Ectopics again, Flecainide, Decaff Coffee, lack of sleep or all of the above

[Massa]

Hi, updating from my previous post re Ectopics and concerns about Bisoprolol lowering my HR to mid 50s I would like to share the following and would obviously be very grateful to hear about anyone else's experiences or opinionsTo summarise I had an AF whilst on Chemo 3 years ago and was immediately put on 5 mg of Bisoprolol twice a day plus also 10 mg of Amlodipine. More recently I have slso been put on Losartan 50mg. Blood pressure is fine.

The 48 hour Holter Monitor showed that I was in sinus rhythm throughout but had frequent ectopic beats. I am awaiting an ECG which the Cardiologist does not seem to be rushing which I guess is a good thing. They have also confirmed to my GP that they can increase my Bisoprolol to 6.25mg twice a day if the palpations continue to cause me concern. Being honest I feel like it's the Bisoprolol that may well be causing the ectopics which only seem to have started since my HR dropped from the mid 60s to the mid 50s. Of course this could just be a coincidence.

The other think worth mentioning is that I was prescribed a pill in the pocket by way of 50mg of flecainide x 2 day as and when required which I haven't used until last Thursday. After 2 days the ectopics stopped but I felt quite fatigued, something that Bisoprolol all seem to do. I continued to take them for a couple more days then stopped. Everything has been fine up until a couple of hours ago when suddenly they started up again.

Other than stopping the flecainide I was wondering if either of these may have started things over.

Been away on holiday for 5 days and other than a couple of cups of decaf tea I have drank water. Looking forward to a treat I ended up buying a large starbucks decaf coffee at lunchtime today followed by another one a couple of hours later. Could this be the cause.

The other one I have read about is lack of sleep causing ectopics. I don't sleep well at the best of time and always seem to wake up in the early hours. I managed to get on top of my sleep before going away but for the last few nights the quality of my sleep has been sleeping to the point that I was ready to go to bed a 6 pm today. Does anyone find lack of sleep a trigger. How many bad nights do you need to have to kick things off.

I have just taken a flecainide but having been symptom free for nearly a week it's all a bit frustrating.

Thanks for reading and look forward to receiving any comments

[SpaceInvader]

Hi. I was initially prescribed bisoprolol with Flecainide pill in pocket. I just didn’t get on with the beta blocker as it made me giddy and I had no energy. They moved me to verapamil once a day and flecainide twice a day and outside of AF things are much better now in terms of daily life

[Massa in reply to SpaceInvader]

Thank you, maybe it's the Bisoprolol that I need to get off or swap out. Bit worrying though that Cardiologist wants to give me more of the stuff. Maybe I should engage with the GP or Pharmacist, other option would be getting a second opinion

[Eddie64]

sounds like you’re having similar symptoms to me

[Massa in reply to Eddie64]

Hi Eddie64, what are your symptoms. Have you identified any triggers? Any plans re meds or other treatments

[Eddie64 in reply to Massa]

Hi my symptoms I can feel the extra heartbeats,and it’s making my chest feel heavy,also get stab pains in my chest,and keep getting odd pains in my left arm and tingling in fingers on left hand

[Bismark]

About 9 months after my Ablation I started getting runs of ectopic beats, I probably had them earlier but didn't notice them as much. Stress seems to be my main cause for getting them and my stress can be caused by unsatisfactory sleeps, health problems and knowing these ectopic episodes are happening. I also have a sneaking suspicion that too many sweets (I won't stop eating lollies until the whole pack is gone) and strong coffee may bring them on.

Concerning your Flecainide PIP, ask your specialist how long you should take it for as my Cardiologist advised me if I use it as a PIP that I should take it for a minimum of 5 days and 7 days would be his preferred option for me. The reason he said is that taking Flecainide for a short period can cause AF.

[Massa in reply to Bismark]

Hi and thanks for your comments. How are you managing your stress? I was on mirtazapine for a couple of years and 1 month after coming off these the ectopic beats started. The other biggie though is that my resting HR was low to mid 60s but all of a sudden it just dropped 10. Having been on Bisoprolol for a few years I would not have expected that to happen. This also coincides with going on Losartan 50 mg.

I have also dropped over a stone in weight although there is still more to go!! If I am getting healthier could the meds be to strong.

