Flecainide PiP posture until conversion to NSR.

When I’ve used Flecainide as a PiP OR (for the last 10 years) as an extra 200mg dose (against the backdrop of 100mg BID if AF breaks through - I am a 220lb 6’ 4” big bloke!), i’ve always lain down until conversion even though quite capable of still walking about and such. Does everyone else here who has used/does use Flecainide as a PiP or as an extra dose if AF strikes lie down until conversion? Or have you/do you just continue about your daily activities if reasonably asymptomatic? Is the required protocol to stay lying down until conversion to NSR or does it not make any difference? For what it’s worth I’ve always stayed lying down so as to keep the heart rate down to try to aid conversion back to NSR. But that sometimes isn’t an option if out and about when the AF strikes!

Cheers,

Mike F

Mike,

EP writer, Dr John Mandrola mentioned one time that he got prone to minimize the possibility of flutter. Of course a beta blocker could do the same thing. I don't take beta blockers so I get prone. I'm not fanatic about it, but is generally what I do to minimize the flutter risk (which I've never had, touch wood).

As an aside: the form of mag I've been using most recently is a di-magnesium acetate powder that is sold for equine purposes. It is not the only form I use but I have used it for 8 years. In any case, I ended up in afib Sunday morning at 6 AM. I had not paid attention to precise dosage for many months & was taking 1 tsp/day. I weighed it, and realized it was only about 5 grams - 20% is magnesium so about a gram of that. For me (who has taken up to 5.5 g/day of elemental mag - not the compound) this is too little, so I have upped it.

I took my normal 300 mg flec, chewed it along with a chaser of 600 mg of magnesium as citrate powder. I went to recline and after about 30 minutes remembered this post <[www.afibbers.org] on conversion using cold. So I went and took a 30 minute bath in 49 deg F (9.5 deg C) water. Well the upshot is, the cold did not help convert me. I still converted in about an hour and 10 minutes, which is usual for me. It may not have helped conversion as I am too used to cold. Because I routinely (most days) take 20-30 minute baths at this temp.

Most of my episodes occur in early morning so getting prone usually means going back to bed. I had planned on skiing on Sunday, but doing that is a bad plan (in my risk estimation) with 300 mg flec in my system. Years ago I had some evening (11 PM) episodes while camping or in a snow cave. I went ahead and did activity the next day, but at least I let 10 or so hours pass to eliminate the flec in my system. My flec conversion rate is usually 85 to 90 (it was a bit lower after the cold bath - 78). My rule of thumb is to wait till it drops into the 60's before I do anything strenuous (I'm not talking about ordinary daily activity, something more strenuous). Others may have a different approach. This was not a prescribed approach, just from my own understanding of risk.

Cheers,

George



Edited 1 time(s). Last edit at 04/12/2018 07:04PM by GeorgeN.

George:

Glad you are OK and didn't take too long to convert, I guess we always have to be vigilant about AF. Does DR. Gundry have any ideas in regards to AF? It seems like for me, I get more episodes in the winter months than I do in the warmer months, I am a lot more active then for one.

Liz

Many thanks for that George - good to hear you converted and at least you know largely why the episode occurred - i.e. lack of Mg. I've woken up at 5 to 6am in AF quite a few times myself.

I agree about lying down if at all possible. These days if I get up and walk around in AF it switches to a regular but slightly bounding arrhythmia of around 80-90 BPM (that doesn't feel particularly unpleasant but still just a bit wrong, then if I lie down again slowly goes back to AF. So I try to lie down! That said I can convert to NSR from both (usually back to my normal resting HR of 60 BPM) but even that said, the conversion from AF to NSR is totally smooth whereas from the other arrhythmia conversion to NSR can be quite lumpy-feeling for a few seconds. I do have the regular bounding arrhythmia on a 12-lead ECG from a few years ago where it is labelled up (by the ECG programming) as accelerated junctional rhythm - EPs who've looked at it say its a bit odd as the ventricular rate is absolutely regular but in between the QRS spikes it does still look like AF! It certainly doesn't appear to be flutter. Even Sabine Ernst didn't quite know what to make of it but felt that it wasn't too much of anything to be worried about in the overall scheme of things.I'll guess it'll show up during pacing as part of an ablation procedure in due course anyway - it almost always shows up at some point in my AF episodes as it is already - particularly, as I said above, if I get up and walk around. We are all truly experiments of one!

Elizabeth, you and me both. 90% of my AF episodes have been Sept to March with hardly any in summer at all (the few of those I've had have been MSG-related).

