Flecainide, Atenalol, Magnesium, trying to win with lifestyle, medications, and supplements

Hello all and thanks for including me. I have been reading many of your posts over the past couple days and can really feel the power of group collaboration. I discovered I was in Afib nearly 2 years ago as a collateral finding. After cardio version I lasted 14 months on 200 mg Flecainide per day plus 25 mg atenolol and 25 mg losartan per day (for a dilated aortic root). Over the last 10 months I fell into Afib/Flutter every 2 to 3 months for between 2 days and 1 week converting back to normal rhythm without intervention. Like everyone, I'm reaching for a cause that I can fix. Between my normal low blood pressure and resting heart rate, and the atenolol (for 17 years) and Losartan (for 6 years) my resting heart rate is 43 BPM (doctors telling me not to worry unless it hits the 30's even though it dropped to 38 on Holter Monitor at night) and resting BP 110/60. After a 1 week spell in Aflutter, ending 2 weeks ago, 1.) I stopped the Losartan thinking that maybe after 6 years of such low BP that could be a cause. I'm 57. 2.)Based on reading many of your blog posts I have ordered a magnesium supplement "Heart Calm" and will start today. Funny after 2 years no doctor has mentioned a magnesium connection. (3.) I have switched my 25 mg atenolol from first thing in the morning to evening since it is only an 18 hour medication and my Afib almost all times has come on between 4:00 and 6:00 AM. (although one blog post seemed to say atenolol could cause my type of Afib), 4.) Also based on reading your blog posts I discontinued sleeping on my left side as I have been for a few years to prevent reflux. I have so many questions, but, some of the big ones are: I'm considering, after starting the magnesium, reducing the felcainide dose slowly over time and see what happens. I like the "pill in the pocket" idea better than a daily intake. Does this make sense given anyone's experience? Any thought on the best time of day to take the atenolol (beta blocker)? Any experience with low heart rate or low blood pressure causing Afib? What is the best sleeping position for the heart? Thanks for your thoughts and look forward to continuing to read everybody's great blog posts.

smb - welcome. That's a lot of information. Could you please list separately the current meds you are using?

On using the magnesium. Yes, it's very unfortunate that the majority of doctors and cardiologists do not recognize that the majority of afibbers are magnesium deficient and since it's such a critical nutrient to heart function... and many other functions as well, it makes sense to begin a repletion program. If you haven't yet discovered the box at the top of the page titled Afib Resources, here is the link that lists some suggestions for nutritional support... titled The Strategy. Shortly, an update will also be included that covers even more helpful suggestions.
Go here: [www.afibbers.org]

Since the Heart Calm provides 300 mg of magnesium in 3 capsules, try using 2 capsules at a time for 5 days to a week; so, that's - 200mg magnesium and you'll probably want to work up to between 600 and 800 mg depending on when you reach the bowel tolerance signal. Then drop back to a slightly lower dose and maintain there for a while. It's highly individualized as to how depleted you are in magnesium and also how easily your cells accept the electrolyte. It may take 3 - 4 months minimum for you to start to notice a difference. When it's time to reorder Heart Calm, you may also want to consider ordering just plain magnesium. I prefer the amino acid chelated form (magnesium glycinate or bisglycinate) because of it's absorption capability; but you could also use other forms such as the taurate, gluconate or malate. The citrate form tends to cause laxation quickly in some people so beware.

On your Heart rate going down to 30... I'd suggest you not let that happen... for a trial, I took a small dose of Rhythmol
and my HR was in the 40's and I was so weak I could hardly stand....so be cautious not to overdo with any med that lowers your HR too much.

In the Conference Room link... there is a discussion on sleeping on your right side for Afib... here: [www.afibbers.org] ....and again at the Resources section... there is a report on Heartburn. Send me a PM and I can help direct you. You need to address the reflux problem because that is a well-known trigger for Afib. Lots of considerations on that topic.

But.. don't let this be overwhelming. We are all here to help.

Best to you,
Jackie

Jackie:

what was the dosage of the Rhythmol that you took? I take one 150mg. at night before bed, I have for a number of years, I havn't noticed weakness. I really don't like taking those kinds of meds everyday but it is a small amount.

Liz

Liz - Sorry, I don't recall.

