ok .. I have the above that started as one episode every 6 weeks but has now increased to every two weeks . 200mg of flecainide stops the episode in an hour or so . The cardiologist has also prescribed 2x50mg daily - but this seems to be what prompted the episode to increase in regularity !
I’m very fit with a resting pulse of 45bpm . Slightly high blood pressure that is fully corrected by ramipril ( 115/70 now )
The episodes occur almost exclusively at 6-7pm in the evening and are seemingly unrelated to food/drink/exercise / dehydration. Does anyone have any idea that would cause the episodes to occur at this time ? Is this a time where certain blood levels dip ? Certain vitamins etc ??
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Low blood sugar is one of my triggers especially in the evening. If I have been out for lunch I have to be careful not to go too long before having a snack in the evening.
Very intriguing! I presume you’ve tried changing all the variables you can - eg eating differently, adding a snack mid afternoon or not, exercising before or not, sitting differently etc? If it’s always when you haven’t eaten for a while, obviously it could be a slump in your blood sugars, or even electrolytes if you haven’t drunk enough, but it sounds like you’ve considered all that.
When it does happen, is it confined to a certain place, eg when you’re home at that time, or does it happen anywhere, if you were out and about? (For me there’s often a post-relax arrhythmia thing, where I’ve been rushing around or stressed about something and it doesn’t kick in til I relax and rest.)
Interesting question about levels at that time of day. I’m not a medic so could be wrong but I remember hearing that PSH (thyroid) and testosterone are both known to slump late afternoon early eve, perhaps others do too. So you could be on to something looking into that train of thought, when you’ve excluded other factors/ variables. Also have you considered if there’s any correlation with when you take your meds- will any of them be high or particularly low in your system at that time?
I’d be interested to hear if you get anywhere with your investigations! But I hope most of all that the episodes subside again. Jx
Intriguing is a word for it . Bloody annoying is another 😀. I appreciate the response . I think I’ve probably had a casual check back after each episode - but maybe I need to be more detailed . They happen only in ‘ down time’ … never during or after exercise. I will come back to you with my findings . I’m starting to think they may be stress related ( even though they happen during relaxed times ) . I’ve had two attacks two Fridays in a row at 7.00pm after two entirely different days . I know that at 6.00pm tomorrow I will be stressed .
Interesting that my six-weekly episodes increased in frequency when the doc added the 2 a day flecainide on top of just a pill in the pocket for every episode . Maybe I need to ask him if taking it daily can have that effect as mentioned by the reply below.
Good idea to ask about the flecainide, the timing of increased frequency seems suspect, doesn’t it… And re the relaxing, for me it does very often happen in the down time after being stressed or busy. My husband tells me I should aim to stay either permanently stressed or permanently relaxed 😆 Jx
I couldn't take flecainide it did the same to me. I had episodes of fast heart rate and had to be swapped to Sotalol. Apparently flecainide can cause problems arrythmia in some people
I felt worse when on Flecainide, my episodes increased,but I persevered for a few months ,then I started to feel great, no episodes . That’s my story.I am no longer on Flecainide, just beta blockers for now.
Have you reduced your exercise? Or tried a day with no exercise? Or a week? have PAF and cut back massively. I was advised by my sports cardiologist to reduce by 20% in intensity and volume. I have more lik halved it. Over the last year I have kept my hr when running right down to 120-130 mostly. I still do weights and walking which take it higher but only briefly. My episodes have reduced this year, possibly due to this? I am still pretty fit though not as I was. I have had to adjust to that.
I had boats of PAF for eight years they were harder to live with than the permanent AF. I mean now so from what my cardiologist has told me puff almost always progresses into permanent AF I’m no longer taking the FLECANIDE as it’s not rhythm control that’s needed but rate control my heart rate now varies from arresting average of around 78 per minute. It used to be 48 before AF started and now goes up to possibly 159 while exercising hard so even if yours progresses into permanent AR it might be a lot easier to live with that’s what it’s been worth my experience Than PAF
My cardiologist would tell you the heart doesn't like a roller coaster of Flecainide PIP, so this could be the cause of your increased AF. I would get the OK to go on daily Flecainide at 100mgs per day, which may (like me) have to be increased to 200mgs per day to stop it completely.
nb my HR & fitness is not quite as impressive as yours but my cardiologist still did not prescribe a BB or CB with the Flecainide (which is usual) saying that it would make me feel unwell. So far 11 yrs in he has been right.
I also used to get AF starting at the end of the day and put it down to relaxing after a busy day. Suggest you try various lifestyle changes. I tried to even my day so I did more later on and not so energetic in the morning. Also consider taking CoQ10 & Taurine supplements after lunch or dinner.
Maybe vagal tone related? Something is triggering a change around that time. Try resetting it - hold nose, mouth shut and push hard like you’re in the loo for brief moments. There are other ways to reset on YT.
