PACs & PVCs & paroxysmal afib

Team,
I saw a new EP today and he described my heart as "beating all over the place" due to me having PACs & PVCs & history of 2 afib episodes (2006, 2018). He said he can do ablation for PVCs, and at another time do an ablation for afib, but the PACs present a different approach which is more difficult. He's been doing ablations for 13yr, over 5000 so I felt he knew what he was talking about. He suggests I discuss with my cardiologist about taking flecainide and metoprolol to reduce PVCs. According to Drugs.com, these two drugs have a risk for interaction which could cause irregular heartbeat and palpitations. Why on earth would I take two meds that could cause the condition I already have??! I see my Cardiologist in two weeks and will ask her since the EP said he really does not want to address drugs but will be available at the time I need an ablation. I'll have a run of PVCs for few minutes that scare me to panic thinking I'm in afib. According to Kardia it is a possible afib, but the EP said it was not. Heart beats a little over 100 during PVC run but I'm not sure how much of that is me being scared.

Anyone out there with similar situation and have found meds that work? I've tried Magn but didn't help. Wonder if the PAC tamer would help PVCs!

Additional history: 68yo female, 145lbs, never smoked, no caffeine, no alcohol.

I had a 33% pvc burden in 2020 that lasted months. I was scheduled for a pvc ablation. My seasoned ep told me to take Tenormin to see if my PVCs would improve before getting an ablation. I was on multaq which lowers one’s hr so I started with a small dose of Tenormin @12.5mg/day. Nothing. The next week I increased to 25mg a day. Nothing. Two or three days into week three taking 37.5mg/day stopped my PVCs cold —four days before my scheduled cancelled pvc ablation.

When I was on flecainide I took a beta blocker. I spaced the two drugs an hour apart to help with liver enzymes processing the drugs out. I had no problem. My husband was a pharmacist and told me it was ok. I know of others taking flecainide with a beta blocker. It’s recommended while on flecainide to take a BB.



Edited 1 time(s). Last edit at 10/08/2021 03:05AM by susan.d.

Muntz,
Flecainide+betablocker are usually prescribed together, mainly to prevent or stop afib episodes.

I've noticed that high calcium consumption tend to increase the number of PVCs I can have. Those PVCs, mostly in bigeminal pattern, seem to have no relation with the PACs I'm having too and that can lead to afib.

FWIW, my experience with rhythm drugs and betablockers didn't help against PVCs. But they were somewhat effective against PACs and afib during about six months.

This is the problem with sites like drugs.com. Although the information is correct, it's so abbreviated that you almost need an MD to interpret it correctly. The warnings drugs.com is talking about don't apply to you. They only apply to people with a history of heart disease, heart attack and/or heart failure in particular. In treating afib, flecainide is almost always combined with metoprolol or diltiazem, which are both rate control drugs. The purpose is to prevent a rare side effect of flecainide known as 1-to-1 conduction. Although very rare, 1:1 conduction is dangerous because it can lead to a heart rate well over 200. So the rate limiter is added in order to slow your heart down just in case that happens.

There is no danger in combining flecainide and metoprolol and it will not cause an irregular heartbeat.

Also, the Kardia will label almost any rhythm that's the least bit irregular as possible afib. It's easily fooled by a bunch of PACs or PVCs. The key is to look at the entire recording. With afib, everything will be irregular, but with PACs it will just be these weird beats now and then. In between the weird beats, if you see normal rhythm, that's not afib.

susan.d
Pompon
Carey
YOU GUYS ARE AWESOME!!! IT'S AMAZING HOW INFORMATION HELPS ME DEAL WITH THIS CONDITION. THANKS FOR BEING HERE AND HELPING EACH OTHER! GOD BLESS!

I took Bisoprolol 2.5 mg (concord) before sleep . It helped me eliminate all palpitations for a complete year.

I have been in nsr since ablation in Bordeaux in 2003 for persistent AF, but I get many ectopic beats, almost 8000 on a 24 hour ecg. I take magnesium, potassium d-ribose and taurine every day which dampens them down so I hardly notice them.

If they ever become really uncomfortable I take 1.25mg (occasionally 2.5mg) bisoprolol and that always calms everything down with no noticeable side effects.

Gill

History of PVC's, PAC's and Afib myself...started way back in 2006 and I have mostly managed...with a little help. So, my current regime...
-50 mg metaprolol succinate 1x/daily...I take it in the am. Replaced Atenelol a few years back.
-Baby aspirin most days...not always.
-Banana daily
-Fruit smoothie daily
-Centrum multi vitamin 3-4 x's per week
-Low fat, low sodium, low cholesterol diet...think Med diet.

If/when the PVC/PAC come on...eat an apple, drink low sodium V8 and if needed, orange juice. They almost always stop 15 minutes later.
Had 3 Afib episodes in 2006/2007. Afib showed back up in 2019 with 2 and 1 in August of 2020.

