New to Afib - question if can ease off Metoprolol - Flecainide

Many Thanks to all contributors here, I've read about 50 threads while getting up to speed on my "recently caught" Afib.

If I could lean on you for some advice I have a few questions I've not been able to self-answer so far in study:

6 weeks ago I went in for a pre-admission appointment at a hospital (for a colon tumor removal), they did an EKG and found the Afib (bouncing from 70 to 155 BPM), put me in the ER, I did 3 days at the hospital, it pretty much stabilized 2nd day, on Metoprolol and Flecainide (other stuff in initial I/V, and anti-coagulant injections etc), and they send me home with the prescriptions (Metoprolol and Flecainide), take twice a day, get refills etc…

I think an earlier operation a year and a half earlier triggered the afib actually. I felt tired and drugged every day for a year and a half, right after an operation! At any rate I've had un-detected Afib, until that recent EKG caught it.

Questions: I got a little finger pulse / oxygen meter off Amazon, it toggles to showing an EKG like "line", similar to what the Kardia thing shows / represents, it is Very Clear when I'm in Afib, very jiggly line etc, yet "nice and smooth" and around 60 BPM when all is good.

About 10 days out of the hospital, I tried going off the Metoprolol and Fecainide, and the meter showed the "very jiggy lines" but it never went crazy high on BPM, and I went back on the meds.

NOW I've added the Magnesium, Potassium, and Taurine, and other things for inflammation, and I'd like to get off of the meds. Running with un-detected Afib I was tired - but on the meds, I think I'm even MORE tired.

If with the Magnesium, Potassium, and Taurine, facing east and coffee one day then none the next (to please all trigger opinions), is it possible I can just stop the beta blocker and anti-rhythmic (Metoprolol - Flecainide), and see if I have managed to "convert" to Normal Sinus Rhythm?

Maybe just hit it with the "pills in the pocket" as I've read about here, if I slip into an Afib, and just see if life can be managed that way?

Any advice re: "that would be a reasonable thing to try"? If I did try to wean off those two meds, would it be best to go half dose for a couple of days then end, or, just end?

I know nobody can predict outcomes, but that said I very much appreciate any experience, advice, or thoughts. I'd really like to avoid the side-effects of the drugs, even short term, the "dull and tired" thing is not good.

I do recognize, if trial and error shows "I can't go off the drugs", or if the drugs stop working, the Dr. Natale route would be an avenue, if it comes to that. Thanks Again - Frank in Florida

There's no danger in stopping them. Worst case is you end up in afib. It's unlikely that you've completely conquered afib so if a PIP approach works for you then that's an option instead of taking the drugs daily.

The usual procedure for using flecainide as a PIP is 300 mg, chewed, and taken with warm water as soon as possible after an episode begins. For safety reasons, you should also take a dose of metoprolol with it.

I didn't see anything about an anticoagulant. Are you on one?

Thank you for the feedback Carey. No I'm not on an anticoagulant, they had me on them initially in the hospital when first addressing the afib, but I'm 62, no heart attacks, not diabetic etc, so, (other than what the afib might influence), low risk for stroke it seems.

This is kind of a definitions question; Let's say somebody took Metoprolol and Flecainide for 2 or 3 weeks or whatever, and "Afib was under control", no Afib, then they stop the meds, and let's say a few days go by.

Maybe heartrate returns upward, maybe some palpitations, but no actual Afib.

"Could you say" at that point that they had "converted", re: (yes it could hit back at any time,) but could you say it had converted to Normal Sinus Rhythm, in essence the same "status" as if they had gotten an electro-conversion done? Thanks again for the help and info.

Same Status, yes, but a chemical cardioversion is less stressful on the atria than an electric one.

Thanks wolfpack (and Carey), I was curious on those points. I am going to try to ease off the meds and see if I can keep decent enough control with the Pill in Pocket (300mg Flecainide sure sounds high, but I guess as a "hit" to bring control, you need what you need).

Being on the Metoprolol and Flecainide "every day" is like being on sleeping pills to me...

Thanks for all the knowledge you all have shared, being able to review the earlier threads etc has been very helpful.

My suggestion would be to decrease your flec dosage gradually and see what happens. The Metoprolol is likely not keeping you in rhythm, but will mitigate the risk that flec could put you in atrial flutter. It is most likely the reason you feel tired. Once you've reduced the flec (you can do this with a pill cutter if you need to), then step the Metoprolol down. You may find there is a dose of flec you need to stay at to maintain NSR or maybe you don't. However there is likely some physical and electrical remodeling that has occurred during the time you were unaware but likely in afib. This will make it harder to stay in NSR without "help."

