I’m having afib breaking through my daily portion of 200 mg of Flecainide (Tambocor) lately, after a quiet time (2 months) with no Afib at all.
Now almost daily and some days even 3 to 4 incidents. I presume the culprit is increased psychological stress (my mother in law with dementia stayed over for a week) , and from then on the daily Afib became the stressor. Kind of a vicious circle…
Any suggestions how to break this circle? I tried excercising but then my heart rate skyrockets….. I must add that I’m quite symptomatic: fish flopping in my chest,, diziness, and frequent urination.
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(Afib)almost daily and some days even 3 to 4 incidents.
Sorry to hear that and yes, stress can be a big trigger. Are you sure these events are afib and not another tachycardia like flutter, or even runs of organized ectopics such as bigeminy or trigeminy? All can be caused by stress. If you're not sure, get an ep taken during an episode or have your doctor hook you up with a holter. If either is not feasible now, get yourself a Kardia or Apple Watch which will capture the events with a medical grade ekg.
Thanks for the reply, Jim. I have an Apple Watch and a Withings Scanwatch, on both of which I can record a simple ECG. This one was made with the Scanwatch a minute ago. It clearly show the irregular HR and the missing P-wave typical of Afib.
Not familiar with the ScanWatch. Does the Apple Watch ekg also show missing "p" waves? Also, are your afib episodes usually with such a low heart rate? Of course you could have afib with any heart rate, but most of us have higher heart rates in afib.
Hi Jim, yes, the Apple Watch shows the missing P-wave too. This EKG was made resting and thanks to the 2,5 mg of Bisoprolol that I take in addition to the Flecainide, my HR stays within acceptable limits. Although it goes up to 135 when exercising. Too high for comfort. When the afib starts, the resting HR is also higher, more like 105.
My cardiologist says I can take the maximum of 400 mg. a day when necessary, but I try to avoid that. I’ve had ‘clusters’ of breakthroughs like this before, but usually they last 10 to. 12 days max.
This one started 16 days ago and is still counting. So I’m starting to wonder if I should change the Flecainide to Disopyramide, which is supposed to work better for vagally triggered afib?
I know exactly what you mean about the vicious cycle of anxiety, causing Afib. If you have not already done so I would recommend learning some simple anxiety control techniques. Breath control generally is a good thing to learn but in a very anxious moment, when you feel anxiety building, immediately focus your attention instead to something as simple as the weight of your body in the chair you are sitting in or the feeling of your feet on the ground. It is surprisingly effective. Even just observing the anxiety as if from outside and as just a feeling, can help.
Thank you for your advice. I’m seeing a psychologist for my anxiety, but this time it was triggered by an unforseen event that cought me defenseless. And it’s a vicious circle: once Afib rears its ugly head on a daily basis, it’s getting harder not to be nervous about avoiding triggers. Which for me are: don’t miss a burp, don’t get up too fast, don’t eat too much, breathe slowly, don’t drink something too hot or too cold, don’t bend over too far, etcetera… A constant ‘being on the lookout’ that exacerbates stress, … and there’s you’re full circle.
But I’m seeing the shrink on Friday, so we’ll work on it. But any advice on escaping anxiety is welcome, as I forgot the second hint you gave me: look ar it as from a distance. Thanks
This happened to me on Flecainide ( and Bisoprolol). I went from infrequent episodes to monthly, weekly then every two days. I had an RF ablation. After a bumpy recovery period I have only had a 1 hour episode since October 2022 ( which was my fault). I know it is probably only a temporary fix in the long term but anything that can slow down it's progression is worth it. Obviously I don't know if you have other health issues that might counter indicate an ablation but It might be interesting to have a chat to your Dr about it ( or better still an EP) while you are still in Paroxysmal Afib ( better chance of it working I am told). Take care
Thank you for your much appreciated advice. I have considered ablation, as my first cardiologist who treated me after my heart attack mentioned it immediately.
After that massive attack, I did every possible thing in my power to limit the damage to and remodeling of my heaert muscle, by cardio-training and medication. The damage therefore is surprisingly limited and I’m still exercising vigouresly every day to keep it hat way.
That is precisely one of the reasons I have decided not to go the ablation route: I would feel very uncomfortable having my heart damaged on purpose, to treat a non-mortal condition.
Moreover, one of my best friends is a retired cardiologist, who also has Afib, and he agrees with me wholeheartedly.
I know that ablation can be succesful, but the average practical succes rate of 60 to 70 % for the first one is not very attractive to me, and the risk of approx. 1 chance in 500 to suffer serious side effects and unforseen damage to heart and oesophagus is too high for my standards.
