PAC tamer suggestions?

Hi,
I am having frequent PACs, especially late evenings while in bed. At the moment 1 mg. Ativan makes them go away quickly. But I don't like using it, so what else could I use? I am aware magnesium deficiency could be a cause. Unfortunately my doctor did not request mag levels on my last blood test. Potassium is on the high side.
Don't use alcohol, don't eat after 7 pm. No triggers for afib - genetic - three immediate family members also diagnosed.
20 yrs. + afib; one ablation; waiting for touch up for atypical flutter which is starting in the scar tissue of the last ablation (10 yrs ago). The only med I take is Bisoprolol to slow down resting heart beat which went up after last ablation. Get 2-3 episodes (mix of afib/flutter) per year. Usually convert with flecainide on demand.
Thanks,
Ritva

An Ablation from 10 years ago is still causing an elevated HR. Can you expand on that more? What is your HR without taking the Bisoprolol?

<[www.afibbers.org]

Hello Ritva and welcome! It's fairly common in those with low magnesium and also with an elevated potassium level for that to be a stimulator of both PACs and arrhythmia. Those talking about the action of intracellular electrolytes mention that magnesium levels...inside the heart cells... must be optimal and without that, higher potassium helps to shorten the refractory period or the time between heart beats. PACs indicate a shorter refractory period and can be followed by Afib.

You may want to consider adding some supplemental magnesium because unless you have kidney disease, it typically is not a problem to add more (without testing) since getting enough magnesium, strictly from diet, is very difficult. Plus, if you take more magnesium than you can utilize, you'll typically have a laxation effect so you get rid of the excess quickly. Take some time to evaluate your dietary calcium intake as that definitely blocks magnesium and don’t take calcium supplements.

Most afibbers take magnesium supplements - spaced out through the day and, often, a bedtime dose as well. Since, as we often say here, "we are all experiments of one," you should start with a low dose of 100-200 milligrams and gradually increase from by 100 - 200 mg/dose every 5 days or so until you decide if you are compatible with it and also if you are noting the laxation effect.

Magnesium is easily and quickly depleted and each person's needs and utilization vary considerably so it becomes your personal experiment. Typically, people tolerate at least 400 - 600 mg daily as a start but it's not uncommon to go to 800 and over 1,000 mg a day when deficiencies are present or if depleting influences such as stress or medications (or calcium) are offering significant competition for magnesium.

There is a great way to take in a highly beneficial form of magnesium by adding a liquid concentrate you can make at home easily and economically to pure drinking water. It’s referenced in previous posts by the names: magnesium bicarbonate water or Waller Water or WW. The alkalizing effect is highly beneficial for overall health and makes your drinking water taste ‘soft and mellow.’ I’ve included the directions and some reference links at the end of this report. I use it as my main source of drinking water in a pitcher I keep in the kitchen and have enjoyed the alkalizing effects since 2003.

Additionally, my magnesium supplement preference is magnesium amino acid chelate by Albion with the TRAACS trademark as it is designed not to break down (into components) in stomach acid and is transported intact to the receptor sites on cells’ outer envelope. If the receptor sites are healthy and functional.. meaning they are not crimped or damaged so that they can't open to accept magnesium... (these work as a lock and key arrangement), then magnesium can't get in. The outer envelope is damaged by a number of factors with the leader being bad fats such as trans fats.

Other forms of magnesium include magnesium malate, magnesium gluconate, magnesium taurate, magnesium carbonate, magnesium sulfate magnesium citrate... which is a known laxative, magnesium chloride and magnesium hydroxide which we know as Milk of Magnesia. Magnesium oxide is the least expensive and also the least absorbable so we don’t recommend using that when we want reliable results. There are probably other’s I’ve forgotten.

Topical magnesium is also found to be extremely effective for fast absorption and especially helpful for sore muscles. Along that line, one can soak in an Epsom Salts bath or use a foot soak with good absorption results.

Here’s a report on magnesium’s many properties that may be helpful
[www.afibbers.org]

Also:
[www.ancient-minerals.com]
[www.mgwater.com]


Following is the recipe for making the WW.

The history of Waller Water came from research reports on the efficacy of Unique Water which was the natural, magnesium bicarbonate spring water from Australia and Dr. Russell Beckett’s research on the longevity of cattle drinking that water. [www.rexresearch.com]

One of our members, Erling Waller, perfected a home-made version so we could enjoy the alkalizing benefits and the special or “Unique” form of the highly beneficial magnesium bicarbonate ion in our drinking water as well.

Hope you find this useful.
Best to you,
Jackie




Directions

Making magnesium-bicarbonate drinking water called WW using magnesium hydroxide in Milk of Magnesia and carbon dioxide in carbonated water. The chemical conversion in water is: Mg(OH)2 + (CO2)2 --> Mg++ and (HCO3-)2

Step 1. Chill to refrigerator temperature a 1 (or 2) liter bottle of carbonated water consisting of water and carbon dioxide (CO2) sometimes called Seltzer.

