My Doctor has prescribed PIP metoprolol 100mg followed 20 minutes later by 100 mg of flecainide and if not reverted in 60 minutes another 100mg of flecainide.
I typically have an episode every four months or so and have been able to revert with only the single dose of each. Until last week…
I was to run a 10k race at 5 AM, and woke up at 1 AM in AFIB. It took the total dose to bring me back to rhythm. I ran and finished but really labored with my time 20 + minutes longer than normal. My legs felt wobbly , had some light headedness and recovery time much longer.
Any similar stories or suggestions?
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Sjorgy
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i'm always wiped out for a few days after an afib episode and don't think that's unusual. I won't comment on the wisdom of running the race right after an episode, but the fact that you were able to do it is impressive
I think many factors play into why an afib episode takes so much out of us, but dehydration is one. That may have accounted at least in part to the way you felt.
Might be time now for a little recovery period in your training.
100mg of Metoprolol is a hefty amount. I was given 100mg in hospital one night and collapsed the next day when I got out of bed. My AF nurse told me that I must never take more than 12.5mg or it could kill me. I don't know if it's just me sensitive to it. Then you're told to take 100mg of flecainide 20minutes later. I have to say I'm amazed.
That happened when my husband was given 15 mg of bisoprolol to take daily he was like a zombie with terrible anxiety worrying about every little thing which didn’t help his AF . Now on 5mg he s so much more like his old self , apart from the symptoms of his stroke . I’m no medic but thst sounds an awful lot .
I'm not a medic either, but yes that sounds like a very high dose to me too. When I was in hospital with pneumonia and covid last year, my heart took off racing because of the infections. The ward consultant wanted me to take 10mg Bisoprolol and I was shocked at that dose. We eventually agreed on 7.5mg, but as soon as I was home I started reducing it slowly.
Your poor husband must have felt dreadful on 15mg and I'm so glad that his dose is now reduced and he's feeling better.
I'm going to second what Jean said about the 100mg of Metoprolol. I get it that your doctor wants you to have nodal protection alongside the Flecainide, but that's a very high dose. Was it an ep that prescribed your PIP dosing? If not, you might want to get a second opinion on how much metoprolol you need prior to the PIP Flecainide.
Ditto others saying Metoprolol dose is higher than I've experienced. I am on 25mg plus 150mg Flecainide twice a day. However, there must be a reason for it and it appears to work for you.
Had my first HRC episode after a colonoscopy 6 years ago. They did cardioversion that night and I went home , but then I woke with it again so they repeated it in the morning as medication’s they tried didn’t work.
They prescribed Metoprolol as a PIP and that worked for all situations ( 1-2 a year) except one about a year ago, which required another cardioversion. I saw a cardiologist then who prescribed the flecainide as additional PIP
I have had to use it four times now in the past year ( all while in training for the race - so probably related) . Only one time (last week before race) required the second dose of flecainide.
I am 15 years your senior, but as a former runner may I caution you about not "overdoing" it. From what I have read, I think overexerting myself on a treadmill (bad weather days) and elliptical may have contributed to my afib (paroxysmal to persistent). After being diagnosed, I went to walking.
Sounds like you are confident with your medical team. Definitely consult with them on your medications and exercise. And if you have not, ask to wear a holter monitor or another medical device for an extended period to determine a true picture of your afib.
Funny you should say thst as it was on a treadmill at the gym thst we had noticed my husbands erratic heart rate in 2016 compared to mine . He used to really go for it in the treadmill and be wringing with sweat . So I wonder if he already had it or over doing it on the treadmill may have contributed towards it ?
Like many things with afib, not a definite answer. But I do think it was a contributing factor in my case. Should have kept heart rate below 120 on the treadmill, instead of 135-140 in my 60’s. Not worry about max heart rate for conditioning.
Yes those are prescribed amounts from a highly respected cardiologist at Health Partners.
I note on the internet these doses are not uncommon. But probably not three hours before running in a 10k marathon! I won’t do that again, and under the circumstances I guess I should feel good about my time of 1:20
Had my first HRC episode after a colonoscopy 6 years ago. They did cardioversion that night and I went home , but then I woke with it again so they repeated it in the morning as medication’s they tried didn’t work.
