Advice and Thoughts Please

[PAP48]

I was diagnosed with Af in May of this year and prescribed Flecainide, 1 tablet at night plus Rivaroxaban (although I had been on this since 2017). I saw consultant at end of September and having had no episodes since March, he was happy to leave things as they were with a 2 Flecainide dose as a pip. I had one minor episode just before Xmas, took pip & it resolved itself in about an hour. We went on holiday on 26th Jan and returned last night, during that time I had 3 episodes. The 1st 2 resolved with pip within an hour and a half but last night it was more like 4 hours. Sorry for long winded explanation! 2 questions, has losing a considerable amount of weight helped at all and what type of diet (food type and quality) do you think is best to help Afib? Thank you so much for any input.

[mjames1]

Flec sometimes works within minutes but sometimes can take 3-4 hours. I assume your nightly dose is 50mg? Are your episodes mostly at night or are you starting to get them during the day? If the latter, speak to your doctor about adding a morning dose flecanide which is usually how it's prescribed, i.e. twice a day. I also have tried once a day dosing at night but that was because all my episodes at that time were at night. Now I'm back to morning and night at least until things calm down. Afib begets afib, I find, even when on flec.

Overall weight loss is encouraged not just for afib but for the rest of the body. That said, losing weight too fast may have upset the system and triggered those episodes. Or not. Diet is a very individual thing, but if I go too much toward keto (low carb) my arrhythmia's can get triggered. On the other hand, sometimes hard to lose weight without restricting carbs, so you have to find a balance, but def keep losing weight until you're at an ideal BMI cause it will pay big dividends down the road.

Jim

[PAP48 in reply to mjames1]

Thank you Jim - my episodes are pretty much always at night. Last night 12.30 having just walked in the door after returning from holiday! I’m thinking also that not drinking enough aggravates. I know I’m over weight so I’ll definitely do something about that. Interesting about blood sugars as yesterday I had hardly eaten anything due to travelling. Penny

[mjames1 in reply to PAP48]

If you're episodes are mostly at night, you might consider a single 100mg night dose. I was on that for awhile and it seemed to help. After things calmed down I went back to 50mg. Working on triggers like hydration, sugar, etc, are good, but because it's so easy to slip up and/or miss something, that extra flec can make the difference. A couple of months ago I was down to 25mg only at night. Last week I had a couple of short episodes, so I'm back on 50mg twice a day until things calm down.

Jim

[PAP48 in reply to mjames1]

So interesting how you adjust your dose to cater for how you are at a particular time and it makes such good sense. May I ask how you do this? My surgery give me 28 tablets at a time, 1 x 50 g tablet per day. I do have an emergency pack for pip purposes which, hopefully will be replaced when I've used them up. I'm not under a consultant now, he signed me back to my GP. I do have other health issues as well and the consultant I originally saw was of the opinion that my Afib was linked to my oxygen levels. Thank you again for such good information.

[mjames1 in reply to PAP48]

My adjustments are generally adjusting down from what I was originally prescribed, so I have the extra flecainide on hand. All I need is a good pill cutter when needed. My last ep was on board and to be honest I haven't asked my current ep for permission

Jim

[PAP48 in reply to mjames1]

Oh OK, I would need to adjust up, I'm not under a cardiologist or ep and I've just changed GP as we've moved areas. Maybe I should be having consultant/ep input. Keep safe. Penny

[mjames1 in reply to PAP48]

To adjust up, you would need a rx for more pills. Also, keep in mind how many pills you might need for PIP and make sure they are also added to your rx.

[secondtry]

Two things come to mind here.

First your AF may be increased by an over sensitive Vagus nerve - lots on this forum if you search VN.

Second what seems to have worked well for me is to have regular Flec am & pm.

Suggestions: You ask your cardio about trying 50gms x2 pd and secondly increase lifestyle actions in particular diet; in the case of the latter homework on 'food type & quality' is needed to make sure you don't jump from the frying pan into the fire. Again plenty of comments arise on this forum.

[PAP48 in reply to secondtry]

Thank you secondtry, I had thought the Vagus nerve had something to do with it, particularly as some of my episodes have taken place after eating later than usual and then going to bed fairly soon afterwards. As I've just replied to mjames1, I am not under a consultant at the moment, I was handed back to my GP and have been continuing with the plan as set out by the Consultant back in September, all was going so well until going on holiday!

[secondtry in reply to PAP48]

I think going on holidays is a common AF trigger, again particularly if you have vagally mediated AF. I certainly had episodes on my favourite winter holidays in Austria.

Why....I think it is down principally to the brain. Often we are very busy getting ready to go away then once you get on the plane, your accommodation, your first dinner or whenever you first kick back and relax is the vulnerable time ie there is too big a contrast between before and on holiday. Also of course different food can cause a gastric issue - the other key area of the Vagus Nerve.

Possible solution: Plan to make sure you are totally relaxed before you go and choose the least stressful transport. On arrival plan a semi-busy first day, eat an early simple evening meal, go to bed +3hrs later and before you are dead tired.

[lizzily]

I’m just back from holiday too but my AF was triggered on the flight out which I believe was due to dehydration. I routinely take 50mgs Flecainide twice daily but as my episodes invariably kick off at night I up the dose to 100mgs nightime until it settles. It’s easy to get out of routine when away, eat more , eat later etc which can cause upset and airport stress is tough to avoid. I just have to be careful that extra Flecainide doesn’t lower my pulse rate too much as this is a trigger in itself. I made sure I drank loads of water on return flight and was fine.

[PAP48 in reply to lizzily]

Thank you lizzily. I was fine during the flights, there and back, however, I do think dehydration plays a part in setting off an episode. I take one 50 g tablet at night only, as recommended by the Consultant I saw in September. He has signed me back to the GP and I'm not sure how I would have enough tablets to up them when required. I think my increased episodes whilst away were due to eating later than normal and my body clock being disrupted.

[drdubb]

I was on flecainide 100mg morning and evening. After my second ablation I was taken off of that Med. I do keep some for a pip. I found that dehydration and maybe large meals are my triggers. I also can’t take steroids. I was using a nasal spray last year and was having lots of small episodes. When I stopped the spray, the episodes stopped. Losing weight can help also. I take s prescription potassium dose and use over the counter magnesium. I also take .25 metoprolol to prevent flutter.

[PAP48 in reply to drdubb]

Thank you drdubb, I have been researching magnesium as a supplement, but I'm a bit concerned as I am under the impression, it does not gel well with antibiotics. Due to also having bronchiectasis, I take an antibiotic 3 days a week for always but will check it out with my GP. Take care.

[MalcolmCClark]

HiYes losing weight will help a lot.

With regards to Rivaroxaban make sure you take the med with food.

I take my Rivaroxaban medication in the morning.

I had to switch to having full fat milk with my cereal in the morning on advice from my arrythmia nurse to help absorbsion of the med.

I've had no problem with this medication and take it with Bisoprolol 1.25 mg for my AF.

I'm 8 weeks post ablation and still experiencing an irregular heart beat which is also low and fluctuates between 42 and 52 beats per min.

I am tired but otherwise feel fine.

AF is something we learn to live with so hope my experience helps.

Stay safe.

[PAP48 in reply to MalcolmCClark]

Thank you - I take rivaroxaban at night, not sure why, but it is just after I've had my main meal of the day. Not sure anyone told me otherwise and I'm not under any care for my Afib, just carrying on myself on Consultants advice in September. Losing weight is my next goal! I am trying to learn to live with it and not get stressed by it, your experience has helped a lot. You stay safe too and thank you for replying.