This said, I’m very glad to read that for you everything worked out perfectly, and I admire your courage. Stay well and happy!
I understand. If you are not sufferering any symptoms while having the episodes and are able to live normally then it seems it suits you best to continue as you are. It sounds as if you have a full and active life which is not disturbed by your AFib.
It took me two years to decide to go ahead as I kept going over the risks but all went well except the EP said I had an asthma attack while under GA -except I don't have asthma. But I do have have terrible spasms if the slightest bit of water goes the wrong way - I can only breathe in and gulp for a minute or so and am unable to breathe out at all. I expect that's what happened as the nurse was aspirating the airways after the procedure before I was woken up.
I wish you all the best and hope you find a medication that suits you . 🙂
If I know something stressful is on the horizon, I try if possible to reduce stress elsewhere & double down on other lifestyle choices to compensate.
Apologies for adding a 'shutting the stable door after the horse has bolted' comment but maybe a useful reminder to all of us to bear in mind when unwelcome life issues are predictable.
I take 200mgs Flecainide & my cardiologist says 300mgs in 24hrs is max.
Just in case, are you taking Flec on a completely empty stomach (3hrs after a meal) and not eating for an hour after taking it, as I understand if not as well as making you feel nauseous it can reduce its effectiveness.
I have found this enforced eating gap good for me as I used to snack too much in between meals. Regularizing the digestion system is I believe of prime importance in holding AF at bay.
I have come to believe that AF is triggered for most people by a combination of factors. So if one becomes unable to control eg a difficult for whatever reason family member, I might avoid more gluten, more sugar, go on an extra Nature walk & before bed watch a light romcom film and before bed say an extra prayer.
On the only occasion I had an episode while taking 100 mg of Flecainide twice daily an extra pill ended it in a few hours and it turned out it must have been a result of being infected with covid which I tested positive for ( no the symptoms - tested after our daughter who we’d seen the previous day reported she’d tested positive!) Of course we know we are all different but when I used to have AF episodes I was told to rest and I would do gentle breathing or meditation. I hope you find what works for you. My Kardia was very helpful at tracking things but now I hardly ever use it as I have been free of episodes for well over a year now.
I use my Withings Scanwatch to monitor my heart rate and detect Afib, but I know deep in my heart that I’d better throw away the bloody thing, as it focuses my attention on the condition, causing more stress. Acting as if ‘it does’t exist’ is really hard though, in my case, as I’m very symptomatic. I envy those lucky people who don’t have the fish flopping in their chest. 😉
I did always feel when my heart went crazy and would then check with my Kardia and then every 20 minutes or so until things were back to normal which never took long after Flec PIP of 100mg.
about 2 years. Was in Sotalol before, for 4 years. But as my afib is mainly vagally triggered, Sotalol was not ideal. I had less breakthroughs but they lasted much longer, up to 24 hours.
hi. Just curious are you on Flecanide twice a day? Reason I ask is that I decided to cut my evening one out for about 3 months results I went into permanent Afib and was admitted with very high HR. They got me down a bit then did a cardioversion. That was November. I’ve been taking my 2 a day since then. Learnt my lesson and 🤞all clear. Good luck
I take is as ‘pill in pocket’ now, but as I have attacks every day, that boils down to 200 mg. in one daily portion. I could take the double as per my cardiologist, but I’m reluctant as I do not want to risk an overdose.
Before I took the slow-release formula, 150 mg/day. I think I will go back to that solution and add 200 mg. fast-acting when Afib breaks through. Today’s episode is 6 hours and counting. Not what I want! 😉
It sounds like your anxiety is exacerbating the AF. If you are vagally triggered then you could try sitting quietly for a good 5 minutes after every meal just tuning into your body and taking slow breaths. I slow my breathing down to 6 rounds a minute. Breathe through your nose as this helps the rest and digest mode to kick in. Sometimes if I'm feeling like I'm full even half way through a meal, I take a few minutes out to do that and then finish off afterwards. I probably have gut dumping syndrome due to abdominal.surgery almost 50 years ago so I'm often triggered during or immediately after eating. Which is of course very upsetting in itself. But I have found this approach of gentle slow breathing seems to help.
Very valuable advice, I think. An attack often starts while getting up from the table after finishing my meal. And yes, certainly anxiety related. Thanks!
It is not unusual if a medication doesn't work for you. Perhaps you need to up your dose or try another medication. I was put on several different medications, some taken together and it did not control my AF. Ultimately, I had an ablation and so far (4 years and 4 months) no AF and no meds.
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