If you happen to be near Weston, FL, I can recommend Dr. Pinkski as an excellent EP <[my.clevelandclinic.org] He trained under Dr. Natale, arguably one of the best EPs anywhere. I recommended him to my cousin 10 years ago with excellent results. Back in that time, there were a number of FL folks who touted him highly and would drive long distances to see him.

George

George (and all here), great info, very very helpful...

I'm near Tampa, I see Weston Florida (with Dr. Pinkski) is in Broward county, I wonder if he helps with hanging chads...

No doubt, worth the drive towards Miami, if more help is needed, thank you very much for the recommendation.

If only all this was as easy as going to the auto parts store, and just swapping out the worn out parts...

The expertise and opinions shared on this board is the next-best-thing.

You need to find a good EP and get some proper advice. Although it sounds like your CHADS-Vasc score is low, that doesn't mean you're not at risk of stroke until your afib is definitively under control.

Thanks and I agree with you Carey. In the pathway getting out of the hospital (tossed into the ER then a 4 day stay) they put me on low dose aspirin as a "continuance" from the injections for anti-coagulation, it did evolve to the side-effects of "irritated digestive tract" and I dropped the aspirin (after some research), but I hear you man. Nobody wants a stroke...

In fact my first night in that hospital they brought in a "roommate", who had just had a stroke... 72 y/o, he was a mess, calling out all night for out of state relatives who were not in the room, crapping the bed, etc etc... I say to myself, sheesh, I need to start exercising, get in better shape, avoid THAT outcome...

His family shows up the next day, talking about how much he loved to work out and run and go to the gym...

Sheesh - scratch that off the list... (LOL). But yeah, avoiding strokes, huge topic.

Hopefully I can ease back on the meds to running "Pills in the Pocket" as needed, and monitor often with my nifty Amazon Finger / pulse / waveform thingie (SantaMedical unit, ~ $20), and stroke avoidance (including L-Arginine powder for Nitric Oxide, etc etc) is the key next area to point the flashlight. My dad had two strokes, it's a re-set button nobody wants to have to go through.

Great! Now that we're in agreement! :-)

I was put on Metoprolol along with "rat poison." This is considered the "tried and true" approach to a-fib. The Metoprolol made things worse. It wasn't until after I took myself off of that stuff (that's being nice) that my heart quit trying to force its way through my chest. Metoprolol is supposed to control the heart rhythm. It did nothing of the sort. I found that d-ribose does what Matoprolol is supposed to do with no side effects. Check out Dr. Stephen Sinatra's protocol for a-fib. It helped me quite a bit.

Wow, thanks for the info alxndr01 - I had never heard of D-Ribose, I just studied up on it, including finding a page on Dr. Stephen Sinatra's site as you recommended, "this is what I have been needing" no doubt, thank you so much for posting this!

Here's that page, for others interested in learning more;

[heartmdinstitute.com]

Quote
alxndr01
Metoprolol is supposed to control the heart rhythm.

Metorprolol is a beta-blocker and is supposed to control the heart rate, not rhythm. Rhythm control is a completely different set of drugs.

What Wolfpack said.

FRANKinFLORIDA,

What is L-Arginine taken for?

Leah H.

L-arginine is a precursor to the blood gas, nitric oxide, which has a vasodialating (relaxing) effect on blood pressure. In short, it can lower BP.

Thanks Wolfpack - and some more info Leah;

a) L-arginine and L-Citrulline both are touted as "healthy for the heart" for a few reasons including the lowering of the BP as Wolfpack pointed out, so as well if one is already on blood thinners one would want to monitor this / be in coordination with your Dr.

b) I've tried the capsules, "didn't notice benefit", and 3 or 4 powders (the most popular form), here's info on this link to what (for me) was the best sourcing on this, the taste can be horrible, this one is actually good, and contains both L-arginine and L-Citrulline,

[www.amazon.com]

Here's more on L-arginine - [draxe.com]

Here's more on L-Citrulline [www.selfhacked.com]

On the citrulline topic... check this study. Very positive.
[www.ncbi.nlm.nih.gov]

If you want more detail on the beneficial action of nitric oxide,
the book, The Nitric Oxide Solution by Nathan Bryan PhD and Janet Zand, OMD is a good one.

The classic is by Louis Ignarro, PhD - NO More Heart Disease

You will be convinced that NO vitally important.

Jackie

Thank you everyone, and GeorgeN your comments up above on dosing reduction were very helpful, I've started a new post with my positive experience on that - Frank



Edited 1 time(s). Last edit at 05/13/2018 01:54PM by FrankInFlorida.