Tambocour better than self conversion?

Hi Folks,
Well i got away without any episodes for over 2 years, but have had 3 in the last 2 months. All started with a fierce full feeling in the stomach, gerd, and much bubbling, at 3 to 4 AM, waking me up. Luckily the heart rate has not been too high or too uncomfortable, so i stayed in bed and got back to sinus after about 9 hours.
I have taken Mag for a number of years, and am generally fit and otherwise healthy at 66.
Cardiology prescribed me Tambocor PIP a few years ago, but i never had cause to take it until recently. My Echo etc back then were all normal.
My question is, would it be better for my body if allow the episodes to run their course [9 or 10 hours, heart rate less than 80, BP normal], or start relying on chemical conversion? What side effects would i experience from the PIP?
From my records i had 3 in a row, then a gap for a few years twice before.
Finally, i discontinued Omeprazole a few months ago after reading the bad press, and have been managing the rebound with Milk of Mag or Gaviscon. Maybe i should go back on it, as it seemed to keep my stomach calm.
Thanks for taking the time to read this, and Greetings from Ireland.

There's no benefit whatsoever to allowing yourself to remain in afib one second longer than necessary. Side effects are minimal to non-existent for most people, so by all means, take the Tambocor (flecainide).

Personally, I wouldn't resume the Omeprazole. Proton pump inhibitors taken long-term aren't a good idea.

You should do research on the Flecainide. Yes, there are serious side effects possible. Starting out with a low trial dose would make sense in your case. Another option is to test out the Flecainide while you are in the Hospital, to see how you react to the Drug. Admission to a Hospital for monitoring when initially using Flecianide is the FDA protocol. What dosage did your Dr. prescribe?

Thanks Carey, i really dont want to go back on the omeprozol However the gerd rebound has been fierce, although some days are fine. I havent yet isolated the triggers.
The Afib trigger seems certainly connected to the stomach. I" not sure why it presents at 3 to 4 am!

Thanks Anti-fib dosage is 50 mg "as required". I took half that in hospital last time i was in ER, under doctors orders with no ill effect, although i was back in sinus by then

John,

Ditto what Carey said.

My philosophy is to stay in afib absolutely as little as possible. Subsequent to a 2 1/2 month episode in 2004 (2 months in to my afib journey), I've used PIP flec to convert every episode. My afib remission program works well enough that I've only had to use it 4 times in five years for a total of about 4 hours out of rhythm. My protocol is the minute I realize I'm in afib, I get my 300 mg of flec, chew it to make it act faster and swallow, maybe with some water - did it once in a snow cave with my water bottle partially frozen. I have also added powdered mag as citrate or malate, which seems to help conversion. I try to stay generally prone till I convert - this mitigates the risks that Anti-Fib talks about. However taking a beta blocker first and waiting a half an hour to mitigate the risk also has merit - though I've never gone this route.

On the GERD, my doc, Steve Gundry, commented that carbs slow digestion, hence allow the food to back up in the gut. Also taking digestive enzymes and/or HCl with food can also mitigate the issue. They acid blockers mitigate the pain when digestive juices end up in the esophagus, but make the slow digestion worse as a paradox.

George

Hi George, and good to hear your advice. You are an example to us all! Converting in a snow cave has got to be a record, and moreover personal bravery to not let the afib change your lifestyle!
I might try enzymes and HCl.
The final piece of the puzzle might be dosage: you take 300 without trouble. Some guidelines say 150 for my weight, my prescription says 50! Whats a poor Chicken to do?
Regards,
John

Quote
The Anti-Fib
Admission to a Hospital for monitoring when initially using Flecianide is the FDA protocol.

That's very rarely done these days. I've been started on flecainide several times without any hospitalization or monitoring and I know dozens of others who've done the same. In fact, I can't recall the last time I heard of anyone being hospitalized to start flecainide. It's been around a long time so there's extensive clinical experience with it, and the old FDA guidelines are no longer viewed as necessary by most EPs.

