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Looking for feedback from anyone on diltiazem and propafenone combo post ablation

FibChick profile image
11 Replies

Hi. I am hoping for some feedback from others with similar medications. Had a PFA AFIB ablation at the end of September (3 mos ago). Since then, my EP has cycled me through sotolol, Metoprolol, Mexiletine, and diltiazem to try to get heart rate (periodic SVTs) and rhythm (frequent PVCs, ranging from 4 to 22 PVCs in 60 second Kardia mobile readings) to settle down. All of them made me non-functional and didn't really provide decent control. I was on Diltiazem only for about 30 days, until it was making be so dizzy that it was unbearable. As of a couple days ago, I was put on propafenone 150 mg 2x day and diltiazem (now 30 mg 2x day, down from 4x daily). Today my HR dropped to mid-50s walking around, and BP down to 76/55. I have a call into the EP office but it can take a couple days to hear back from them. I do have Holter monitor appt to assess PVC load in late January (earliest available). I am wondering if anyone has had similar challenges with BB, CCB, and arthmia medications, and the combination of propafenone and diltiazem? So sorry if TMI!

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mav7 profile image
mav7

Today my HR dropped to mid-50s walking around, and BP down to 76/55.

Are you monitoring your heart rate and blood pressure to get an average ? Any concerning symptoms like breathlessness ?

Use your judgment, but would not rule out a trip to the ER if blood pressure remains or averages below 90. Would also call again to EP's office to expedite care.

FibChick profile image
FibChick in reply tomav7

Thanks! My BP fluctuates quite a bit, in the normal range half the time, and a bit elevated 125/80 the rest of the time. HR with light activity typically in 80/85 bpm range. No breathlessness. Today's rates were an anomaly so wondering if it could be the combination of meds, if anyone has had anything similar.Unfortunately calling the EP office is an exercise in futility...they toss you into a voice-mail that never responds or tell you go to ER. These are "the best" rated cardiologist group in the area, and this response is unfortunately not that unusual for specialists in the area of FL that I reside. Only decent ER is ~60 minutes away, if you aren't actively symptomatic there's nothing to treat - had this ER experience in December when I had Tachycardia >60 min and chest pains. Local hospitals have literally worst Health Grades ratings. My bad pick on where to live. Feels like I'm on my own with this. Sorry to vent, and really appreciate your response.

mav7 profile image
mav7 in reply toFibChick

HR and BP seem good.

Best to You and hope you find good care.

Buffafly profile image
Buffafly

I used to take Propafenone and Diltiazem before my ablation - 150 x2 Propafenone and 240 Diltiazem. Turned me into a zombi but didn’t have the same effect as you describe. That is a tiny dose of Diltiazem so it must be the Propafenone doing the damage.

Buffafly profile image
Buffafly in reply toBuffafly

Though I remember that the first time I took the Propafenone/diltiazem combo I had to lie on the floor for some time because my bp and hr dropped too low so maybe it takes getting used to?

FibChick profile image
FibChick in reply toBuffafly

Thanks! That sounds like my experience. Good to know it may be an adjustment issue.

kliving profile image
kliving

After some adjusting, I take 120mg twice a day diltiazem CD and 225 mg propafenone twice a day, as well as 3.125 mg carvedilol twice a day. For me, diltiazem lowers my heart rate but only so much. Carvedilol works to keep my BP in a normal range. Propafenone helps to keep the rhythm. Propafenone also has some heart rate lower capabilities. It would be worth talking to your doctor about some adjustment in the dosages, or possibly just trying the propafenone alone. I have already had an ablation and haven't had AFIB in over a year, but I do have awful ectopic beats. This works for me. Hopefully you can find something that works well for you.

Cookie24 profile image
Cookie24

I have taken Diltiazem and Propafenone for 8 years Recently, Diltiazem has been lowered 240 mg to 12p mg because of slow heart rate.

BobsBeat profile image
BobsBeat

Did you have the PVCs before the AFib PFA Ablation or as a result of the ablation?

I have not had any procedures yet and my AFib burden is fairly low, but the PVCs are awful. I take varying dosages of Metoprolol and Flecainide to try and quell them. Sometimes it helps, other times not. My cardiologist is open to trying a CCB like Diltziem, but haven't done it yet. I don't believe PVCs are addressed procedurally until they are at 20% burden.

Anecdotally, there are reports on this forum and other forums of things like low sodium V8, Magnesium, Taurine, CoQ10, LArginine, DRibrose, Vit C, Vit D, etc. helping. In addition, there are also claims of breathing exercises and anxiety treatment also helping.

I can empathize with struggling to find good providers. I've been underwhelmed with the EP's I've seen in my area. I would likely travel if I was to have any procedure done. Your EP office needs to assist you, especially if it's as a result of the procedure or some blanking period issue.

FibChick profile image
FibChick in reply toBobsBeat

Thank you for the info on supplements to assist, will definitely check the forum. The PVCS were not an issue until after the AFIB ablation, confirmed with an earlier 5 day heart monitor (Zio). I did find articles referencing studies that there may be a correlation in PVCs appearing after AFIB ablation.

BobsBeat profile image
BobsBeat in reply toFibChick

That's interesting that it's from the procedure. It could be inflammation and blanking period stuff and things may settle with time by keeping your heart as calm as possible. Again the EP office should be on this. Best to you.

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