Resting pulse of 45 might have something to do with it. Others have suggested that when in bradycardia your natural beat is so slow that the AF takes over. I think there’s something in this, my resting HR has been above 60 since my ablation last December and stopping the bisoprolol in March, I feel I’m better for it. Good luck working it out.
I have noticed a peculiar sequence of events when going into afib episodes. I get a few ectopics which provoke me into taking my pulse. This is followed by a very slow heartbeat for a minute or two then a short bout of tachy and the afib kicks in. If the ectopics are not followed by the slow heart beat I am ok.
Yep - I can almost feel mine come on 20 minutes before … I feel like my heart ‘bubbles’ , take my pulse and Bp and are all fine … but then the af episode starts. It would be good to know its stress that sets them off as at least I could concentrate on that .
I take flecainide 50mg twice a day, and it works for me 99.9% of the time. you say 6-7pm is when the afib occurs, is that after eating ? what times do you take the flecainide ? I do think it could be vagus nerve as mentioned by others, slouching can bring it on, I can feel it start if I get pressure on part of my back for some reason. maybe you could try sitting fully upright in a dining chair, or indeed try walking around during that period and see if that keeps it away, I think flecainide can bring on atrial flutter in some people
Likewise I’m pretty fit (62) with similarly low pulse. For me, flecanide has cut both frequency and duration of AF episodes. However, it didn’t happen immediately. I’ve a spreadsheet of AF events and it took several months to reach the good place I’m now at. Could be worth persevering.
Your situation is very interesting - in some ways similar to mine, but in some ways different.
I’m a 71 year old fit male.
I take Lisinopril to control hypertension and usually have relatively normal BP levels.
I’ve had AF for about 18 months - initially every 4/5 weeks and caused by alcohol, then, after cutting back alcohol it seemed to be stress driven (which I couldn’t control).
More recently episodes occur every couple of weeks (sometimes less, sometimes more) seem to have no specific cause, and my last one started during an early morning 8 a side football game - earlier in the game my pulse rate had reacted 180 bpm.
I’m almost totally asymptomatic (sometimes feel slightly light headed), most episodes start when I wake up, and stop after a couple of 100mg Flecainide tablets.
Like you I play sport 2 or 3 times a week (tennis and football) so in my case it’s difficult to ease up to keep my pulse down (I have an Apple Watch so can see my pulse rate continuously) - also my cardiologist (who I see every 6 months) told me that exercise doesn’t start AF episodes, and because of my fitness level not to worry about occasional very high pulse rates.
My resting pulse varies but often is low 50’s and another cardiologist (an ablation specialist) told me that people in my situation were often in a strange situation- between needing a pacemaker due to very low pulse as it reduces gradually as time goes by, and an ablation if the consequences of AF episodes start to cause high levels of discomfort.
He also told me that the incidence of AF in top level athletes is high.
Incidentally I was advised not to have an ablation as my level of discomfort during AF episodes is minimal.
Overall, for me, the main benefit of the Forum is to learn from other people’s AF experiences, but it seems that AF is confusing and complicated, and there seem to be more differences than similarities!
Agree on that last paragraph. I almost feel safe from AF only when I’m exercising- my heart shows no sign of stress when I’m exercising ( other than what’s expected ) and the recovery to normal resting pulse in 2 minutes is still as good as it’s always been . I know the usual rule is that PAF turns to constant AF eventually - but I’m not going to give up trying to find a cure or at least the trigger that causes mine …
How different we all are! When I was first prescribed Flecainide to take as a Pip it was for 100mg and it always stopped episodes in a few hours. The maximum daily dose is 300mg. I’m an 80 year old woman and I now take 50mg two hours after breakfast (reduced from 100mg) and 100mg last thing at night. When an episode started before I’d taken the first pill, taking 100mg ended the episode in an hour.
I also had more AF when I took Flecainide 50 mg bd. It also triggered atrial flutter. There are alternative anti-arrhythmic medications. I note in the chat others stuck with Flecainide and things improved. My AF nearly also between 12 noon and 4pm…don’t know why though.
Good luck trying to figure out ‘causes’ of arrhythmias. I’ve given up the ‘trigger’ search realizing it was a knight’s errand. I’m convinced it’s all random and the best we can do is figure out how to get out of the arrhythmia when it happens. Figuring that out is itself quite a mystery while figuring out ‘triggers’ is impossible. Good luck.
After going through six ablations, dozens of cardioversions, and the entire pharmacopoeia, my successful regimen (at the moment) is sotolol, yoga, deep breathing, … and cannabis tea. Fortunately I live in a blue state where growing it and using it is legal. Unfortunately, we are stuck with the orange buffoon once more. I’m surprised that didn’t set me off.
In my opinion AF is a mongrel condition and it will do what it wants, when it wants, as my EP said you may look forever for the trigger and never find it!!!
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