Okay thanks for all your support.
I shall start enzymes and HCl for the stomach, and next afib episode take a metoprolol, wait 30 mins then take 50 mg of flec.
Any final comments?
Best Wishes and long NSR to ye all.:

I was never admitted to hospital for Flecainide. It worked for me for 9 months after diagnosis perfectly at 100mg x 2. No afib. Then started to not, I was upped to 150mg x 2 for 2 years thereafter and would take an extra 150mg when needed. I pretty much became locked in AFIB. I had no issues with Flecainide but it ultimately was not going to work.

If only had afib a couple a times a year and a PIP worked I would not worry about taking it. That's me.

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JohnBM
Okay thanks for all your support.
I shall start enzymes and HCl for the stomach, and next afib episode take a metoprolol, wait 30 mins then take 50 mg of flec.
Any final comments?
Best Wishes and long NSR to ye all.:

I'm glad to see that your EP told you to take the metoprolol first before the flecainide. That protects against the one serious (but rare) side effect of flecainide, so I think you're good to go.

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JohnBM

The final piece of the puzzle might be dosage: you take 300 without trouble. Some guidelines say 150 for my weight, my prescription says 50! Whats a poor Chicken to do?
Regards,
John

Most guidelines I've seen say 300 mg for a PIP dose for those >70kb (154 #) and 200 mg for those under. 50 mg is a light PIP dose IMO and unlikely to cause issue.

There are some protocols to start low, like 50 and increase every x hours if not converted. I think Jackie used to do a scale up approach. I always take the max as I want to have the episode as short as possible. There is more risk in this approach, but I've not ever had a problem.

Of course we are all individual, but I wouldn't be concerned about starting with 50 and seeing what happens. I would predict the worse case is it does not shorten your episode, rather that a worst case of atrial flutter.

JohnBM:

50 is so low a dose, as not to worry. You could titrate up slowly. Maybe start out at 75mg on your second Episode, if 50 doesn't work the first time. Since your Converting on your own there is no rush to push the dosage up as to cause risk.

Everyone Else:

The problem with having a Pro-Arrythmic event from a Cardiac Drug, is that you might not get help in time. If you take too much that your system can't handle it could be fatal. If you pass out, there might not be anyone to explain what Drug you took, even if you had called the Paramedics. Most Paramedics, and even ER staff, are not going to understand the concept of taking a Bolus dose of Flecainide, in order to convert to NSR. In the initial studies of Flecainide taken at 400mg Bolus dose, 10% of the study group died, even thought the were already in the Hospital being monitored. Granted this Patient group were not Lone Afibbers, and had a history of V-Tach, Heart Attach, CHF, or low Ejection Fraction.

My Dr. had me start out at 100mg, then go to 150, 175, then 200. All of this was done at home. I did start feeling a little queezy and light-headed at 200mg. Since I was still have AFIB after numerous Episode, my Dr. sent me to the ER Room to be monitored at 300mg. He Faxed Instructions/Dr's Order to the ER, and also called the ER Dr, and the Head Charge Nurse to tell them what was going on. I took the 300mg right as I went in to the ER. I told the Triage Nurse what was going on, and they did an EKG, BP check etc. This only took 10 minutes or so. My EKG came back as stable very well controlled AFIB, with at HR around 75. At this point they showed the EKG to the Dr. who said I was OK and not any danger, and then had me wait until he could see me.

Now the Faxed over Instructions from my Dr. became lost, and were never matched up to my file. After 30 minutes I started feeling very poorly, Light-headed, a little Nauseous. After 45 minutes I knew I was in trouble, having trouble walking more than several steps, and having some difficulty finishing phrases. I told the Nurse what was going on, and that I was there for Heart Monitoring, but she said I was fine, that the Dr. had already looked at my EKG, and it was nothing to worry about. I tried to get the attention of another Nurse, who scolded me that the side effects I was describing were not attributed to Flecainide. By this time it was close to an hour since I took the 300mg of Flec. I started feeling like I was going to pass out. The Security Gaurd came over, as one of the Nurses had complained that I was being disruptive, and not respectful of what she said. They kept saying my EKG was fine, and the Dr. had looked at it, and he would talk to me when he had time. They put me on a bed in a back room in the ER with several other patients, where the Nurses would only come in every 15-30 minutes or so and check up on people.