They prescribed Metoprolol as a PIP and that worked for all situations ( 1-2 a year) except one about a year ago, which required another cardioversion. I saw a cardiologist then who prescribed the flecainide as additional PIP
I have had to use it four times now in the past year ( all while in training for the race - so probably related) . Only one time (last week before race) required the second dose of flecainide.
Hi Sjorgy, interesting post. The first thing which occurred to me was that the thought of starting a marathon here in UK at 5 am, given our current Arctic weather, would be enough to cause anyone to go into AF! Perhaps you live somewhere where the weather is a bit kinder.
First I must mention I am not medically trained, nor do I have any experience or Metropol so cannot comment on dosage etc. Under normal circumstances, if Flecainide only is prescribed as a PiP in the UK, we are told it does not have to be taken with either a beta blocker or a calcium channel blocker which is not the case if it is taken as a regular daily maintenance dose. When I was prescribed, my cardiologist recommended that I should take the full maximum daily dose of 300 mg in one go because it was the nearest way of replicating the effect of having a cardioversion (not literally but in principle). This method is commonly used although occasionally medics may suggest like yours, prefer a gradual increase.
As far as I know, combining arrhythmia medication with rate medication as a PiP therapy is not so commonly used in the UK, generally Flecainide is used on its own once the medics are happy that it’s well tolerated by the patient. I’m sure you are well aware that extreme sporting activity and AF are not good bedfellows but it needs to be mentioned. Obviously, what I have mentioned relates to treatment in the UK and may not be appropriate elsewhere, but hope you find it helpful…..
• in reply to
I'm in the UK and am prescribed a beta blocker and Flecainide as PiP, Flapjack
me too Top Biscuit. 100 mg of Flec and 2.5 bisoprolol immediately and then another bisoprolol if still in A fib after 6 hrs. As a side question, have you noticed an increase in your episodes since taking this Pip? I. In Herts.
Well, my episodes are certainly increasing in frequency but it hadn't occurred to me that that is connected to my taking Flecainide as a PiP. The beta blocker I take is Propranolol which I've taken for a few years as needed for anxiety so that's not a new medication to me.
Afib is a progressive condition so I'd put it down to that.
It could literally be a coincidence, and that the PIP or medication you had was just not fully effective with that particular episode.If the episode is still continuing despite the PIP it would be more likely to mean that your aFib could be changing or your doses need altering to be more effective so it's important to get to talk to your GP about incidents like that and get more advice.
Let's say , it certainly tries to keep you on your toes.Even when you think you have it all sorted , your body decides to throw a new curve ball of chaos into the order and you need to adjust everything all over again.
So, interestingly, I was just looking at the NICE website as I'm thinking about going to a daily dose of Flecainide instead of as PiP when I found the following while looking at drug interactions:
Bisoprolol
Flecainide is predicted to increase the risk of cardiovascular adverse effects when given with Bisoprolol. Manufacturer advises use with caution or avoid.
Severity: Severe Evidence:Study
Both Flecainide and Bisoprolol can increase the risk of bradycardia.
After my ablation I was prescribed 50mg in morning and 50mg at night of Metoprolol as maintainence. If I have an Afib episode 100mgs of Amiodarone every 8 hours till it subsides. Been afib free 2+ years now.
Sorry to hear that you are having these episodes. As a runner myself I can sympathise and tell you about my own experience which is that I have had to adjust downwards my training so as not to trigger afib episodes and would not claim to have been fully successful. Many will tell you afib is progressive and that has been my experience also. I had my first episode after doing 4x1600, followed by a few sprints, and was advised to cut back in volume and intensity by 20%. I was 18 months afib free after that including doing a marathon but had another episode 18 months later after getting cold following a run plus a cold water swim. This year I have had four episodes with the triggers being cold, flu vaccine, running with HR of 130 plus. So it’s not looking good and I am hoping for an ablation. For the last episode I took PIP - bisoprolol and flecanide 50mg which didn’t work but I eventually went back into NSR as usual. Now I am doing all running under 120 HR, and sticking to 5k. I have also taken up weight training as an alternative although if the weights are too heavy they provoke ectopics. Some people would regard even this as extreme but if you are in the company of people all doing the same thing it is difficult to see it like that. I have you read The Haywire Heart? It is an excellent read for athletes and the the Afib cure which gives some detailed advice on how you can manage the afib. What I would say about continuing to run in afib is that it could be a bad idea. I don’t know if they tested your troponin levels but they did mine and they indicated heart stress which can lead to damage, which no one wants. It’s not the same as some people with controlled AF doing gentle exercise. If you are in NSR most of the time, then treasure it and try to preserve it by seeing what works for you. I bought a fourth frontier chest strap which records a continuous ecg which exercising so you and your cardiologist can see more clearly what your heart is doing. Good luck!
