Latest episode details....

In brief, I'm a 56 year-old 6' 4" 100Kg male in decent enough overall health. Familial PAF - mother and both her sisters (mother PAF since mid-30s didn't go permanent until age 70, just passed aged 80 after bad fall haematoma). First PAF in 1999. MSG is a potent trigger. Almost always nocturnal (from 8pm if MSG up until 7am in morning). Up until 2008 just a handful of episodes as in 1 every couple of years. In early 2008 I had 3 episodes in 3 months, and with 300mg Flecainide having worked well as a PiP for an episode in 07 (hospital setting) and then the aforementioned 3 in early 08. I started it daily and am still on it 100mg BiD today (+ SR 60mg diltiazem mornings to try and head off any ProA/1:1 flutter - not keen on daily BBs being a vagal PAFr). Episodes from 08 to date average a couple per year that have always converted within an hour or two after an extra 250mg Flecainide (with 20mg propranolol). Until last night....

Last night I awoke with PAF at 12:35am - actually least symptomatic episode I've ever had; more just weird than uncomfortable, but plain as day AF. Nothing out of the ordinary to eat or drink yesterday. I took the extra Flec and waited....and waited... 2 hours later I noticed a change whilst going for a pee to a quite fast (for me with normal resting HR of 60 or so) regular rhythm varying from around 90 to 100 bpm. I felt fine walking around but still had that weird eerie upper chest feeling that tells me my atria are fibbing. Walking around kept the 90 to 100 bpm regular rhythm. Lying down resulted in it slowly drifting back to AF. I repeated this many times before finally converting to NSR at 60 bpm at 7am this morning lying down in bed. (Episodes used to last 4 to 8 hours in the pre-Flec days.) Kept peeing every hour or so so quite convinced my atria were fibrillating the whole time even with the strange 90 to 100 bpm regular rhythm when standing up/walking around.

So what was this fast regular rhythm? I can't imagine it was flutter unless it was 4:1 and it wasn't rock steady as it varied from 90 to 100 bpm as aforementioned. Or was it just some type of SVT?? Hard to say, but I'd stress that the transition between AF lying down was fairly instant when getting up and walking around, but was quite gradual from it back to AF when lying down - as in a couple of minutes of what resembled increasing PVC-like ectopics.

I must admit to being a bit down about the Flec having not worked it's usual magic in an hr or two, but I guess it was going to start to lose its efficacy at some point, and nearly 10 years isn't bad in that regard. Plus I never wanted to be on it for the rest of my life anyway. Two private consults with a highly recommended chap in Leeds called Chris Pepper and Sabine Ernst at the Royal Brompton booked in now as I'm figuring an ablation or two might not be far off for me after last night.

As another aside, has anyone here ever had an isolated time when a PiP didn't work after it which it DID work again for subsequent episodes?? Or am I really looking at the prospect of Flecainide likely not working for me again in the future at converting me back to NSR?

Anyway, just sharing and would be interested to hear whether anyone else here has experienced what I describe above. To be honest I've noticed this in the past too but not as pronounced as last night - particularly on those rare occasions PAF has tried to start up in the daytime. In 2003 I had a brief 1 minute or so episode that felt regular when bending over and like AF when standing up! In 2010 I thought I felt AF coming on in the daytime in a supermarket car park and went to the local hospital where an ECG - according to the cardio guy there - showed a steady rhythm of 80 bpm but with no P waves! - it converted back to NSR at 60 bpm after about 20 minutes. The last near miss I had with AF a couple of months ago kicked off with a couple of minutes AF, then a few minutes of the same 90 to 100 bpm steady rhythm and then back to NSR.

Thanks for reading guys and best wishes to all.

Mike F.



Edited 4 time(s). Last edit at 11/03/2017 09:17AM by mwcf.

Hey Mike,

No advice. Just wanted to say Hi - it has been a long time we've been together on this forum!

My guess, and that is what it is, is flutter. Though I will say, the few times someone gave me a beat to beat Polar heart monitor strip to look at that had flutter, the rate was rock solid.