Step 2. Shake well a bottle of plain Milk of Magnesia (MoM), then measure out 3 tbsp* (6 tbsp for 2 liters). The plastic measuring cup that comes with the MoM is accurate and ideal for the purpose. Use only plain MoM without flavorings, sweeteners, mineral oil, or other additives. The "active ingredient" should be only magnesium hydroxide, 400 mg per teaspoon (5 ml), and the "inactive ingredient" should be only water (check the label). (3 tablespoons (45 ml) of MoM has 1,500 mg of Mg from 3,600 mg Mg hydroxide*)

*Alternatively use 3,600 mg Mg hydroxide powder (pharmaceutical grade) a bit less than 1 tsp (1 tsp = ~4,100 mg).

Step 3. Making concentrated magnesium bicarbonate water: Remove the cap of the chilled bottle of carbonated water slowly to minimize loss of CO2. Pour out a few inches into a glass and save it. Pour in the pre-measured MoM and replace as much as possible of the saved carbonated water. Replace the cap tightly. and shake the bottle vigorously making the liquid cloudy. After 1/2 hour or so the liquid will have cleared, and un-dissolved Mg hydroxide will have settled to the bottom. Again shake the bottle vigorously making the liquid cloudy again. After several hours (up to 24?) all of the Mg hydroxide in the MoM will have reacted with the CO2 to become dissolved ionized magnesium (Mg++) and bicarbonate (HCO3-). If a small amount of un-dissolved Mg hydroxide remains as a sediment ignore it. One liter of this concentrated magnesium bicarbonate water will have ~1,500 mg of magnesium and ~9,000 mg of bicarbonate. Diluting this concentrate 11 to 1 makes it essentially identical to Unique Water..

Step 4. Making WW essentially identical to Unique Water: Dilute the concentrate 11 to 1 with plain water.
-- Example: 1 oz. concentrate + 11 oz. water = 12 oz. WW, which is a bit more than 1/3 liter or 1/3 quart.
-- Example: 3 oz. concentrate + 33 oz. water = 36 oz. WW, which is a bit more than 1 liter (34 oz) or 1 quart (32 oz.).
-- Example: 11 oz. concentrate + 121 oz. water = 132 oz. WW, which is close to 4 liters (135 oz) or 1 gallon (128 oz).

=========================================================================================

WW analysis:
Magnesium 125 mg/L (calculated)
Bicarbonate 751 mg/L (Evergreen Analytical Labs, Wheatridge, Colorado, Dec 5, '02)
pH 8.63 (Evergreen Analytical Labs, Dec 5, '02)

WW cost per liter / quart: about 7 cents.

===================

Ideal consumption: 1 1/2 to 2 liters (quarts) per day providing 125 mg magnesium and 751 mg bicarbonate.per liter
See: How best to consume Unique Water? [web.archive.org]
"If you are not in the habit of drinking water, you should commence by consuming small amounts of water daily until your body adapts. Take at least a month to reach the water consumption of 1 1/2 to 2 litres per day recommended by health experts. Unique Water is best consumed at regular intervals throughout the day."

General information and recommended reading

-- The term ‘magnesium bicarbonate’ is used universally to describe the mixture of magnesium cations and bicarbonate anions in certain spring waters and mineral waters.

-- WW is an inexpensive, easily made magnesium bicarbonate water equivalent to Australia's Unique Water.

-- WW is equivalent to the naturally occurring Adobe Springs water in California: [www.mgwater.com]
(Noah’s California Spring Water is bottled Adobe Springs water) [www.noahs7up.com]
Magnesium 110 mg/l
Bicarbonate 529 mg/l
pH 8.7

-- WW's flavor is typical of naturally occurring magnesium-bicarbonate spring waters, such as from Adobe Springs.

-- This slightly alkaline magnesium-bicarbonate water should be consumed throughout the day.

-- A person not used to drinking much water should begin by consuming small daily amounts of WW, gradually increasing to the ideal consumption of 1 1/2 to 2 liters / quarts per day. See recommendations for ‘Unique Water’ at ]

-- Magnesium dissolved in water (ionized), as in WW, is considerably more ‘bio-assimilable’ than the magnesium in most solid tablets or capsules.