Good stuff.. I had some similar experiences. After several years and two ablations on this afib conveyor belt, my exercise has become more moderate.. i used to trail run long distances, often in hot weather...and moderation and awareness has been forced upon me in running, stress, exercise, alcohol, vaccines, to name a few. Afib wins. And as most here know, when we are in afib we will do just about anything to get out if it! Like Scrooge and Christmas, I try and keep the lessons of the Afib spirits thriving within me.
thanks. Yes , I have had a full battery of tests and wore a monitor for a couple weeks. Everything normal. Stress and dehydration typically the culprit for the occasional AFIB but the day prior to the race In Jamaica I was well hydrated and it wasn’t Red Stripe! Had a great massage the day prior and was feeling prime for the run. But I was excited and also a loud reggae party did not allow hardly any sleep so those may be part of issue
hello Skorgy, as a fellow runner I can sympathise with you. As a PAF sufferer, usually about one episode a month, and a advocate on PIP - I use a Beta blocker to good effect. It took me quite a while to address my running program. After two episodes of AF during hard runs >220 bpm I had to accept that it meant running within limitations. Using the formula of220 minus age as the target heart rate when running. I still enjoy running but accept that at 76 competitive running is over. It took me a couple of years to accept this but with a PIP I cope with the AF.
I'd tend to agree with what you have finally concluded. It's not really sensible to take part in a run straight after a incident if aFib even if you have a PIP to take and it's been effective.The over exertion can cause more problems and you are more likely to experience a return of the aFib because you haven't given your system time to get used to normal rhythm again.
The doses may be quite high to some , but types and doses of medications can differ from one individual to another , based on their gender , size and weight. tolerance to medication , individual effectiveness of the doses , physical condition and cardiac needs and general activity/ stress levels.
What you need to do is double check on the doses if you feel they might be too high with a medical professional, and consider how those medications affect you, as well as considering taking assessments of your personal risk and ways to avoid flares by pacing your activity according to your symptoms.
If you wouldn't mind sharing your particular episode symptoms as I have never been given a diagnosis to the 2 of my "episodes" that have forced me into a prone position or I would have fainted. Doc prescribed 25 mg metoprolol 2X along with perindopril X1 per day. I have also been having palpitations for many years that get really bad about 3 X a year for 6 weeks so I'm hoping that the new meds will ward off the "on the floor events."
I’m not sure if it’s unusual that I can typically feel my heartbeat in my chest. So I can feel that the rhythm is irregular when I go into AFIB. Typically I also feel chilled, and Also frequent urination about every 15 to 20 minutes.
Hi Sjorgy, If you are a runner, you might want to get on Dr. John Mandrola's site. He's a cardiologist who has/had atrial fib as a result of his competitive cycling hobby, and has done a lot of research into afib in athletes. He's a balanced thinker who researches the various studies and interprets the results for the rest of us. drjohnm.org Cheers, Diane
Have they considered looking further into your case.Looking at the pattern of your condition it has similarities to mine , I have aFib but it's caused by another combined condition which affects the autonomic nervous system as well as my heart rate and rhythm.
The pattern of timings , plus things like chills, obvious feeling of chest palpitations and frequent urination happening at a similar time to your aFib are all autonomic dysfunction symptoms.
This can be caused by chronic cardiac Dysautonomia like me , but there are also other macro electrical reasons for it , and it can be induced by an imbalance in your electrolytes, kidney dysfunction and dehydration, all common side effects of running.
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