Attempting off of Metoprolol & Flecainide - "conversion tricks" when Afib hits?

Thanks for all the great knowledge shared on the forum - OK, after 7 months on Metoprolol & Flecainide (after Afib was discovered / diagnosed), I am really tired of the side-effects of the drugs (foggy headed, tired, "motivation is whacked"), I did manage to reduce the amounts of each by about half and still have normal rhythm, but the side effects didn't really reduce much.

I forgot to take my night dosing last night, then in the morning I just said "screw it" and went without the pills, to see what would happen.

Up until evening time, "nice rhythm" and pulse up a bit to 85 or so, I've got a fingertip pulsemeter with the wave display (amazon or ebay, $27 or so) and it's very accurate at showing when the pulse goes "all sketchy", and it shows pulse going to 120, 145 etc, when I go into afib.

So, the normal rhythm didn't last, I've been in afib for about 2 hours, I know I could "hit it will pills" and knock it back in rhythm, "but" I really want to try and be off these drugs, they make quality of life so much worse.

There was a thread going several months ago about "pursing your lips and slowly breathing out" with some pressure in the lungs, that actually (for me) brings the "speed" down (to like 85), but the rhythm is still very jerky / sketchy. (If I lean back in a chair while doing the slow restricted breathing out, that seems more effective).

Any other "tricks" or things you all have done, to "bring" a conversion to normal?

And, I know the medical view is "afib brings a stroke risk" due to potential coagulation / blood not flowing & leaving the heart properly - in actual truth does that happen often at all, really, afib riding along, causing or precipitating strokes?

What else "bad happens" just letting afib go, and being in afib, like for days / weeks etc?

Frank in Florida

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FrankInFlorida


What else "bad happens" just letting afib go, and being in afib, like for days / weeks etc?

Frank in Florida

Wrecks your heart, and your odds of successful treatment decline. I hope you're on AC's

With the usual "risk factor assessment" I was not put on anti-coagulants.

I've been curious what toll Afib has on the heart, re: "wrecks your heart", what are the details there - harms valves, shortens lifespan of heart function?

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FrankInFlorida
With the usual "risk factor assessment" I was not put on anti-coagulants.

I've been curious what toll Afib has on the heart, re: "wrecks your heart", what are the details there - harms valves, shortens lifespan of heart function?

Stroke, first and foremost. Maybe you were judged not to need anticoagulants at first, but if you're in afib now and don't plan to stop it then things have changed. You need to be on anticoagulants yesterday.

Next comes heart enlargement leading to heart failure. That would be the wrecking of your heart thing jpeters mentioned. However, heart failure is mainly only a risk if your heart rate is consistently over 100. If you're in persistent afib and your rate remains below 100, your risks are atrial enlargement and persistent afib that will become increasingly difficult to ablate should you ever decide to go that route.

Living with persistent afib is a perfectly viable option but to do so you need to control your heart rate and prevent stroke. Lack of an anticoagulant is your only immediate threat. Like I said, you need to be on one yesterday.

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FrankInFlorida
With the usual "risk factor assessment" I was not put on anti-coagulants.

I've been curious what toll Afib has on the heart, re: "wrecks your heart", what are the details there - harms valves, shortens lifespan of heart function?

Enlargement, walls thicken, ejection function declines, etc. In terms of having a successful ablation, there's a window of opportunity that decreases the longer that you're in persistent.

Thank you Carey and jpeters (I wish there was a thanking system on the forum), from the ~145 BPM showing on my pulsemeter (with waveform display), after a few hours it now seems a bit stabilized at around 85 BPM.

"But", the rhythm is irregular (the waveform display shows that "clearly", and it was nice and smooth while on Metoprolol / Flecainide, but the whole issue here is seeing if I "can" get off the meds due to side effects).

I guess ~ 85 BPM but rhythm irregular "is still Afib"? Same dangers / issues basically as would be with your warnings posted above, generally speaking? (Thanks again for the feedback).

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FrankInFlorida


I guess ~ 85 BPM but rhythm irregular "is still Afib"? Same dangers / issues basically as would be with your warnings posted above, generally speaking? (Thanks again for the feedback).

With persistent, there's a wide range.i.e, 80-167. The Atrium just quivers continuously.