Jackie

Hi Jackie,

Thank you for all the great information, sense of comfort, and navigation around the afibbers.org website. This is such a valuable place to be connected with. Sounds like I need to really step up the dose of magnesium over the coming weeks.. Thanks!

The current meds I’m using:

• Atenolol 25mg once per day for 17 years (was taking in the morning; now changed to evening)
• Flecainide 150mg 2X per day (total 300mg) at 10:00 AM and 10:00 PM

After 6 years of off-label use of Losartan (25 mg once per day) I discontinued last week. There was some internet chatter about Losartan possibly causing Afib and ultimately the clinical trial proved no better outcomes than Atenlolol for reducing aortic root size.

While my cardiologist says I should take the flecainide indefinitely, or until a successful ablation, after reading many of the posts here I’m not sure I want to take that drug for 20 years. Rather, I think I will try to get my magnesium dosage up and start reducing the flecainide and see what happens. I would love to find that there is a cause for my Afib and make the required lifestyle/nutritional change.

As for the reflux, I probably miscommunicated that situation. I do not have an active acid reflux symptom problem as far as I know. But, I do notice if I eat within a couple hours of going to bed, as I always do, when I turn on my right side I definitely feel the reflux. So, I simply have made it a point to sleep on my left side. Coincidentally, about the same time my Afib started 2 years ago.. Interesting. And no more eating before bed... bummer...

Another interesting note from the medical profession, my PCP's advice is that since my risk of stroke is so low i'm crazy to do anything. Just live in Afib/Flutter and take no medications. And certainly don't consider an ablation. He says Afib has no affect on life expectancy and the risk of all the medications, antiarrhythmics and blood thinners, and ablation is far more than any benefit I would have. At 57 and highly active I really struggle with that advice.

Steve

Quote
Elizabeth
Jackie:

what was the dosage of the Rhythmol that you took? I take one 150mg. at night before bed, I have for a number of years, I havn't noticed weakness. I really don't like taking those kinds of meds everyday but it is a small amount.

Liz

Hey Liz,

If you are vagal, I recall Rythmol as having beta blocking properties and Hans recommended against it for vagal afibbers because of that in his first book. He suggested Flecainide instead.

George

George:

You are correct there is some beta blocker in Rythmol. My EP was not confortable prescribing Flecainide to me. I do have a pacemaker that is set at 50, so my heart rate does not fall below 50 so that might make the difference in my taking rythmol.

liz

As far as body position, there is individual variation, as PAC's manifest themselves in different positions for different people. I do better on my Left side.

Did the Flutter start after you initiated the Flecainide? Flutter is a side effect of Flec.

Based on what you said, you don't really know if the Flec is even helping or not. Many here just use Flec during episodes, but some patients have adverse reactions to large doses of Flec, so it is standard that Doctors have their patients monitored in a Hosptal the first time, to see how you react to the larger dose. Some here use 300mg Bolus dose of Flec at AF onset successfully, but I tried that and I had a severe adverse reaction. I can only handle 200mg at one time.

I think your PCP's advice is not bad. There is no certain way to treat this condition, but a choice of acceptable paths.

I think the consensus of most is that if your episodes last less than 48 hours, then Blood Thinners are not needed, but if they are lasting a week, then it would probably be wise to anti-coagulate starting at episode onset, continuing at least a week past your conversion date.

I disagree with the advice above concerning magnesium supplementation, especially the usual thing about increasing to bowel tolerance. Magneisum has calcium channel blocking properties, which can relax muscle and reduce HR. Given your HR is already in the low 40's, this could cause problems. Adding magnesium on top of the beta blocker may also be ill-advised. I would consult an MD before supplementing. Maybe cut back on the beta blocker first, if that is what is causing the low HR to start with.

Hello The Anti-Fib,

Thank you and you are correct. I don’t know if Flecainide is helping or not. I feel like it’s worth a try finding out by cutting it back, especially after starting the magnesium regiment, but, my EP doctor is telling me not to. it’s a struggle.

Although my 3 episodes in the last year or so resolved without cardio version, but maintaining 300 mg Flecainide per day, my fear is that if I fool around with my meds the next time it won’t flip back on its own. But if I never try, I’ll never know.