Cheers,

Mike



Edited 1 time(s). Last edit at 04/13/2018 06:00PM by mwcf.

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Elizabeth
George:

Glad you are OK and didn't take too long to convert, I guess we always have to be vigilant about AF. Does DR. Gundry have any ideas in regards to AF? It seems like for me, I get more episodes in the winter months than I do in the warmer months, I am a lot more active then for one.

Liz

Thanks LIz!. Gundry knows about my afib and that I take lots of mag to keep it at bay. I've never chatted about any different strategies as what I do works pretty well. Also, our hour consults are pricey, so we come prepared with a prioritized list of questions to discuss after we review our labs with him.

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mwcf
Elizabeth, you and me both. 90% of my ADF episodes have been Sept to March with hardly any in summer at all (the few of those I've had have been MSG-related).

Liz & Mike,

What comes to mind is a lack of UV in the winter. I know you both live in northern latitudes. Liz you are probably 40 something and Mike in the mid 50's. I'm at 40 also, but at 5500' (1675m) elevation, which makes a difference. I also spend a lot of time at 11,000-13,000'. I don't have this correlation with UV and afib, but have been playing around with maximizing UV exposure both winter & summer for other reasons. John Ott, who did the time lapses of plants growing and flowering for Disney, wrote a book about light in 1973 <[ratical.org] Not that it tells you what you should do, it just describes how different light frequencies impact the growth and health of various plants and animals. It is very interesting.

In Oct 2016, my uncorrected vision was 20:200 - in feet (I'm 62). My integrative eye doc suggested I stop using sunglasses and get outside as much as possible without any eye covering - glasses or contacts.. I took her up on this. In Feb 2018, I had a recheck. Uncorrected vision was 20:80. I knew it was going to be dramatically better as I could operate in may environments without correction where it was previously required (I rechecked on an eye chart at home yesterday and it was 20:63). On the exam, she said I have no indications of AMD or cataract. She said all my eye structures and vessels look excellent. She also said I was her only patient to follow her prescription. I well know this is very much against standard of care, hence I would not suggest others do this.

George

George:

Ha, ha, ha, yep I am 40 something, I guess one could say that, its the something that is bothersome.

George do you recall that Hans did a survey once asking how many had less AF in the summer months and there were a few of us.

Why do you lay down when you get AF? AF gets me when I am at rest or after eating and resting or sleeping. During the day when working, moving around I don't get it. We are vagal so shouldn't we do some activity to terminate it? Sometimes that works for me and other times it doesn't, I keep trying.

Liz

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Elizabeth
George:

Ha, ha, ha, yep I am 40 something, I guess one could say that, its the something that is bothersome.

I meant 40 degrees north latitude for UV in the winter...

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Elizabeth
George do you recall that Hans did a survey once asking how many had less AF in the summer months and there were a few of us.

Maybe vaguely, that never applied to me, so I likely didn't pay much attention.

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Elizabeth
Why do you lay down when you get AF? AF gets me when I am at rest or after eating and resting or sleeping. During the day when working, moving around I don't get it. We are vagal so shouldn't we do some activity to terminate it? Sometimes that works for me and other times it doesn't, I keep trying.

Liz

If I weren't taking a med I would get up and move around. I have warded off some episodes that way over time.

I get prone because of the flutter risk from flec since I don't take a beta blocker. Flec can be pro-arrythmic and one way to minimize that risk is to be quiet. Fortunately, flec has never flipped me into flutter.

George

George, i've read John Ott's book many years ago and it was fascinating. There is a German MD who has done a lot of work on light and health as well.
I don't wear sunglasses either but others think i'm mistaken and risk cataracts.
Exposing our bare skin to the sun in moderation is important i thing.
[parkinsonhope.org]
[goodmenproject.com]

Sorry, should be in general health but wonder if there could be some relationship with afib as well???

Good Post, I never heard much of lying down to Convert. Personally, I just thought in terms of normal resting around the House, or Exertion like Exercise. I seemed to convert better if I was really as calm as possible, after Exercise like Swimming. In my case I think it has to do with less Adrenalin going to the Heart, that is allowing the Flecainide to work better. As far as I can tell, I don't convert right away, because I have to much Adrenalin going to the Heart after an Episode starts. I believe I am getting AFIB, because of Acute Adrenal suppression, where my Cortisol levels are too low, causing Adrenalin is released to compensate for the low Cortisol levels. This scenario may explain why Beta-Blockers help some people out of AFIB, even though their not Anti-Arrythmics, because Beta-Blockers block the Impact of Adrenalin on the Heart.