-- Recommended reading: Information and recommendations pertaining to "Unique Water" are the same for WW. The consumer of WW is encouraged to read the literature at "Non Pharmaceutical Health Care and Unique Water"

Refer to this link for the original post since some of the report links are inactive.
[www.afibbers.org]

Thank you Jackie,
I am not at all new to this website. In fact, most of my early info came from here right from the beginning. I know that you personally have posted much excellent info over the years. I just have not been active for many years as my afib really was well under control and caused me no grief.
It was suggested already two years ago that I should consider a touch up ablation to fix the flutter which only started around that time. I let it go since my episodes were few and far between and controllable easily. Now I have had two in short term that lasted longer, but I am pretty sure that I became proarrhythmic due to too much flec. Also flec is known to deplete magnesium.

I am taking magnesium supplements, but only about 300 mg. per day. I notice that the one you are suggesting is available in Canada through the Canadian Vitamin Shop (online). I am not taking calcium, but eat some dairy like yogurt and milk in my coffee. No more cheese except a sprinkling on pasta.

My fast heartbeat only started being a problem (according to my cardiologist) about two years after my ablation. I understand that this is a possible side effect of ablations. I felt it myself and it was getting into the high 80s and 90s. With Bisoprolol I keep it between 60 and 74. I just need to get the frequent PACs under control as they make me feel uncomfortable.
Thanks,
Ritva

Hi Rita - I apologize for not recognizing your name! Very sorry.

Boosting your magnesium may help. Calculate how much calcium is in your food items... yogurt has around 400 mg and be sure that your magnesium is twice that of calcium... or lower the calcium intake significantly. Some say that your magnesium to calcium intake should be 2:1 (at minimum). It's worth a try.

If the flutter continues and becomes more frequent, then quite likely, the second procedure will be needed as that seems to be the typical progression. Once I started into flutter episodes, not much helped stave that off. I hope you can get yours managed quickly. The WW is worth a try as well.

Best to you,
Jackie

Good to hear from. you Rita,

I recall some of your posts from long ago, welcome back, though its a dubious honor as it usually means a revisit from the beast for those who have been absent a long time.

And definitely go get the atypical flutter ablation, though it may not be strictly from the scar pattern of your original ablation. Almost always atypical flutter arising in an uno predictable fashion from the lesion pattern of the index ablation will have triggered in the first year post ablation (often from the early blanking period through the first 6 to 9 months) within that initial 1 to 1.5 years, even its it goes quiet again for a prolonged time before inevitably acting up again and either quickly or gradually becoming an increasingly frequent annoying visitor.

When a person goes over two full years with no early or later flutter or AFIB at all after an ablation. it is very rare for any recurrence that may trigger after that long a time to either be from a true reconnection of original ablation lesions that have reconnected at such a late date, or from the 'typical' course of left 'atypical' flutter. Usually, once your arrhythmia has been silent post ablation for over 1.5 years and with no early blanking period recurrences even, then any much later recurrence is usually due to new Non-PV triggers that were not fully mature enough to raise their heads and enough to get noticed during the index ablation.

The origin of the flutter is not a real issue though for the patient, as it still needs to be addressed. And as Jackie noted, once such atrial flutter starts to trigger it is not likely to behave itself and will almost invariably progress without a touch up ablation.

Just be sure you choose the EP carefully for this job,. Your original ablation EP may well be fine as the choice as, by definition, he has at least 10 years of added experience under his or her belt by now. You just don't want to rely on an ablationist to track down an atypical left atrial flutter who limits their ablation strategy to only doing PVI only ablation with no real time EP being done, to speak of, during the ablation. And thus, does not do any real time sleuthing for other Non-PV triggers that might be triggering one's flutter mischief.

Other than that, I suggest not wasting too much time trying to bottle up the flutter as from hard won experience, you are not all likely to find much=m, if any success in putting a permanent lid on such a flutter kettle by any means I know of other than an expert Non-PV trigger ablation.

Best wishes,
Shannon

You said Ativan stops your Pacs. Are you stressed out about something because Ativan is a benzo for calming the nerves but extremely addictive.

Hi,
Not stressed about anything really. One of those laid back individuals. But my cardio said Ativan occasionally is enough. I only take rarely not every night, so not worried about addiction. Interestingly sometimes when I seem to go into afib, Ativan stops it after about five minutes. So no need for more toxic things like flec.

Quote
Ritva
Interestingly sometimes when I seem to go into afib, Ativan stops it after about five minutes. So no need for more toxic things like flec.

Five minutes isn't even time enough for the pill to dissolve. You may have found a very effective placebo. :-)

Using Ativan by sublingual or buccal administration... .. hold it there a few minutes and the drug will be in your blood stream rapidly and without going through the stomach acid process to reach the blood stream which takes considerably longer. It just needs to be in contact with the mucosal tissue for a few minutes to make a transfer. Results reported to be felt very quickly.

And, often, just knowing that something (placebo effect) has the potential to work, often works miraculously well... which can be a very good thing.

Jackie

Sublingual is what I have used. It dissolves in about a minute or less.
Ritva