skipped beats

Hi - I have had AFIB for several years. It is mostly controlled by flecanide at this time. I have always had some skipped beats here and there throughout my life. However, for the last three or four days I have had almost constant skipped beats. It's a beat-skip, beat-skip or sometimes 2 beats and then a skip. My pulse rate is slow , 60-70. It mostly bothers me at night. I have been careful to get enough potassium and am taking taurine and other supplements and drinking lots of water. Nothing seems to work to get them stopped. And I am not aware of anything I have done to bring them on. (I am not completely clear about the difference between PACS and ectopics.) I saw my cardiology nurse practitioner for a routine check up a few weeks ago and I mentioned having them (although not all the time like now) and she was unconcerned and said I could take an extra flecanide if they bothered me. I have since done that, but it isn't working. I am not on any blood thinner although I am under the impression that irregular beat that is not afib is not an increased risk for stroke. I have read a little bit about bigeminy and am wondering if this is it. I have no underlying heart condition other than the afib. I feel fine, otherwise, am not in pain or short of breath. Should I be concerned?

Depending on your weight, be careful when taking extra flecainide. I listened to an EP and ended up in the ICU with 24-37 HR flecainide overdose. Flecainide is a black label drug

Thanks! I am taking 50 mg twice a day and can take two more if I want. She said mine is a low dose.Other than that, I don't know. Flecaninde makes me nervous to begin with, but has basically stopped the afib (for now). I have only taken an extra pill three or four times to see if it would help.

What you're describing sounds like PACs. And the beat-skip, beat-skip sensation probably means there's one PAC in between each normal beat. As you suspected, that's bigeminy. Bigeminy isn't a condition or disease; it's just a description of the pattern. There's also trigeminy and quadrageminy. I used to get PACs in a bigeminal pattern that would go on for weeks. Annoying as hell and no drug I tried would stop them.

Taking an extra pill now and then may not raise the concentration of the drug in your blood sufficiently to help, so I would try the 100 mg dose for a week. At 200 mg per day you'll still be well under the 300 mg maximum.

If after a week it hasn't helped, that may mean you've reached the point where flecainide's not going to work for you anymore. It and some other antiarrhythmics are known for that. They eventually just stop working for you and you have to switch to something else.

There is no difference between PACs and ectopics. An ectopic beat is any type of beat that's out of place, so both PACs and PVCs would be examples of ectopics.

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Carey
At 200 mg per day you'll still be well under the 300 mg maximum.

The maximum dose for a person weighing less than 154 pounds (70 Kg) is 200 mg, 300 for those weighing more.

I would experiment with elevating your HR temporarily (like going for a Walk), and see if the PAC's go away. It sounds like the Ectopy could be related to a lower HR, since they are worse when you lie down. If they go away when you raise your HR, then taking Drugs that lower your HR would be counter-productive. You would need to keep track of how the increased Flecainide is effecting your HR. Using higher doses of Flecainide may necessitate using a Beta or CCB to protect against the possibility of high HR, from Flecainide-induced Atrial Flutter with a 1:1 conduction ratio. This might be counter-productive if indeed a lower HR is contributing to the PAC's in the first place.

The extra Flecainide may help, but it might be better to treat the PACs separately from the AFIB. There have been many who have posted about using Electrolyte balancing to address Ectopy. Usually increasing Magnesium or Potassium, as you are probably aware. I would get a recent Blood Panel to check your Electrolytes including an RBC Magnesium Test. Everyone is different, and I have unusual Physiology, but I had very similar issues to yours with the Rythmic PACs. After some experimentation, I found that adding Sea Salt to my Water supply brought me out of the constant PACs. Drinking too much plain Water can flush Sodium out of the Body. I was only in the low-normal range for Na+ at 136 to 138, but adding Salt did help, and I also feel much better.

How much water do you drink in a day? Don’t overdo it. That’ll flush things out.

Like Anti-fib said it could be associated with low HR.

I have been dealing with occasional eptopics since my ablation in July. They have all been associated with either laying down or extended periods of sitting. They go away as soon as I move.

Increased K and Mg have reduced their occurrence considerably.

My skipped beats do seem to be worse at night, but don't go away when I exercise. I have been aiming to have my potassium level at 3500 mg through foods and supplements. Should it be higher than that. I only get about 400 mg of MG because of bowel tolerance. I also use a MG spray everyday to get a little more.