AF, Flecainide & Salt

[Onthebeat]

I have AF and have been on Flecainide for several years. With permission of cardiologist I vary the dose based on my ongoing experience and this seems to work well in managing the AF. I realise we are all different and am definitely not recommending this approach to others. I personally believe what I eat has a significant affect on ectopics and AF and tend to record potential triggers. I have of late been eating a lot of added salt and salted nuts and my latest finding/theory is that cutting right back on salt tends to eliminate irregularity. (I believe that adding salt to water alters its conductivity so ) I wonder if excessive salt in the body can affect the electrical impulses in the heart?? Just a theory.

[BenHall1]

I eliminated added salt from my diet, literally, decades ago. Can't remember when ...... maybe 1990's. My GP back in the day advised this because of its impact on BP. As I aged my BP worsened and ultimately in 2010 I was diagnosed with paroxysmal AF. BUT, I cannot truly, hand on heart, blame dodgy BP and AF on salt (whatever format) as my fathers side of my family have a history of strokes, cardiac issues and AF. That said, minimising salt and sugar can only be a positive.

[Onthebeat in reply to BenHall1]

Thanks for your reply. Yes I agree one cannot put BP or AF down to a single cause and generational characteristics definitely have a bearing. Although known salt not good for us for many years, only now do I realise it’s possibly a trigger.

[CDreamer]

I have to increase salt intake to at least 6g a day to maintain BP. It’s about getting the balance right for you. Sodium is an electrolyte and many people have too much salt because they don’t take into account salt already in processed foods such as salted nuts/crisps. They are my go to if I have ectopics along with hydration & breathing exercises.

Advice on sodium intake is changing as it is recognised that not a good idea to eliminate salt altogether.

[Onthebeat in reply to CDreamer]

Yes agree it’s what’s right for each individual. Interesting that you have also found possible correlation between salt and arrhythmias. I agree with finding the balance but in my case probably was overdosing. Yes hydration also something to keep eye on.

[Alemo27 in reply to CDreamer]

your comments as usual make sense I have noticed that avoid salt completely sometimes give me a huge craving for salty food. This is perhaps helps to keep electrolytes balance. Also, I noticed to have as less food in the intestines as possible helps to prevent AFIB.

[CDreamer in reply to Alemo27]

Smaller meals and no snacking helps for sure!

[AfibSufferer]

I agree Sodium (salt) levels do have an impact. In my experience avoiding having too much salt and keeping well hydrated reduces likelihood of AF attack. Higher salt concentration in the body increases electrical conductivity which makes "rogue" conduction paths more likely. I also note that Flecainide is a sodium channel blocker (reduces conductivity). There's another interesting observation, AF often causes increased urination as the heart secretes a natural diuretic (Atrial Natriuretic Peptide) which increases renal secretion of sodium helping the body flush out excess sodium. It's almost as if the heart has an inbuilt protection mechanism to try to restore NSR by reducing conductivity. So yes, I think there's a strong link.

[Onthebeat in reply to AfibSufferer]

That is all really informative. Thanks for your reply 👍

[JOY2THEWORLD49]

Hi

Hey, interesting thought.

But my AF is now controlled but persistent.

What do others think.

I like a bag of chips now and then but I must stop before the bag empties.

I have favoured KETTLE chips with flavour cheddar cheese and ? forgotten. I also like sweet chilli.

cheriJOY

We do need salt for part of our energy - salt, glucose, lemon/lime juice to keep hydrated.

[Onthebeat in reply to JOY2THEWORLD49]

Hi, I think what made salted nuts worse for me was when one empties the bag you can get all the ‘surplus’ salt from the bottom which I now get rid off.

[Auriculaire in reply to Onthebeat]

You can make your own roasted nuts quite easily by roasting them in the oven with spices and adding as much or as little salt as you want.

[Onthebeat in reply to Auriculaire]

Yes, that’s the way to go. Thanks 👍

[JOY2THEWORLD49 in reply to Onthebeat]

Hi

Yes, I know what you mean.

Also broken chips seem to have salt cling to them.

Now I have the occasional fish and chips unsalted. There is already salt in the batter of fish without extra.

I wonder if everyone uses iodized salt and if it is iodize overload that causes the thyroid to react that caused the AF.

Interesting thinking.

Problems with thyroid cause AF.

cheri JOY

[Ppiman]

You would hope not and it's safe to say that there should never be any excess or lack of sodium in the blood that nourishes the heart muscle thanks to the vital metabolic process of homeostasis.

Excess sodium ions are near instantly removed from the bloodstream by the brain and kidneys which respond by releasing powerful steroids. The kidneys also react by conserving water by concentrating the urine and by bringing us to feel less thirsty.

I have a theory about the link between diet and arrhythmia. I suspect that most often it might not be different foods that affect AF, but the heart being directly and physically disturbed by its anatomical closeness to the gastro-intestinal system. Both the oesophagus and the stomach lie adjacent to it and the the intestines swell and push the stomach higher into contact with the heart. Such pressure on the heart has been shown to spark off ectopic beats and these, in prone individuals, can set off AF.

Steve

[Onthebeat in reply to Ppiman]

Thanks for your reply Steve. You obviously have a greater understanding of salt levels in the body than I have but all these theories are interesting. Tbh Anatomical proximity is something I had not considered.