BY the time I was on this bed, I was almost completely incapacitated. I tried speaking loudly, but only a low sound turning to a wisper came out. I tried to get other Patients attention to no avail. I tried to stick out my leg to knock over a Trash Can, but I could not reach it, hard to move my Leg. I kept feeling like Passing out, but I knew that would be a mistake, because if I stopped breathing, I would of just Died quietly there.

This went on for 20-30 minutes, untill after (about 2 hours from when I took the 300mg of Flec.) I finally started rebounded, and was able to get my breathe back enough to be able to Speak. When the Nurse came back she still didn't do any thing to help me. She said there were no beds available with Heart Monitoring, and again was Rude to me. The thing is she still could of provided other Care, like another ECK, or rechecking my Vitals. Obviously things can change in a hurry with Heart Patients. The ER Staff just based everything off of the intitial EKG and refused any follow-up.

After several hours, I finally got through to my EP, a top Dr. in my City, and he called the ER Dr. and Charge Nurse again to express grave concern. They waited another 30 minutes to talk to me, and did not relay any info to the Nurses who were handling me.

The point is like I said before, there is a chance even if you were close to an ER, or called an Ambulance, that you would not get proper Treatment for a Pro-Arrythmic Event from Flecainide or another AAM taken as a Bolus dose (PIP).
If you are doing 300mg Flec PIP for the 1st time, right down what you are doing, and have someone there to look out for you.

Well Anti-fib that was a nasty experience, to say the least! I live at least an hour from a hospital, which is why i have always been wary of taking the flec. The medical profession can be quite blasé. I think i might start with 50 of flec, after a metoprolol, as i am quite sensitive to medication.
@fibrillator it seems flec has become less efficacious for you over time. Is this common experience?
Regards
John

Yes it is very common for Flecainide to become less effective overtime. How fast and to what degree I imagine will vary greatly by person based on their underlying severity of AFIB, triggers and rate of natural progression of this beast.

By the time I was heading up to my Natale abaltion, Flecainide, Tikosyn (Wish I didn't waste three days in a hospital trying that one) and Multaq were all ineffective. I stopped a few weeks before my procedure, loaded up on calcium channel blocker and metoprolol to try and keep my rate below 100 (not much luck) and here we are today fingers crossed in NSR since my procedure 3.5 months ago.

My own view at this point is I shoudl have gone for an ablation quickly and not even bothered with Flecainide. After three failed local abaltions I should have trusted my gut and saw Natale sooner and not wasted three years of my life. Learn from my mistakes.

Fibrillator is right that flecainide usually does lose effectiveness eventually. Some people get many years out of it and others just one or two. In addition to losing effectiveness, it can also become pro-arrhythmic. Both problems are common with several antiarrhythmic drugs.

Anti-Fib's experience was extremely unusual for flecainide, and what I heard there was a whole lot of medical bungling and negligence contributing to the problem. The biggest risk with flecainide is that it can cause 1:1 conduction, meaning every single beat of your atria gets transmitted to the ventricles, resulting in a heart rate of 250-300. That's why your EP prescribed a beta blocker to be taken before the flec. It's a very rare side effect, but potentially fatal, so that's why the BB as a precaution. It will prevent the 1:1 conduction.

Well, i have no chance of getting to a top EP, having neither private health insurance nor that amount of savings, so am attempting to make smart choices for my circumstances, hence all the questions.
A rock and a hard place are the answers! Start taking the flec too soon and shorten the time until ablation by people with little experience. Take too much and maybe blow a fuse.
I asked the local cardiologist how many pva's he had done. He looked me up and down and said " None yet". I fled the building!
One would think that because the condition seems caused by faulty electrical impulses, episodes might be brought under control by pemf's or other electrical means rather than burning or scarrng the inside of the heart. I have read some experimentation in this field. Is there much progress?
I go to France to get my Dupytrens treated with an hour long proceedure using needle fasciotomy. I can use my hand again within a couple of days, and the cost is around 80 euro. Here in Ireland the protocol is in-patient surgery, a month to heal and costs many thousands. Do you think the ablation industry is holding back other research, whilst creating added value all round?
Regards
John

