AFIB durations.

[beach_bum]

Hope you all are enjoying you spring. 🙂

I have been AFIB free for a couple of years now, with the exception of 1 episode a couple of months ago, which 811 recommended I go to the ER (always on weekends eh?) to get a conversion back to NSR. After several hours of having blood taken, hooked up to monitors, I went back into NSR before any conversion. I went home, all good and carried on with my retirement routine…morning hikes with the dog, 25-35k rides on the gravel bike etc.

Friday morning while walking hiking, I noticed I was feeling unusually fatigued going up a hill…a sure sign. Anyway, I was back into AFIB, so again called 811, and they told me if I wasnt back into NSR within a 24 hr period to go to the ER (again with the weekends). So it’s Sunday, Fathers Day, and off I I’ll be going *sigh* I also have an appt with my GP tomorrow morning, but I don’t feel like spending another 24 hrs in AFIB.

Question is, is it normal to be in AFIB for days? I’m on 180 Diltizem and Xeralto for over 2 years since it started. I have no side effects.

[mjames1]

It's normal to be in afib for days, but not necessarily desirable.

My ep for example, wanted me to call him after day three of an afib episode so he could arrange an electro cardioversion by day five or six.

Going to the emergency room A&E) for an immediate cardioversion is another option at least in the United States.

Later I got qualified for the anti-arhythmic medication, Flecainide, which always cardioverted me within 2 to 4 hours. So no more cardioversions and no more emergency room visits 😀

Jim

[beach_bum in reply to mjames1]

Good to know 🙂 Update…I decided to walk the dog around the block (it’s a flat 1.3k stroll) , quite a crisp spring morning here in “the Colonies (Canada) and don’t know if it was the crisp air, the brisk walk, but not even halfway through i went back into NSR, and still holding 20 minutes later…the cold air? The brisk walk? Who knows. I also had been trying valsalva/cold water on the face, deep breathing exercises…to no avail. Anyway, I’m going to stand down with the ER visit, and keep my GP appt for tomorrow morning, and see If I can adjust the meds to something more stable.

Thanks so much for the feedback 👍🏻

[mjames1 in reply to beach_bum]

Great news! Once I had my rate controlled, going for a walk often put me back into normal rhythm.

Moving forward, you should definitely consider PIP Flecainide, which in most cases can reliably convert you to normal rhythm in one to four hours. But at least in the US. that would have to be prescribed by an electrophysiologist, not a GP.. When I mentioned Flecainde to my GP, I quickly realized he didn't know much about it.

Jim

[beach_bum in reply to mjames1]

Thanks again! When I mentioned PIP to my cardiologist and GP, they both said no, not on top of a BP/HR med. By itself, maybe, if I had a condition that was normally under control by itself without meds. But I’ll mention it again tomorrow, who knows, maybe do some presto-switcho with meds works 🙂 That would be the ideal for me…”oh! AFIB again *pop pop fizz fizz of what a relief it is!” Sorry for the old Alkaseltzer reference 😆

[mjames1 in reply to beach_bum]

GP's and even many cardiologists are scared of Flecainide primarily because they're not that knowledgeable about it. The person to prescribe it would be an electrophysiologist (ep). Many people who take flecainide are on blood pressure meds, including myself. As to rate control meds. It's usually important to take them with flecainide so they are certainly not contraindicated..

Jim

[beach_bum in reply to mjames1]

I will certainly inquire! Diltizem is a BP and rate control drug, and I take the once a day slow release 180mg. Maybe that is why they said no? who knows, I’ll find out.

And btw, it was the EP who recommended Diltizem, so I’ll talk to them.

[mjames1 in reply to beach_bum]

Diltizem is a BP and rate control drug, and I take the once a day slow release 180mg. Maybe that is why they said no?

Diltiazem is routinely prescribed alongside Flecainide for protection. I took it every time I took Flecainide and so do thousands of others. 180mg slow release it's not a particularly large dose not that it would matter.

Again, Most GP's and many cardiologists don't know how to prescribe Flecainide and that's why you really have to seek out an electrophysiologist (ep).

Jim

[beach_bum in reply to mjames1]

I will certainly bring up that point 🙂

[mjames1 in reply to beach_bum]

Good luck telling a GP or Cardiologist that they don't know what they are talking about 😀 When I get to that point, I just switch. But do report back!

Jim

[beach_bum in reply to mjames1]

I don’t get drug referral or dosage amounts from them, it’s the EP who does that. The Cardio did the stress test, imaging and mapping, the GP consults with both the EP and cardiologist who are all in the same office, he just records the incidents, recommendations and results.

[sunlovah in reply to mjames1]

My Cardiologist prescribed flecainide PIP, but no beta blocker, I have asked twice If I need one, was told 'no'. Originally told 50mg PIP then if no NSR another half an hour later, the A &E if still didn't work. (Which it didn't, so had another cardioversion). On speaking to arrhythmia nurse later (who seemed to know her stuff) she was surprised at dose and commented that small dose wouldn't work, needs to be at least 150mg. I have lost confidence in said Cardiologist, haven't seen him yet to query small dose.So she has prescribed 200mg as a PIP , I have not taken yet, what side effects may I expect when I take, will it wipe my day out? Is this comparable with your dose? Thanks

[mjames1 in reply to sunlovah]

Let's define "PIP dose" as the dose of Flecainde you take to convert from afib when there is no Flecainide in your system, as might be the case if you're on daily flecainide.

By that definition, my PIP dose was to take 100mg at the onset of afib and then take another 50mg an hour later if still in afib. Later, I was told to take 150mg at onset and then another 50mg an hour later.