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FrankInFlorida
I guess ~ 85 BPM but rhythm irregular "is still Afib"? Same dangers / issues

Yes.

If your rate stays under 100 you don't face much heart failure risk, but you mentioned 145 so I'm guessing it doesn't stay low consistently. You still face the stroke risk no matter what your heart rate. You can't just ignore this.

Thanks for all the helpful data - Well I'm going back on the Metoprolol - Flecainide right now then, to knock this back into normal rhythm, it seems I'm not one who can get away with "it has converted - OK now I can just go with the pills in my pocket for as needed use" type of protocol.

Frank, I hate those meds as much as you do, but when afib comes back (and it often does), I don't wait a long time before taking my flecainide ( I usually self convert within one hour, but if not, I take my PIP flecainide). And I'm still taking a low dose of betablocker on a daily basis (in the evening). This small dose of BB doesn't disable me as much as the rhythm drug.

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Carey

With the usual "risk factor assessment" I was not put on anti-coagulants.

I've been curious what toll Afib has on the heart, re: "wrecks your heart", what are the details there - harms valves, shortens lifespan of heart function?

Stroke, first and foremost. Maybe you were judged not to need anticoagulants at first, but if you're in afib now and don't plan to stop it then things have changed. You need to be on anticoagulants yesterday.


Living with persistent afib is a perfectly viable option but to do so you need to control your heart rate and prevent stroke. Lack of an anticoagulant is your only immediate threat. Like I said, you need to be on one yesterday.

If his CHADS VASc is 0 for instance why would he need to be on anticoagulant? I understand the LAA issue but I've always been confused that if it is the cause of strokes in AFib (and it is) then why even use the CHADS VASc at all? Shouldn't all afibbers be on AC then?

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FrankInFlorida
With the usual "risk factor assessment" I was not put on anti-coagulants.

I've been curious what toll Afib has on the heart, re: "wrecks your heart", what are the details there - harms valves, shortens lifespan of heart function?

Assume you mean your CHA2DS2–VASc score <[en.wikipedia.org] is 0.

One issue is that, as the saying goes, "afib begets afib." Hence the more/longer you are out of rhythm, physical and electrical remodeling occurs. This may impact the effectiveness of future treatment and make, for example, ablations more difficult.

Some months ago I wrote a post about using breath holds on an exhale to convert an episode. <[www.afibbers.org] The way you do this is to do a normal exhale and then hold your breath out. To work, you have to push this breath hold pretty far. You don't want to pass out, but it is to a point where your brain is screaming at you to breathe. If you want to play with this, It might be good to practice when you don't need it so you get used to the feelings.

George

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Brian_og
If his CHADS VASc is 0 for instance why would he need to be on anticoagulant? I understand the LAA issue but I've always been confused that if it is the cause of strokes in AFib (and it is) then why even use the CHADS VASc at all? Shouldn't all afibbers be on AC then?

If you're in persistent afib then your CHADS-Vasc score is almost irrelevant. You face a stroke risk due to blood stagnating in the atria, and the LAA in particular. If you're a CHADS-Vasc 0 or 1 and your afib is under control then an anticoagulant probably isn't necessary. By "under control" I mean never in afib. If you're paroxysmal then you still face the risk, and that risk is greatest when you convert from afib back to normal, which is why they won't do a cardioversion without either anticoagulants or a TEE.

Hope the drugs got you back to rhythm. However, even if they did you really should be on an anticoagulant.

I know the drugs stink but you need to keep your hear in rhythm until you decide your approach to being rid of it completely.

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Carey

If his CHADS VASc is 0 for instance why would he need to be on anticoagulant? I understand the LAA issue but I've always been confused that if it is the cause of strokes in AFib (and it is) then why even use the CHADS VASc at all? Shouldn't all afibbers be on AC then?

If you're in persistent afib then your CHADS-Vasc score is almost irrelevant. You face a stroke risk due to blood stagnating in the atria, and the LAA in particular. If you're a CHADS-Vasc 0 or 1 and your afib is under control then an anticoagulant probably isn't necessary. By "under control" I mean never in afib. If you're paroxysmal then you still face the risk, and that risk is greatest when you convert from afib back to normal, which is why they won't do a cardioversion without either anticoagulants or a TEE.

