous heart rhythms in the ventricles and you should combine a beta blocker with an anti rhythmic drug such as Flecainide? My GP and my cardiologist don’t seem to acknowledge that vagal Afib is even a “thing” and as in these covid times I remain un-monitored I’ve decided to come off the Bisoprolol and take 2.5mg along with a 50mg of Flecainide as a pill in pocket approach. I should mention I’m a warfarin lifer anyway as I have Factor V Lieden, diagnosed seven years ago following a DVT and bilateral pulmonary embolism. I strive to keep my INR around 2.5 to 3 which seems to suit the DVT management and apparently is plenty high enough to manage any stroke risk during an Afib attack. I’m also exploring the options of taking magnesium, potassium, Q10 and Taurine on a daily basis in exactly the same doses as are in the US market only supplement, Heart Calm. Haven’t noticed anything good or bad to report on these supplements so far, other than they all reduce blood pressure, which in itself might be another reason to knock daily beta blockers on the head as they also reduce blood pressure? My BP sits circa 110 to 120 over 72 to 82 at the moment. Interested in other folks thoughts on all of the above? Happy New Year to all my fellow “Hearties” out there!
Flecainide and Bisoprolol as a PIP ap... - Atrial Fibrillati...
Flecainide and Bisoprolol as a PIP approach for Vagal Afib?
Hi Mot.
I found Flec the best PIP out, although it's not everyones cuppa. I'm not a medic so I can't tell you what do. I was taken off it which IMO is a big mistake. Flec and small amount of beta blocker would be a better bet than what I'm now. I think a CV /flec /beta 1.25 max would be far better than what I'm now.
Paul
G'day Motov,
I am both a Warfarin and Bisoprolol user and have been since January 2010, almost 12 years to the day when I was diagnosed with paroxysmal AF. My average daily Warfarin dose is around 4.4 mg. My Bisoprolol dose is 7.5 mg. I am also on Statins and other blood pressure medication, i.e. Ramipril and Felodopine. No sweat .... my Consultant prescribed Bisoprolol as a heart rate control drug. That said thats its primary task ! I have learned over the years that Bisoprolol does have some properties which enable it to be prescribed for blood pressure control - BUT - it is not its primary job ! The only other thing I take is Bio Q10.
My heart rate holds nice 'n steady at around 62 to 67 bpm ( for 12 years) , however, every once in a while, totally at random it drops to as low as 44 and is regularly hovering at around 52 to 57 bpm. No sweat. Its doing its job - pure and simple.
My INR range is 2.0 to 3.0 with my target being 2.5 - I seldom hit the 2.5 but am in range 90% of the time, the usual INR is between 2.4 and 2.7. At 77 years I'm happy with my BP being 130/70 ish. It can swing from as low as 113/60 up as high as 150/85 - but it doesn't stay at either level for very long.
So my personal belief based on my experience is that beta blockers are NOT bad for vagal AF whereas food and - for some - drink can be. To me Flec is just a "stopper" ... it isn't a "controller" ... that said too, I also am well aware that many cannot handle Bisoprolol, much as many can't handle Warfarin, and much as many now cannot always handle these NOAC's. Its horses for courses I'm afraid. I suggest you need to check out why Bisoprolol is often prescribed for BP control - when it is a heart rate controller. I guess it is likely that it has some sorta calming effect on the arteries, improves their elasticity which in so doing CONTROLS the HR and calms the BP. Dunno I'm not a medic. Having done that then you need to check out whether its true for all beta blockers. I dunno, but, thats my take. For me, bisop and Warfarin are my best forever friends.
By the way, I self test my INR with my coaguchek XS device and as and when needed I self dose ( that is adjust ) my Warfarin too. Hope these thoughts help.
John
Thanks John your input was helpful. I’m fully up to speed with warfarin and like you use a Coagucheck machine, my INR target was 3 to 4 originally as set by my consultant following my VTE episode seven years ago, however my cardiologist thinks 3 is the sweet spot for my Afib. I take 13 to 14mg of warfarin daily. I’m really only questioning the Bisoprolol as my understanding of vagal Afib is that often bradycardia occurs just before an Afib episode and as I believe I definitely have vagal Afib I have read lots of anecdotal evidence to suggest that beta blockers make it worse? As an aside, it’s definitely food that trips my episodes, coffee and indeed alcohol don’t seem to figure in causing the Afib?
If you haven’t already seen this - suggest you pass onto your doctors. richardbogle.com/blog/vagal...
As to supplements - I can’t comment on Magnesium as I cannot take oral Mag but do take COQ10 and found that very helpful, Potassium supplements are extremely dangerous to take unsupervised so I was told very firmly to avoid, Taurine I tried for a while but didn’t notice a difference,
I am aware of HeartCalm but know nothing about it. I try to get all of my micronutrients through foods rather than supplements - the main reason being that the body doesn’t recognise supplements as food so like pharmaceuticals tends the bioavailability within the body tends to be low. Look at your eating plan before taking supplement.
I like these blogs for both information but also the recipes
heartmdinstitute.com/diet-n...
Check out the blog on D-Ribose - I did use that for a while and found it helpful when in a particularly bad period of arrythmias.
I’m also a fan of nutritional smoothies with plenty of seeds, micro sprouts and nuts. All the micronutrients you need in a much more bio available form.
Hope that helps.
I am on Bisoprolol 1.25mg daily and use Flecainide as a PiP but I must admit I have never checked my heart rate before an episode - the episode starts and I treat it! That said my heart rate is normally in the upper 60s early 70s so I don't suffer from bradycardia but the Bisoprolol does make me feel as if I am wearing lead boots.