In practice I converted 30 per cent of the time with the initial 100mg and 100% of the time when I added the extra 50mg an hour later. Never had to take 200mg to convert.

In your case the 50/50 recommended by your cardiologist is on the low side and only would have converted me 30 per cent of the time. The nurse's suggestion of 200mg PIP seems reasonable, but you might ask them why not start at 100 or 150 and then add a bit if needed? Also keep in mind that in general, you should never take more than 300mg of Flecainide in 24 hours for afib, but that can vary by patient. My maxium 24 hour limit was 200mg, including any Flecainide I had in my system from taking it daily.

As to taking it with a nodal blocking agent -- beta blocker or Diltiazem -- at least in the US, this is usually the case for safety reasons although some ep's do prescribe Flecainide with a nodal blocking agent. Something to discuss with your nurse. It could be as simple as taking "x" mg of "y" 20-30 minutes before your first PIP dose of Flecainide.

Jim

[sunlovah in reply to mjames1]

Thank you, do you take flecainide daily and gave a top up PIP dose? I'm only taking thinners at the moment. I will discuss with nurse dose and beta blocker, although she has advised to go to A &E to take first dose, I'm hoping that they may know.Taking beta blocker'for safety reasons although some'...what could be the implications? Would this still be the case as a single dose PIP?

[mjames1 in reply to sunlovah]

do you take flecainide daily and gave a top up PIP dose?

I've done it both ways. Daily Flecainide when my afib episodes were frequent and PIP only when my afib episodes were infrequent.

Most of the time I was on daily flecainide and used an extra (PIP) dose when needed, which was very infrequently. During this period, I was on daily Diltiazem, which served the same nodal blocking function as a daily beta blocker would, however I tolerate Diltiazem better. When I was not on daily Flecainide, I would take the Diltiazem 30-40 minutes before my PIP Flecainide dose. Keep in mind that when you are on daily Flecainide, you have a certain amount "on board" which your ep will factor in to your PIP instructions. In my case that meant taking less Flecainide PIP when I was on daily Flecainide.

Since my ablation I have been off daily Flecainide but still keep it around as a PIP in case I need it.

Jim

[Fishingqueen]

I always go out or my heart acts up on the weekends too!! 🙄 what is up with that. I had been in aflutter for 12 weeks and got cardioverted 4 days ago. Had been 2 years since I had had trouble. Tonight I went in afib for a couple hours. I am still on my eliquis tho so wasn't going to go to ER. The small one near me doesn't cardiovert anyway.. have to go 2 hours from where I live. I live in a very rural area. I need to go check again bc I feel my heart flopping. Could just be pvc's but could be afib too. Aflutter is much more regular just fast. It's so annoying. I only made it 4 days. I have had a horrible headache most of the day too. Ugh

[beach_bum in reply to Fishingqueen]

I find food seems to be my trigger. Just a bit too much of a portion for a late supper, and going to bed too soon after that will trigger.

I also wear an Apple Watch (some prefer the much cheaper Cardio mobile) and it has an EKG feature which is very handy for determining if you are in or out of AFIB. It also records events for your doctor or ER staff. It does not record heart attacks.

[Vonnegut]

Flecainide taken as a pip stopped my episodes in a few hours and now I take it regularly I haven’t had an episode for well over a year so I don’t take anything else for my heart. Hope you find something that works for you, as we know ( though doctors don’t seem to) that we are all different!

[beach_bum in reply to Vonnegut]

Oh yes, that is the very first thing they told me when I “suggested” things I had been suggested to me on this forum “everyone is different with many having other comorbidities or ailments” To be fair, the Diltizem 180 and Xeralto has worked like a charm for almost 3 years, with only 2 episodes, but the latest was over 24 hrs in duration, and that’s why I’m seeing the doc this morning. He may recommend upping from 180 to 240, a PIP, or who knows. Also read some disturbing news about Diltizem/Xeralto combos causing internal bleeding, so I’m bring that up also. Apperantly that is not an issue with Diltizem/Eliquis.

drugs.com/drug-interactions....

[Vonnegut in reply to beach_bum]

What are you taking as a PIP? It should be Flecainide as that’s what works on the electrical parts of the heart.

[beach_bum in reply to Vonnegut]

No pip. My EP, Cardio and GP were all in agreement that it was not a good fit for my particular case, as it would expire before I got to use it as I have only had 2 episodes in 3 years, and both resolved themselves. I just take 180mg slow release Diltiazem daily.

[Vonnegut]

Don’t know what that is but slow release sounds a good idea and if it works for you that’s great!

[beach_bum in reply to Vonnegut]

It has been working perfectly until the other day. Turns out exercise converted me back to NSR, but still would like to know if a PIP can be used in conjunction with a slow release daily calcium chanel blocker. Or maybe up my dosage, but I don’t want something that will make me feel like a vegetable. That happened with beta blockers, couldn’t function like that.

[Vonnegut]

I know what you mean about the beta blockers! The lowest dose proved too much for me to take! Wish I could manage exercise as I used to but just gentle very short walks are all I can manage now though I am over 80, so fortunate to still be alive with my brain still functioning!

[beach_bum in reply to Vonnegut]

I’m 69, and am very active…daily hikes and 25-35k cycling 3-4 times a week. The beta blockers wiped my energy levels out, so they quickly switched me to calcium Chanel blockers, and it is just like I wan’t an any drug. Back to my old self…but every single person is different.

[Vonnegut in reply to beach_bum]

That’s great for you but you are a fair bit younger than I was when my paroxysmal atrial fibrillation struck along with chronic fatigue as a result of a virus when I was unable to get an appointment at our surgery when an antiviral might have saved me! I was fit, active and healthy until then when I was 75 and i have made it to 80 with my brain still working well!