I see that completely. So why is CHADS VASc ever brought into the equation then by EPs that consider AC? You're basically stating that it's always irrelevant since we never know if we're going into AFib tomorrow or even while we're sleeping? So everyone with Parox AFib should be on AC regardless of their CHADS VASc?

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Brian_og
I see that completely. So why is CHADS VASc ever brought into the equation then by EPs that consider AC? You're basically stating that it's always irrelevant since we never know if we're going into AFib tomorrow or even while we're sleeping? So everyone with Parox AFib should be on AC regardless of their CHADS VASc?

I think probably so, yes, but I also think afib burden is a factor. For example, if I were a CHADS 0 and I had episodes only rarely and they didn't last more than a few hours, I probably wouldn't. In fact, I did that for about six years because I had only one or two episodes per year and they never lasted longer than 4-6 hours. But once they started becoming more frequent and lasting longer, I started warfarin (that was circa 2008). But if I had a CHADS > 1 I would have started the warfarin in the beginning.

In the end it's always a judgement call for each individual, especially people with low CHADS scores.

George I read your thread back in June on the breathing, that is part of what inspired me to ask about "any tricks or things that have worked" to bring conversion, and I re-read it now and with Liz's follow-up thread, "very helpful info".

And to Carey and the other contributors, "scary data" re: the stroke risk etc but I'm glad to have my face pushed back into those realities, thank you for the perspectives and insight.

"We are all different", but reading about others who converted then were able to cruise along without Metoprolol - Flecainide had me wanting to see if I could go that ways, seems I can't so, seems I'm persistent afib. I'm going to keep doing the Metoprolol - Flecainide daily, monitor it often, and if I'm staying in rhythm, for now I'm not going to do the anticoagulant route (I am "otherwise" a 0 on the rating score).

I know how my heartrate and waveform are when I'm "in afib", correct me if I'm wrong but if with the meds my heartrate is around 70 or so and the wave is "pretty smooth, but occasional irregularities", but generally a pretty constant smooth representation, I'm figuring that is "acceptable". Any thoughts on that would be appreciated (and I know a full electrodes EKG would give a more precise picture of things).



Edited 2 time(s). Last edit at 10/28/2018 06:28PM by FrankInFlorida.

Frank, i think you should have a holter monitor for at least 24 hrs to be safe.
I've got a pulse oximeter as well and the wave does sort of give an indication. Don't think the pulse rate is much good when in AF because i suspect the sample rate is too short?
E.g. mine would show 80 and next thing it would be 110 or more. The lower readings could give us a false sense of hope?

Initially (3 years ago) they had me on Metoprolol as well - it was horrible and i stopped it. After he prescribed Sotolol which was almost side effect free. Now, i'm on Atenolol and i don't have much of a side effect either - a little less energy i suppose.

Hi Joe, my finger pulse meter seems (for what it is) to be amazingly accurate, when I feel "shaky, sketchy beats" is shows that way on the waveform display (like the needle of an earthquake measure LOL), and when I feel "in rhythm" it's very smooth, but still showing any "dirt" in the pattern, little skips etc...

Why did you drop Sotolol (for Atenolol), did it stop working well? Do you also take Flecainide or s/g for rhythm control? I don't know which (or if it's both) that makes me feel tired and fog headed, the Metoprolol or Flecainide. Would love to know which is usually the main offender.

Probably the metoprolol. That’s a beta blocker and they are famous for feeling like boat anchors.

Unfortunately, betas go hand in hand with the flecainide due to the flutter risk. You can ask about Propafenone instead as an anti arrhythmic. I’ve used that in the past sans beta blocker and it was OK. That’s a discussion with your cardiologist or EP, though. Don’t take my word for it.

Sotalol to Atenolol change was on Cardiologist's advise. Didn't ask why but perhaps he had better feedback with Atenolol/Flecanide combination?
Also found out that my TSH (thyroid) is 5.55 - quite a bit too high (hypo) and therefor not a reason for my AF (but it could have been 3 years ago when i was hyper < 0.01.
Is your thyroid function good?