If you do come off daily Bisoprolol, be aware that some people - not all - suffer side effects. I did for about three months; racing heart, the jitters, a complete adrenaline overload. I almost started again as I thought I must really need the medication until I googled and found there were many other people out there who had the same experience. So it would be worth titrating down.
I used to take the supplements (bar potassium) you are thinking of and had to stop due to treatment for something else, but I now think stopping them led to runs of tachycardia which is why I went back on Bisoprolol daily. I am not an expert on supplements and many doctors completely dismiss their efficacy but with hindsight they worked well for me.
Best of luck!
I currently take the same as you, 1.25mg of Bisoprolol and 50 to 100mg of Flecainide as a PIP. My thinking is, come off of Bisoprolol and take the 1.25mg of Bisoprolol with the 50mg of Flecainide as a PIP approach as I’ve read the Bisoprolol (and other beta blockers) help prevent ventricular fibrillation from starting which is obviously a different and more dangerous heart rhythm disorder. That said, there are many who simply take just Flecainide so who knows? We’re all different I guess?
It depends which doctor you speak to - my GP was extremely helpful and suggested taking Bisoprolol alongside the Flecainide as a PiP as his view was Flecainide can introduce other arrhythmias. I take 200mg flecainide (again with advice) as a lower dose was less reliable and took a long time to work. Best of luck!
Hello Motov. My afib attacks are also at night time. After changing my diet and increasing my exercise, I tried to progressively get off sotalol. I was taking it twice daily 80 mg. Since that change triggered an afib attack, I am back on sotalol but only once daily in the evening. That seems to do the trick for me.
Just wondering are they vagal AF or ectopics? I get ectopics and sometimes wake up with sinus tachy at night and I take flec and Bisoprolol as PIP which works although I am fortunate to have a loop recorder fitted. Ask your Cardio if this is a possibility for you?
Mine are definitely vagal related Afib episodes. My view is still that it would be better to just take 1.25mg of Bisoprolol alongside the 50mg of Flecainide as pill in pocket approach as and when an attack comes along. Meanwhile I’m optimistic that a few lifestyle tweeks along with some supplements might lessen the attack intervals?
I take 800 mg of magnesium on a regular basis.
What type of Magnesium do you take please, magnesium citrate, magnesium taurate etc.? 800mg seems a high daily dose??
Interesting stuff.I started with metoprolol 25mg to control my episodes and that worked for 6 years. Then the episodes started to be frequent. After thorough testing, exercise and nuclear stress tests and echocardiogram, I was started on Flecainide 50 mg twice a day. I also take Eliquis 5 mg twice a day. My EP said the Flecainide would PREVENT episodes. It’s been miraculous for me. Haven’t had one yet and it’s been a few weeks. Mine, too, were in the evening, completely relaxed. The EP is not concerned with the low heart rate which is usually in the mid to low 50s. Isn’t that the point? I hope so. Reading everyone’s comments are so interesting as to the approach to this issue. I’ve also read the standard treatment is a beta blocker with low dose, to start, Flecainide which put my mind at ease. Treatment is so individualized.
CoQ10 made me lightheaded when I took it years ago. I won’t take supplements unless recommended so as not to mess with my electrolytes. An occasional magnesium if I am constipated.
Good luck on your journey. This forum has helped me greatly in understanding this phenomenon ❤️ Happy New Year!
Different cardiologists prefer different medications and most feel out of their depth when the Vagus Nerve is mentioned. So my experience is you have to do a lot of research and trial and error yourself and challenge the medics, in the end working on a Quality of Life scoring system.
I think you have taken some good decisions so far on medicines & supplements but I would say if you are getting more than one episode every 6 months, you need to discuss your medication. My cardiologist does not favour PIP as the heart is habitually disrupted and can't settle.
I was diagnosed with Lone PAF at age 60 (vagally mediated was my own diagnosis!). With similar BP & HR to you, my cardio went for just Flecainide (200mgs), unusual I know. He said an accompanying CB/BB would make me feel unwell. I matched this with a lot of Lifestyle changes and for 8 years now I have been virtually AF free, just 2 very short episodes caused by Vagus Nerve triggers.
Lastly, can I ask you a question? Are you Homo (both genes) or Hetero (just one gene) Factor V Leiden. I had a DVT 20 years ago and was diagnosed with Hetero but haven't taken any ACs.
Hope all goes well for you.
I used to do well with 2.5mg bisoprolol and 300mg flecanaid as PIP whilst taking 1.25mg bisoprolol daily. Unfortunatly following a sucessful ablation 2-3 yrs ago whem my AF and now A Flutter returned in Oct. 2021 the PIP didnt work and Im now stuck in AF and flutter and on a high dose of bisoprolol thats messing up my life big style!
Sorry to hear that, I can only imagine how uncomfortable that must be after bing stuck in afib myself previously for three weeks. I had an episode last night, (fourth one since Xmas Eve! ) that wouldn’t end with my usual 100 mg of Flecainide. In the end I took another 50mg of Flecainide and a further 1.25mg of Bisoprolol and after 4.5 hours I shifted it! I’m concerned now however at how quickly I’m getting episode after episode, whereas previously it was maybe once a month! I’m putting down to Xmas over eating, wrong food, wrong time of day, too much chocolate and booze!
Are beta blockers prescribed in paroxysmal AF without proper consideration?
Switching from 100mg Flecainide twice daily, to Pill in the Pocket. Has anyone done this?