Quote
The Anti-Fib
My Dr. had me start out at 100mg, then go to 150, 175, then 200. All of this was done at home. I did start feeling a little queezy and light-headed at 200mg. Since I was still have AFIB after numerous Episode, my Dr. sent me to the ER Room to be monitored at 300mg. He Faxed Instructions/Dr's Order to the ER, and also called the ER Dr, and the Head Charge Nurse to tell them what was going on. I took the 300mg right as I went in to the ER. I told the Triage Nurse what was going on, and they did an EKG, BP check etc. This only took 10 minutes or so. My EKG came back as stable very well controlled AFIB, with at HR around 75. At this point they showed the EKG to the Dr. who said I was OK and not any danger, and then had me wait until he could see me.

.

Question, are the 100, 150, 175, 200, 300 doses cumulative? That is did you take 100, then add 50, then another 25 & etc, or did you take 100, then 150 & etc? I assume cumulative not additive, but wanted to clarify.

Also, not surprised it took a moment for the bad effects to appear. It usually takes about an hour for flecainide to become effective and convert me.

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GeorgeN

My Dr. had me start out at 100mg, then go to 150, 175, then 200. All of this was done at home. I did start feeling a little queezy and light-headed at 200mg. Since I was still have AFIB after numerous Episode, my Dr. sent me to the ER Room to be monitored at 300mg. He Faxed Instructions/Dr's Order to the ER, and also called the ER Dr, and the Head Charge Nurse to tell them what was going on. I took the 300mg right as I went in to the ER. I told the Triage Nurse what was going on, and they did an EKG, BP check etc. This only took 10 minutes or so. My EKG came back as stable very well controlled AFIB, with at HR around 75. At this point they showed the EKG to the Dr. who said I was OK and not any danger, and then had me wait until he could see me.

.

Question, are the 100, 150, 175, 200, 300 doses cumulative? That is did you take 100, then add 50, then another 25 & etc, or did you take 100, then 150 & etc? I assume cumulative not additive, but wanted to clarify.

Also, not surprised it took a moment for the bad effects to appear. It usually takes about an hour for flecainide to become effective and convert me.

That is stepped up per Episode. So I would take 150 at once (PIP), then back to a maintenance dose 12 hours later. Next Episode, start at 175, then back to 75mg/2X Day. then several months later on the next Episode, I would start at 200, then back to 150/mg/day, until I converted, Then I would stop the Flec until the next Episode. So on the the day I took 300mg and had issues, I was starting out fresh, had an Episode, and took the 300 at once.

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Carey
Fibrillator is right that flecainide usually does lose effectiveness eventually. Some people get many years out of it and others just one or two. In addition to losing effectiveness, it can also become pro-arrhythmic. Both problems are common with several antiarrhythmic drugs.

Anti-Fib's experience was extremely unusual for flecainide, and what I heard there was a whole lot of medical bungling and negligence contributing to the problem. The biggest risk with flecainide is that it can cause 1:1 conduction, meaning every single beat of your atria gets transmitted to the ventricles, resulting in a heart rate of 250-300. That's why your EP prescribed a beta blocker to be taken before the flec. It's a very rare side effect, but potentially fatal, so that's why the BB as a precaution. It will prevent the 1:1 conduction.

I agree a Beta-Blocker needs to be in place. It's the only Anti-Arrythmic that doesn't have one in the Drug itself.
In my case, I was on an Beta-Blocker, my rate was in the 70's. I have read about Drug-Induced Brugada Syndrome, that Flecainide can cause this Brugada ( another dangerous IR HR). It looked like it on the Heart Monitor when they first hooked it up, about 3 hours into this. unfortunately a Cardiologist never saw it. I did go into Flutter after 3 hours or so from when I took the Flec, but my HR was only in the high 80's. Anyway they ended up Cardioverting me finally, after 5 hours from when I went in, and at that point I had too much help and Staff around. Everybody wants to watch the Guy get blasted with a big Shock. About 5-6 Hospital Staff were there, along with 4-5 EMT's watching.