Thanks Wolfpack, "boat anchor" is a good description... Joe on the thyroid, long story short I have an autoimmune issue and I supplement natural thyroid (4x through the day) and I take adrenal support (hydrocortisone) so I'm bypassing my thyroid gland basically (and I check the levels with labs - TSH is the pituitary's "calling for thyroid", it's not "the" yardstick so to speak, free / available T3 and T4 in the blood gives a better representation of "what you have" vs. what is being called for). So Joe with your info above, you've been taking Flecainide through that, and felt better with the switch off of Metoprolol as the beta blocker?

I use liquid magnesium--1 teaspoon every few hours (Cardiovascular Research LTD) and knock on wood, so far convert within 1-2 hours. I can almost feel my heart say, "Thank you!" That is on top of 4 magnesium pills a day, which has held the Afib at bay. It also has brought my husband back into rhythm the few times he goes out after two ablations.

Thanks for the tip Karin, looks like this is the product? [www.amazon.com] One guy said it tastes horrible, but it does seem a great product. I take two types of magnesium but will add the liquid. Thought that hits me, "so many here" have a spouse also with Afib, had ablations etc, geeze louize what did they do 50, 60 years ago and further back, I guess most didn't know what was going on re: Afib, and just suffered through...

Deja-vu all over again... checking out alternatives to Metoprolol - Flecainide... Propafenone as a Flecainide alternative, scary looking potential side-effects (as with Flecainide though), and the Metoprolol alternatives mentioned above, same story (though Metoprolol isn't "pretty", as Wolfpack said "they are boat anchors". The Metoprolol - Flecainide has brought me a fairly stable "normal readings", but I feel foggy and tired, drained, 24/7 (and am getting tired of that scenario). Amazing that even an ablation route includes stints of these drugs, then I guess in most instances they can be dropped out. I've been doing magnesium, taurine, ashwaganda, d-ribose, for several months in hopes of being able to ease off of Metoprolol - Flecainide.

Researching the (many) great posts / threads on the forum, as a Metoprolol alternative I'm checking out Bystolic (Nebivolol), I've seen where some found it less tiring... [en.wikipedia.org]

As is probably a tag line for many of us here, "the struggle continues".



Edited 2 time(s). Last edit at 10/29/2018 02:17AM by FrankInFlorida.

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FrankInFlorida
So Joe with your info above, you've been taking Flecainide through that, and felt better with the switch off of Metoprolol as the beta blocker?

Metroprolol was given to me 3 years ago at the ER. It was as mentioned, a proverbial boat anchor. Walking 80 steps to a lift left me exhausted and i was quite fit prior to AF. I simply stopped taking after a few days because i found AF less of a problem doing over 100/130 ppm. I was totally ignorant of the potential consequences of doing this.
My last AF episode began about 6 weeks ago and i took Sotolol + Eliquis. Two weeks ago i began Atenolol/Flec/Eliquis. I feel ok as long as i don't exert myself e.g. fast walking. I also get a full/weird/slightly unpleasant feeling in the gut after eating a meal. Not sure why but did not have that problem with just Sotolol and Eliquis.
Looking forward to hear a solution to your problem - best of luck!

Best way to take the liquid magnesium I have found is with orange juice. Hardly notice the teaspoon in 8 ounces!

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karin
Best way to take the liquid magnesium I have found is with orange juice. Hardly notice the teaspoon in 8 ounces!

Ditto for powdered

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FrankInFlorida
Deja-vu all over again... checking out alternatives to Metoprolol - Flecainide... Propafenone as a Flecainide alternative, scary looking potential side-effects (as with Flecainide though), and the Metoprolol alternatives mentioned above, same story (though Metoprolol isn't "pretty", as Wolfpack said "they are boat anchors". The Metoprolol - Flecainide has brought me a fairly stable "normal readings", but I feel foggy and tired, drained, 24/7 (and am getting tired of that scenario). Amazing that even an ablation route includes stints of these drugs, then I guess in most instances they can be dropped out. I've been doing magnesium, taurine, ashwaganda, d-ribose, for several months in hopes of being able to ease off of Metoprolol - Flecainide.

Researching the (many) great posts / threads on the forum, as a Metoprolol alternative I'm checking out Bystolic (Nebivolol), I've seen where some found it less tiring... [en.wikipedia.org]

As is probably a tag line for many of us here, "the struggle continues".

These reasons you keep going back to is why I personally would do the Ablation. I am a Firm believer that stress causes AFIB episodes.