The other thing I don’t know is am I prone to go into Afib and the Flecainide helps by stopping me at Aflutter, is the Flecainide causing the Aflutter but not letting it move into Afib, or am I prone to Aflutter and the Flutter converts to Fib. The significance of the latter is that a Flutter ablation seems like a simple 30-minute procedure, but, the EP doc says it might work if my Flutter is causing the Fib, or, it might make things worse because I’ll just start going into Afib rather than Aflutter.

What I know for sure is the first time I was in Afib and Aflutter (they alternated on Holter test) I didn’t even know it. Best analysis I was in it for 5 months and it took the maximum jewels to get me back to normal. Since then, the 3 times I know the second it happens, and, I have been on Flecainide the whole time. So, is the Flecainide helping me go 3 months between episodes? Would it be 3 months w/o Flecainide? Will Magnesium really make a difference? There is no way to know without trying.

300 of Flecainide gives me no noticeable side effects at all. Perfectly tolerable.

Thanks again. Awesome information.

steve

Hi safib,

Thanks for the opposing viewpoint. It really highlights how individualized this all is. It’s great to be able to hear all the different ideas in order to navigate the maze of solutions. Note from The Anti-Fib’s comment above simply adjusting and living in Afib is just as good a choice for some.

I know for me, for now, I would like to try to figure out if there is a cause and correct it. My next doctor’s appointment is next week and it does make sense to tell him what I’m doing.

What’s interesting about the beta blocker and the low heart rate is that the doctor says 25 mg is so low, and it is only an 18-hour medication (atenolol), that it’s more likely the Flecainide that is slowing things down.

Also goes to show that while I can’t live w/o my doctors, there’s so much they don’t know. Just another huge reason why a blog like this, where people can share experiences, is so awesome!

Thanks again for your input.

steve

Steve - Most definitely, this is highly individualized. If flecainide works for you, that's absolutely great.

My experience was that flecainide did not help with flutter. I experimented using the PIP with various doses... with and without the beta blocker. Even tried Rhythmol which was awful. + Nothing worked for the flutter. I had numerous cardioversions and sometimes less than a week apart. The pill in pocket approach typically worked great for just AFib, but that flutter issue was a nightmare and that led up to my second ablation.

I certainly hope you can find what works best for you. As we often say here, 'we are experiments of one.'

Best to you,
Jackie

SMB:

I wouldn't do a Flutter Ablation until you know how you do without the Flec. I was were you are now, considering a Flutter Ablation, until I figured out that the Flec was causing it. I found this evident on my own experience, and on scouring Medicle Journals, studies, etc. My EP/Cardio Doctors never saw the Flec/Flutter correlation.

Thanks The Anti-Fib,

I’m going to slowly cut the Flec dose and see if my Afib/flutter situation changes. I think that will be very valuable information.

I also read some research that suggested physicians believed that 10% of the Aflutter in patients taking Flec was caused by the Flec. I will be sure to post my experience.

steve

Quote
GeorgeN

If you are vagal, I recall Rythmol as having beta blocking properties and Hans recommended against it for vagal afibbers because of that in his first book. He suggested Flecainide instead.

George

I can attest to that. I was vagal and Rhythmol was "middling" at best. Plenty of AF breakthroughs. In the end I actually found it worked better if I drank beer (DONT do this - I'm just an outlier of sorts).

To answer the previous question about dosing, Rhythmol (propafenone) generally has three dosing levels per day. It's something like 200/400/600 mg. There are two types - "normal" (3x daily) and extended release (2x daily). The XR is better but sometimes you still get caught up in the lack of generics which makes it cost a lot. Hopefully that's less the case now. One may need to educate one's doctor or pharmacist if still paying $100 or more for the XR.

SMB:

You said you thought you were in AF for 5 months unnoticed? This sounds like you are a "low responder" to AF, that your HR doesn't get that high when your in AF, and you are relatively Asymptomatic. If that is true, keep in mind that the worse a patient symptoms are the more sense it makes to pursue Ablation Strategy.

Yes The Anti-Fib, You are correct.

Over that original 5-month period there were times when I felt different, but, never made a connection to a heart problem. I’m in pretty good physical shape (I’m 57) but others even noticed I was unusually out of breath walking up 4 flights of stairs. I also could periodically feel my heart was funny, especially trying to sleep, but not so much that I connected it with a problem. I had no exposure to Afib through friends or relatives (that I knew about at the time... now it seems like my whole family in the generation before me is in Afib. Sure seems like there is a genetic connection that I have not seen appear in this blog?)

