silly me back in AF, what PIP dose?

[OzJames]

feeling great last 4 months since last CV. Have been in Fiji with my wife and leaving tomorrow but AF hit me this morning.

last night was Indian buffet so silly me decided we should go. I tried to be sensible but I guess all the rich flavours and desert I woke up this morning feeling fine and did my usual routine of sits ups and push ups and bingo I could feel the AF. Interesting I checked my HRV and when I got up it was around 40 within my normal. At the time of AF about an hour later 250.

I’ve tried to get in touch with my cardiologist PA to ask what dose PIP to take, Today I’ve taken 100mg then 2 hours later another 50mg no resolution yet does that sound right? It’s 2.30pm and not sure what dose to take tonight?

2 years ago we went on holidays when I was in AF and was given 100mg bd for 3 weeks till we got back then a CV. Last September I had a CV and was put on Flecainide for 4 weeks post CV at 50mg bd.

Did I take the right PIP dose and what about tonight’s dose. I’m sure I’ll hear back by tomorrow. I’ll start the Apixaban tonight. I’m so annoyed at my self as I’ve had a great 4 months

[CDreamer]

You don’t say dose of what? If it’s a PIP and at those doses I’m guessing Flec? If so, everyone’s dose seems to be different but when I was taking Flec as a PIP - I would take the maximum daily dose of 300mg all at once within the magic first hour of AF starting.

300mg is the MAXIMUM dose within 24 hours so whatever you do, stay within that limit. I think maybe the morning exercise following the meal………..

I was talking to a cardio trainer recently who said that traditional push ups are the worst thing to do for arrythmias. They recommend a modification -standing push ups against a wall.

Hope AF abates soon - keep well hydrated!

[OzJames in reply to CDreamer]

Thanks yes its Flecainide… I ended up taking 150mg but some 6 hours have passed and still in AF though rate seems controlled. I might take another 50mg in a few hours though they won’t be 12 hours apart it’s about 7.30pm here

[Vonnegut in reply to OzJames]

When I took Flecainide as a PIP I was told to take Bisoprolol if my heart rate was still high 20 minutes after taking it. It rarely happened to me but I didn’t do the crazy stuff you do!

[RiderontheStorm]

300 MG one time works for me within 3 hrs. As soon as I notice AFib I jump into action with 30 push ups or movement of some type. I normally wait for 12 hours or the next day within 24 hrs to take the Flec as it kicks my Arse with exhaustion if I have not converted naturally. **This time this week was unusually scary as I awoke with BP of only 55/60 BP.. I immediately took the dose and ragained my compose and BP slowly as NSR returned. Not going to wait that long again for fear of sudden heart attack or stroke from Hypotension.

[OzJames in reply to RiderontheStorm]

Ok I guess that’s the max permitted in a day. No wonder the 150 I took didn’t put me back into NSR. I took another 50 later in the evening and still no change. Taking the 300mg in one hit I’d say works like the shock you get from exercising or a cardioversion

[Iamfuzzyduck]

Dr.N told me to start the blood thinners if the afib has been going on for five hours. I wouldn’t wait …

[secondtry]

Don't be too critical of yourself, it is so easy when feeling well, particularly on holiday, to get complacent - but do learn from it.

Just saw my cardiologist and he repeated the Flecainide maxim, no more than 300mgs in 24 hrs. Working within that limit I would say it is important to make sure it stops by upping the PIP; the longer it lasts the more the heart gets used to 'slipping out of gear'.

Hope you are sorted now.

[Hidden]

We can't advise on medication, as of course you know, but I personally take 200mgs of Flec as soon as an episode starts and so far (fingers crossed) it usually stops the episode in about an hour. I've tried taking a lower dose and it has never worked, not once. When I then 'top up' to a total of 200mgs (ie if I took 100, I take another 100, if I originally took 150 I take another 50) several hours into the episode it has always stopped it almost immediately.

Of course, we are all different. That's just what works for me. Sorry you've had a resurgence of the dreaded AF! Hope you get back to happy NSR very soon.

[OzJames in reply to Hidden]

Thanks for reply yes I know we’re all different. I suspected my dose was a little low as a result I’m still in AF but HR is well controlled. The cardiologist suggested Flecainide as PIP but never suggested a dose. I thought I’d take the same as I was given for a few weeks before a CV which was 100mg. I’ll contact his office Monday and get some advice as I’d rather have another CV than stay in AF

[OzJames in reply to Hidden]

Just a quick question when the PIP works for you do you take any further Flecainide that night or next morning or is the one hit Pip all that you do?