[Ppiman in reply to Onthebeat]

Me too until a specialist showed me my heart on a scan - pressed against and slightly distorted by my stomach pushing against the diaphragm muscle below. He explained that this natural process can cause ectopic beats t form, and (although not till many years later), set off AF.

I spent many years with a pharmaceutical company that gave me my fascination with health (but a little knowledge can be a dangerous thing so maybe take what I say with a pinch of... salt! )

Steve

[Vonnegut]

I’m sure we all learnt salt isn’t a good idea some time ago!

[Onthebeat in reply to Vonnegut]

Yes in general I’m sure that’s right, just never looked upon it as a trigger for ectopics and AF before.

[Vonnegut in reply to Onthebeat]

I don’t think I knew that either but guess I’m fortunate that I have never liked very salty or sweet stuff or highly spiced food either. As we all know (but doctors don’t appear to) we are all different so must find what works for us as individuals. Good luck finding what works for you and what you should avoid!

[OzJames]

I find getting dehydrated opens the door to ectopics which in turn can flip me into AF. You mentioned you vary Flecainide, by how much?

[Onthebeat in reply to OzJames]

I think hydration is probably one of most important considerations. Varying flecainide is a very personal thing and may be counter productive in many cases. I normally take 50mg bd. But if I go into AF will take an extra 50 or 100mg when it starts and usually goes back to NR within a few hours. Can take up to 100mg bd but rarely do that. But that’s just me. Not recommended.

[OzJames in reply to Onthebeat]

I find that Flecainide can lower my HR too much so Cardiologist and I agreed to lower to 25mg. I do take low dose metoprolol with it as well so he felt the combo both affects the lower HR. My normal HR is around 60 on no drugs and in AF about 80-85. The new adjustment seems to work ok. Prior to that I was only on the metoprolol and going anywhere from 4-10 months between episodes. So far the lower dosage seems to work ok

[JoniM in reply to OzJames]

I am also on flecainide (50 mg bid) and metoprolol which has been reduced to 25mg once a day, at night before bed. Curious as to what dosage of metoprolol you are taking OzJames. My resting heart rate on these drugs is around 47-53 on daily basis and still struggling a bit with fatigue. I’ve thought it was the metoprolol that was the culprit, hadn’t considered the flecainide to also lower HR. The good news, haven’t had any episodes of afib since March 5, 2023 after almost daily episodes so happy with that!

[OzJames in reply to JoniM]

Hi Joni in some people Flecainide especially with a BB can have an affect on rate. Due to my normal rate being low anyway then when on your your dosage my rate would be 42-50 so I experimented with Doctor's approval. We reduced Metoprolol to 12.5 twice a day and rate was 45-early 50’s then Flecainide to 25 twice a day and I’m now 55-60. I must say I do test the edges of my tolerance. My Cardiologist is relying on me giving honest feedback and at the moment there’s no AF or feeling that I could flip. I will continue to test and the risk is I could flip if I go to low. Last year I was only on Metoprolol and reduce it down to 10.5 twice a day and was going ok then tried 7mg and on a stressful day when I’d forgotten to drink water I flipped into AF in September after being 10 months free.

I’m also on magnesium Taurate and glycinate at one each day and Vit d3 2000iu and coq10 at 200mg per day. I did test for all 3 and was low in each.

As we get older the body sometimes can’t absorb these important nutrients. This is not advice and you have to do your own research as we are all different

[JoniM in reply to OzJames]

thanks my situation seems similar to yours and I also tend to push the limits .might see if I can get the metropolol and/or flecaide down a bit more as I think would be happier with a rate more solidly in mid to high 50s . Also taking magnesium, vitamin D and B12 . My cardiologist and PCP are into “shared decision making” which helps with this trial and error approach and I am very happy to be afib free for the past year and need to balance that with the issue of fatigue.

[AustinElliot]

Hi Onthebeat,

I am convinced that excess salt from Powerade and Tyramine (from Parmesan) lead to several of my AF episodes. I was starting to get them once a month around this time last year. Its now back to once every 4 months (hopefully) after I cut back on the 'added' salt and watched my Parmesan intake.

I know I abused myself by work in the excess heat and sweating out tons of salt, so dehydrated, yet I am convinced I over compensated. I get that maybe it did not give me AF, but after 10/15 years of Hot Texas Summers, I am sure it contributed.

[Onthebeat in reply to AustinElliot]

Hi Austin,

There is salt in a lot of things I didn’t realise. Never thought about it in cheese and eat a lot of that. Hot Texas summers must have one heck of an upside though!

[AustinElliot in reply to Onthebeat]

10 years ago I saw the upside, with climate change, there is no upside. We had 5 days of below 0 degrees two years ago, and a heavy ice storm last year that killed 20+ nice trees and our yard entirely.

Than you have drought and 110 degree summers.

Nah its time to move on. Thanks

[Onthebeat in reply to AustinElliot]

Get the picture. No upside. Take care buddy.

[CarolinaRabbit]

more than likely it’s salt making you dehydrated and dehydration is a trigger

[Onthebeat in reply to CarolinaRabbit]

Yeah, that makes sense,