My normal resting heart rate is below 50 BPM. In Afib/flutter it ranges between 65 and 75. In exercise it gets funny and can bounce around between 110 and 135.

So, while I am in no hurry to get an ablation (although the doctor keeps reminding me that an Aflutter ablation is way simple, about 30 minutes, and has a 90% success rate) since my Afib/flutter would be relatively easy to live with compared to many on this blog site, they also tell me that if I live in Afib too long (not sure what “too long” is), that my heart will reshape itself and my opportunity to ever live in normal rhythm will be lost.

That leads to the question, is there a point of no return with Afib? If I cannot figure out how to stay in normal rhythm with lifestyle/supplement changes and decide to adapt to living in Afib, in 5 or 10 years is ablation even still an option?

steve

Steve,

From reading here for nearly 13 years, high dose flec usually loses effectiveness over time.

You triggers sound vagal. Some thoughts as a vagal afibber.

- for me, ginger (organic powder spice) was helpful. There was a period when I was consuming too much calcium (I didn't know it was a problem), I started taking 300 mg flec, then added in ginger and titrated the flec to 0. <[www.google.com] I then only used the flec on-demand.

- 3 episodes in a year would be a reasonable number to address with on-demand flec. If you reduce daily flec and you get more episodes, you can always go back up (my non-medical opinion, but how I approach it).

- addressing your GERD with diet might be very helpful. There have been a number here who fixed their GERD and dramatically helped their afib - again a vagal connection.

- whenever you are in afib, both structural and electrical remodeling (can) happen. This makes it harder to stay in NSR. This would argue for an ablation sooner rather than later, if your time out of rhythm is material and increasing.

- there are data that suggest that long term afib can lead to micro issues in the brain, that accumulate and lead to diminished cognitive function. Shannon posted this here previously, here are some posts <[www.google.com] Whether a very healthy lone afibber would have these issues is an open question. I'll let Shannon address this further, if he chooses as he knows much more about this. This might argue for not staying out of rhythm at a low rate as a long term strategy.

- excessive endurance exercise can exacerbate vagal issues. This was my path to afib 13 years ago. Though I remain active, I have significantly detrained, especially with endurance training.

- lots of mag has not lowered my resting heart rate. It was in the low 50's before afib 13 years ago (and as low as the high 30's during sleep), today it remains in the low 50's with sleep in the 40's. I have consumed as much as 5.5 grams of mag/day, currently around 2.4 g/day. My analysis is my sleeping heart rate has increased a bit due to detraining. The mag makes no difference in my heart rate. Not saying it couldn't make a difference for someone, just doesn't seem to work that way for me. Detraining, mag, and keeping calcium intake modest (600-700 mg/day from food), are likely the biggest factors allowing me to stay in afib remission most of the time (3 episodes in 4 years for about a total of 2.5 hours out of rhythm, all episodes converted with 300 mg flec).

George

Wolfpack:

Since I am Vagal I take Rhythmol only at bedtime, why take it during the day when i don't need it.

Liz

George,

Thank you for the information and for helping others in this forum for 13 years!

I like the idea of getting to Flec only on demand. It will be interesting to see if I can make it 3 months without it. I have read a bit about ginger also and there doesn’t seem to be a downside to trying that. While I love to work out, I would not call it endurance training. I do a gym cardio machine 30 minutes, 6 days per week, plus, light weights 3 days per week. Even in my running days my training topped out at 5 miles per day. I ran 5 and 10 K’s, but no marathons.

Thanks again. All of the information in this and other strings is starting to fit together into a plan I am comfortable with.

steve

" I do a gym cardio machine 30 minutes, 6 days per week, plus, light weights 3 days per week. Even in my running days my training topped out at 5 miles per day. I ran 5 and 10 K’s, but no marathons. "

Could be enough- everybody is different. My mantra now is "minimum effective dose." I will do Tabatas on a fan bike. They are very high intensity, but only last 4 minutes. I do a lot of bodyweight strength training. One of my benchmarks is having to open my mouth to breathe. If I feel I need to, I slow down on whatever I'm doing - this includes going uphill at 12,000'. I ski all day downhill, always breathing through my nose. Adding uphill hikes to each lap is enough to be a vagal trigger at the end of the day.

George