When I first went keto - 2009, I didn't know the electrolyte story as well as I do now. After a few days & the insulin dropped, I would get "hard" beats whilst getting prone to go to sleep. In the past, this meant low potassium. Hence I took a bunch. It didn't really do the trick. I recall thinking, "if this keeps up, I'm going to wake up in afib." And I did wake up with 3AM afib one time. Took my 300 mg flec and I converted after a couple of hours. However I converted to 125 BPM. Always before (and after), my rate after a flec conversion was in the high 80's. After thinking about it, considered it might be not enough mag (even though I had been taking a lot of mag, which I've continued). So I took a 200 mg of elemental magnesium as citrate powder plus 400 mg of magnesium as glycinate tablets, I recall watching my rate decline over about 10 minutes to 80. Not sure what the 125 was, but it wasn't afib. Here is a much earlier note about this episode, written fairly close to when it occurred <[www.afibbers.org]

I have successfully used PIP flec since and have never had this happen again. I do take more mag now than before this episode.

Cheers,

George

Many thanks for your input George. And 'Hi' to you too! I've always been (and still am) in total awe of both your knowledge and resolve/will power!

Interesting you say your conversion that time was to 125 BPM. On Thursday night my after-2-hour 'conversion' from AF whilst walking around was to around 100 BPM. This dropped to 90 over the next few minutes and to the mid 80s a little after that. However, still the eerie upper chest feeling and AF gradually re-established when lying back down. When I finally did convert properly 6 hours after the whole thing started it was to a rock solid blissfully quiescent 60 BPM.

What had I done different on Thursday? You'll shake your wise head in despair, but I'd had a very spicy latish curry, a large LARGE whisky and coke, probably the best part of a bottle of wine..... Of note this time was that upon waking in AF I always take 20mg propanolol with my Flec - this I did as usual but after 2 hours I took a 60mg diltiazem.... Class IV AADs are - I've since read - not good news for flutter, so if it was (likely) flutter I was alternating with the other night, then the diltiazem could have either instigated or worsened this. I also took a fair dollop of Mg citrate at bedtime and 30 Concentrace drops and as of old mag supplements have never sat well with me ectopy-wise. I suppose having written all of the aforementioned down, it's maybe no wonder I experienced as I did the other night!

I did split up with my partner (of 16 years) 6 months ago and have been hitting the booze pretty hard even during the day sometimes..... not at all proud of that and that Stops. As. Of. NOW. I also noted your comments somewhere else about chillies - I've been loading virtually everything I eat up with red chillies and Tabasco this last few months and need to back that off also. Also 2 stone needs shedding (6' 4" currently 16 1/2 stone and need to get to 14 1/2 stone). At the end of the day I need to create a positive out of a negative here!

Anyway, great to chat with you and wishing you and yours all the very best,

Mike F.

Just a couple of questions. I had several episodes of afib in a three mo. period going to ER each time. My Cardiologist sent me to an electrophysiologist who put in a Pace Maker. He put me on Flecinide 100 mg twice a day. I also take a 40 mg of Nadolol for W/P/W Wolf - Parkinson - White. This has been two years. Each time I go in to get the device checked that say I had one for 13 sec. or one min. I have been researching the cons on Flecinide and am thinking about asking my dr. about getting off this medication. My family Dr. refuses to refill it, he tells me I will have to get my Cardiologist to do it. He is not fond of this medication. Does anyone else who has a Pace Maker continue to take medication? I thought the device was to prevent the need of this. Thanks to any answers I can get.

Annie,

A pacemaker's job is to set a "floor" which will keep your heart rate from going below that level. It will not keep you out of afib. There is a procedure known as an "AV node ablation" that can be used to treat afib, but is extremely out of favor. In this case the AV node is ablated and you are dependent on a pacemaker to keep your ventricles beating. The atria can still fibrillate after the operation, just the signals from the atria to the ventricles are disconnected. WPW is another situation - in WPW there are multiple pathways in the AV node and you can get signals going from the ventricles to the atria. In other words going the wrong way. This can lead to a variety of arrhythmias and tachycardias, the worst being ventricular fibrillation.

George

Thanks George, I have appt. on Thursday with my cardiologist and will be asking him about a change of medication seem to not be doing well in regards to the Flecinide, the feeling of weakness, lack of energy, etc. Am hoping this may resolve my problem. If not, on to the next phase. At 74 I'm sure this has a lot to do with the problem.. Again thanks.