On demand or not

I have had afib for many years and now get about three episodes a month which if left alone, taking sotalol for comfort, seem to convert in about 48 hours.I only take ramipril for blood pressurs and a baby aspirin but no anti arrythmic meds. I have for many years terminated my episodes after 12 hours by taking vigorous exercise, running or walking fast up a hill ,when I usually convert into NSR after about 15 minutes.
Recently I have been experimenting with on demand and taking 300mg tambocor and 50mg metroprolol immediately upon starting an episode. I dont feel especially good on this but I do convert in less than 8 hours. However the on-demand increases my episode frequency and I am going into AFIB twice a week. I have decided therefore to go back to my old routine except for occasions when I am anxious to convert quickly.
In view of the popularity of on demand termination I wonder if others have had a similar experience where their episodes increased in frequency.

Hi Alastair,

Nothing useful to contribute myself I'm afraid, except to point out that it might be useful for other folks here comparing your experience with their own as to whether your episodes come on at rest/in bed in the PM OR during the day and particularly whilst putting yourself under physical or psychological stress. BTW, how long have you been getting AF? Has your episode frequency continued to increase during this time whilst you have been on NO fulltime anti-arrythmic meds, or has it stayed much the same over recent years?

Best wishes,

Mike F.

My advice will always be consult with your Cardiologist, thats why they are paid the big bucks.

I was on betapace, one of many over the years, and it NEVER converted me.

Once I went to flecanide, i would convert, much better tham being ZAPPED with the pads.

JRBabb

Greetings Alistair
This last month I have started taking Flecainide on demand, 100mg at onset. I too have noticed increased freq of attacks of the same order twice a week . A point to confuse the issue is that I have not been avoiding any triggers, however attacks without recognisable triggers have increased to two a week. This is the same responce as you.
My next course of action is eradication of all triggers again and see what happens. My thoughts on this were posted two days ago but here they are again.

Yes the question is, and what my cardio implied to the on demand approach is;
Why not take them to prevent AF as opposed to once the AF has started.
However;
1. If you take them daily then you could build up resistance. Does however NSR beget NSR?
2. If you take them on demand and get attacks, does AF beget AF?
3.Do you take them daily and ignore (within reason) triggers? (Providing you then get no AF).
4. Do the triggers put strain on the system and eventually break it down.?

Han's reports seem to indicate that taking the drugs daily does not seem to influence the frequency of attacks, assuming all triggers are avoided. This would suggest the on demand approach.
However if triggers are not avoided then possibly daily would be more suitable.

Personally I think one should keep a diary and monitor attacks without triggers. If the frequency of attacks is of a certain rate (possibly twice a month??? ANY IDEAS HERE??). Then take it daily. If less then on demand. Of course if attacks do not change in frequency then switch to on demand.
If you cannot or refuse to avoid your triggers then possibly take it on demand to limit the time in AF, that is if of course taking it daily doesn't control AF, although it will be asking much of the drug as you are supplying triggers for it to fight against.
I know people will say that you should be avoiding triggers completely as a matter of course but life and what people get out of life differs from person to person. It is easy for some harder for others it depends on so many factors, social, historical cultural, psychological etc. Everything in moderation sob!!.

Hmm everyone is different, triggers are different, suck it and see methinks.
I would be interested in what people see as an acceptable frequency if there is such a thing.

Be seeing you
Chris H

Alaistair:

I started the on-demand approach and it does terminate my episode within 3 hrs., whereas I would be in afib for about 12-18 hrs. But, I too am now getting more runs of afib, my normal schedule for afib was usually every two weeks, since starting the on-demand I am more sporadic, I have gotten afib 2 and sometimes 3 times a week then I can go a week or two and again the 3 or 2 times a week, so I definitely have gotten more frequent episodes. It is nice to only be in afib for about 3 hrs., but I don't like the increased frequencies. It will be interesting if anyone else has similiar experiences. So are you going to stop the on-demand and go back to just waiting it out? I believe I will be talking to my EP about this and get his thoughts.

Good Luck
Liz

A:

I am sorry, I see that you did say that you would stop the on-demand and go for it only when you needed to terminate your episodes quickly, you have already answered my question.

Liz

I use flec. on demand but take 150 mg. on onset, which is always
at night and I follow with 150 in morning. I always convert w/in 12-14 hrs.
Perhaps the high initial dose is causing a problem. I don't think increase
in frequency is a common problem with the on demand approach. It is
most definitely a problem with daily use. Try lowering the dosage
and see what happens.

I had been taking propafenone daily and getting worse and worse in terms of severity of episodes. I went off in August and now take it only on demand. I fell much better, lots more energy and zest.

For awhile I went about 3 weeks without an episode then had two a few days apart, then another 3 weeks later. There seems to be no pattern yet. The interesting thing is that they are all at night. I get up, take the propafenone and go back to bed. The episode is over before I get up.

In hindsight I am convinced that while I was using it daily it had become proarythmic for me. So far no complaints about the on-demand approach.

Alistair,

According to our recent LAF survey 26 out of 138 respondents had tried the on-demand approach. Nineteen or 73% had found the approach beneficial and only 10% had found that the effectiveness decreased over time.

I wonder if the 50 mg of metropolol could be the problem. You may want to try just 200mg Tambocor (flecainide) with 12.5mg atenolol or 80mg verapamil. I use the on-demand approach myself (300mg propafenone + 12.5mg atenolol) and have not noticed an increase in episode frequency.

Hans

My first afib episode was in March; four months later, my second; and two months after that, my third. I was hospitalized the first two times and converted with meds; I'm not sure what they gave me the first time; the second time was rhythmol (propafenone). I converted within 30 minutes of taking it. The last episode, in September, I took no meds but did take high doses of mag glycinate, fish oil, Vitamin E and CoQ10, and converted on my own in 13 hours.

Given Fran's story of conquering afib after 20+ years by a change of diet and eliminating free glutamate, I'm not sure I believe in the "remodeling" theory, at least not for everyone. I don't feel well on the meds and the side effects are very rough on me. If I have another episode I again will try to wait it out, take extra supplements (maybe even try cayenne tincture!) and see if I convert. I'll try the rhythmol if I don't (sigh).