Cheers

[Hidden in reply to OzJames]

Just the one shot. It's worked for me every time so far (fingers crossed that that continues!). I'm currently having one episode about every 10-12 days and don't take anything other than the one dose at the onset of an episode.

[OzJames in reply to Hidden]

good luck with it. Have you been able to work out what triggers your episodes?

[AustinElliot]

Ah, yeah my EP started me on 50 mg of Flec (and was vauge on the rest) That has never worked.

I tried 100 mg at my last AF and then 100 mg 1 hour later, that knocked it out in about another hour.

At my next episode I plan to do either 150 mg and then another 50 mg or try the 200 mg other folks talk about.

Hope it improves

[OzJames in reply to AustinElliot]

Thanks for reply, yes I think I needed to give it a bigger upfront dose. I’m still in AF 2 days in and he told me to stick with 50mg morning and night to see if things change back to sinus in a few days but I’m not feeling like it will. However it does quieten down things where I don’t feel the AF other than my Apple Watch buzzing me every few hours to say I’m in AF.

When you mention your initial time at 50mg that didn’t work did you maintain that dose daily?, how long where you in AF before it went back to sinus?

Thanks James

[OzJames in reply to AustinElliot]

Curious but do you take any further Flecainide once your back in sinus that evening or next morning?

[AustinElliot in reply to OzJames]

Hi James,

So far I only take Flec as a PIP. No daily dose. In the past I have self converted after 8-12 hours. Five episodes I believe

The Flec has been hit and miss. First time was in hospital with 50 mg, that did nothing, two times converted after PIP 2-3 hours (50/50). And one time I just self converted in the morning after going to sleep with AF, about 8 hours later.(100/100)

So my plan is for the next AF to go to 150 mg, and then 50 mg 1/2 hour later to see if that does it. Might even do another 50 mg 1/2 after that and max the dose out, don't know.

Overall I am just bidding time until my August date with Dr. Wolf for the Wolf Mini-maze. Hope you are doing better.

[OzJames in reply to AustinElliot]

Thanks… im guessing your name is Elliott from Austin? anyway I’ve always self converted with vigorous exercise up until 2022 and since then its been a cardioversion a few times I’m due for another tomorrow as my PIP was too low and didn’t do anything. It’s an interesting beast as my episodes were on average 5 years apart over the last 30 years up until 2022.

I spoke to an EP in December who now does RF ablation for Flutter up one catheter and the other leg Pulse Field for AF. He said he’s done over 1,000 RF but only about 70 Pulse as it’s newish here Sydney. I’d have a serious look at the WMM but nothing here yet though Japan is about a 9 hour flight. I’d be keen to know how you go after the chat

[AustinElliot in reply to OzJames]

Hi James,

Yes its Elliot from Austin, Texas. So a short 2.5 hours from Houston. There are a lot of interesting ways of dealing with AF. Since we are all individuals, it seems there are no right answers.

My first episode was in 2019, than not again until 2022, I finally figured I need to see a doctor in 2023 to find out what it was, and pretty shocking to find AF. I am now going on 2 months since my last AF, hopefully it will go longer.

I have met lots of folks that are going to Japan, If my insurance did not cover it, I might consider it, seem fun (if not for AF).

[snak3eyes]

Your heart rate was 250 bpm when the afib episode started ? And what was your bpm after taking flecanide ?

Also, I'm not sure you should take anticoagulants only when afib starts. According to the European afib guidelines, anyone with a CHA2DS2-VASc score greater than 1 should be on anticoagulants.

And how are you feeling now ? I hope you get into NSR asap if you didn't already.

[OzJames in reply to snak3eyes]

Thanks for your concern… I was referring to heart rate variability. My actual HR was 85 at rest when I went into AF. My chad score is 1 and doctor said only as PIP unless things change. The AF is still with me so I’m booked for a cardioversion tomorrow., a bit nervous but I’m staying positive

[snak3eyes in reply to OzJames]

HR of 85 means that your afib is under control. Don't stress too much, stay positive and busy until cardioversion.

Too be honest, I would have been very nervous if it's an afib with rvr, with pulse staying at 180 bpm or higher. I don't know what to do in that situation.

[OzJames in reply to snak3eyes]

Yes I’ve seen some people with that high rate, mine was at rest obviously if I go for a brisk walk it starts to climb into the 130-140 range but now on the drugs the HR at rest is between 65-75. I’ve just returned from a breathing class which teaches us to focus on breathing through our nose, definitely more calm after