It should be noted that I had my AF whilst on Chemo 3 tears ago and they sent me home with 5mg Bisoprolol x2 a day. Never had a follow up since, but obviously pushing for this.

I am struggling with tiredness and am lethargic but seem to pick up as the say progresses normally 6 hours plus after taking all my meds

[Bismark in reply to Massa]

I don't take any drugs for the stress but I have found that doing things I like helps and keeping my mind busy while not overloading it helps. Also finding out more about my AF and doing the things they recommend such as an exercise regime, healthy eating and just about giving up drinking alcohol. Also I take Apixaban so I try to forget about the Ectopic episodes and think of them as a minor annoyance and I'm safe by taking the blood thinner.

My Flecainide and Digoxon which I had been taking for over 10 years kept my resting pulse just below 60 and when I slept around the very low 50s. Now after the Ablation my resting pulse is a little higher during the day, just over 60 and my pulse when sleeping is still in the low 50s. I do exercise a fair bit but I don't think I'm that fit for my pulse to be that low. These low heart rates don't bother my Cardiologist so I just accept it as this is how it is.

[Choccie55]

My ectopics are definitely made worse by dehydration, tiredness and stress. They were also much worse during peri menopause so I’m pretty sure hormones have an effect too. Since I’ve been on Bisoprolol for supra ventricular tachycardia the ectopics have been much better.

[Eddie64 in reply to Choccie55]

For me I seem very calm when it’s happening,witch at the moment is 24 hours a day,I’m also on bisoprolol 1.25 ,they won’t put me on stronger ones as my heart rate is in the 40s and 50s and bp is in the 90s over 60 most of the time

[Massa in reply to Eddie64]

What is the plan going forward, try to ignore it and live with it?

[Eddie64 in reply to Massa]

lol I wish I could ignore it , I have dr appointment on the 3 rd of June and a cardiologist appointment on the 10th of June if they don’t cancel yet again,and hopefully take it from there just keep my fingers crossed that nothing happens before then , and they can hopefully find out the cause and sort it out

[Massa in reply to Eddie64]

Hopefully they will get it sorted for you. There are that many different triggers though not sure how they will pin point mine other than trial and error

[Eddie64 in reply to Massa]

Think that’s how they will find mine , through trial and error

[Choccie55 in reply to Eddie64]

I’m on 2.5mg but can’t increase my dose either because my blood pressure is naturally low. My ectopics got worse with age and were definitely linked to hormonal changes in the menopause too.

[Eddie64 in reply to Choccie55]

It’s a real pain in the ass all this heart stuff lol I just want to get better so I can visit my old school friend in Australia

[Choccie55 in reply to Eddie64]

It really is! I’m on the waiting list for an ablation then I can visit my sister who also lives in Australia! I don’t want to fly until my arrhythmia is sorted (as long as the procedure works 🤞).

[Eddie64 in reply to Choccie55]

Let’s keep our fingers crossed

[Massa in reply to Choccie55]

Thanks Choccie55, how much stress or tiredness do you need to aggravate things. If you don't sleep well for a couple of nights or worry for a couple of days will that trigger things or do you need something a bit more sustained

[bluemoon572]

Seeing that you take flecainide as needed, tells me your ectopics are premature atrial contractions and not ventricular ones. PACs&PVCs

can be provoked by the sympathetic nervous system (tension,stress,exertion,lack of sleep,caffeine,alcohol,etc) or the parasympathetic nervous system (distended stomach after meals,changing body positions in bed,nausea,etc). Decaffeinated coffee contains small amounts of caffeine,so be careful there. Bisoprolol should suppress PACs,though it may cause some sleep disturbance in some people.

[Massa in reply to bluemoon572]

Thanks Bluemoon572, yep I struggle to stay asleep wake up at around 4am then that's me done for the night. I was on the Mirtazapine primarily for sleep although it helped with the anxiety. I decided to come off it as I was sleeping for 12 hours and the weekends were just passing me by. It was about 4 weeks after being fully weened of Mirtazapine that the Ectopics became noticeable. Think the triggers are in there somewhere I just need to work it out.

I don't drink so that's one of the list but stress, anxiety, and lack of sleep well I am right up there

[bluemoon572 in reply to Massa]

Ask your prescriber if you're a candidate to try Trazodone,an antidepressant that can be effective as a sleep aid.