Two other items to take heed of...stay hydrated and get sleep. I drink, occasionaly too much, and have to stay hyrdated and get proper sleep...a must...

54 year old male, 175...moderately active.

Good luck!!! This board is full of wonderful people with lots of knowledge...

[pubmed.ncbi.nlm.nih.gov]

"We searched for nutrient deficiencies that could cause cardiac arrhythmias [premature atrial contractions (PACs), premature ventricular contractions (PVCs), atrial fibrillation, and related sinus pauses], and found literature support for deficiencies of taurine and l-arginine. Case histories of people with very frequent arrhythmias are presented showing 10-20g taurine per day reduced PACs by 50% and prevented all PVCs but did not prevent pauses. Adding 4-6g of l-arginine immediately terminated essentially all remaining pauses and PACs, maintaining normal cardiac rhythm with continued treatment"

Supplementation worked VERY quickly for my husband. Might run it by your doctor.

Cedars-Sinai heart clinic cardiologists discontinued advising patients to take l-arginine. Something to do about higher mortality.

[www.health.harvard.edu]. (Cons)
Play it safe, avoid L-arginine supplements

[www.webmd.com]. Con
[www.frontiersin.org] Pro

[www.mayoclinic.org] Pros and cons (see side effects)

[www.medicalnewstoday.com] (cons if Too much):

Although L-arginine is considered safe in moderate doses, too much L-arginine can have severe side effects, including death. It is important to understand how the supplement may interact with the body and with additional medications before taking it.



Edited 1 time(s). Last edit at 10/19/2021 12:09AM by susan.d.

Before my ablation in 2016 the PACs and PVCs were almost worse than the afib episodes themselves and were very disruptive. I was taking propafenone and metoprolol and still started getting break through ectopic beats . Before my ablation I asked the Dr. Hocici if the ablation would help the PACs. She said "maybe, let's hope so".
After the ablation it has been 95% better with a few breakthrough episodes when I do things I know I shouldn't. I take a small daily dose of bisoprolol which seems to keep them under control.

A few links in my files... on the L-arginine topic :

[www.afibbers.org]
[pubmed.ncbi.nlm.nih.gov]
[www.health.harvard.edu]

And these clips from the product data sheet by Designs for Health on their L-arginine:

*These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure or prevent any disease.

Consult with your healthcare practitioner about your specific circumstances and any questions you may have.
Designs for Health’s L-Arginine provides 750 mg of the amino acid L-arginine per capsule.

L-Arginine serves as a building block for structural proteins, enzymes and other signaling molecules in the body. It is a conditionally essential amino acid, meaning that while the body can synthesize arginine internally, certain conditions may increase the body’s requirement for arginine beyond that which it is capable of generating on its own. L-arginine is abundant in both animal and plant foods sources, but some individuals may benefit from additional amounts via supplementation.

L-Arginine is the precursor to a compound called nitric oxide. Nitric oxide helps support healthy blood pressure
by influencing the dilation and elasticity of blood vessels, thus allowing blood to flow more smoothly. Nitric oxide
also supports healthy function of the cells that make up the inner lining of blood vessels, called the endothelium.

Benefits of L-Arginine

Through regulation of nitric oxide signaling, L-arginine may support:*
• Communication among nerve cells
• Proper blood circulation
• Healthy immune function
• Healthy liver function
• Proper platelet aggregation and blood clotting
• A healthy inflammatory response
• Sexual arousal, via facilitating blood flow to the sexual organs

Recommended Use:
As a dietary supplement, take one capsule per day, or as directed by your health care practitioner
=====

Jackie

Good morning team! Just a quick follow-up... yesterday I started flec 50mg b.i.d. with 25mg Metoprolol q.d. I still take Eliquis 5mg b.i.d. since 2018. Took 2mg Melatonin my pcp recommended since the PVCs keep me awake (and scared) at night. My 2 week monitor showed 2% burden so I don't qualify for ablation. I'm wondering how long it will take meds to work because last night was no change. I had runs of PVCs which is worse when I lay down ( I even try to sleep sitting up with pillows!) Got to sleep about 130am, woke up at 6 and damn... they started again but not in runs just one every couple minutes. I guess I'm overly anxious (ya think!) to get rid of them so I can get back to enjoying an ectopic free life! But maybe that's not in the cards for me and we have to learn to play with the cards we're dealt! Hubby has made plans for Key West trip next spring and I'm terrified to go thinking I'll spend the whole vacation checking my pulse and hoping I can find a hospital if needed!!! Back to my question...how long before my meds will work? Is there a forum for worry warts 🤣
Luv you guys!

Quote
Muntz
Hubby has made plans for Key West trip next spring and I'm terrified to go thinking I'll spend the whole vacation checking my pulse and hoping I can find a hospital if needed!!! Back to my question...how long before my meds will work? Is there a forum for worry warts 🤣

Why would you need a hospital? Ectopics present no threat to you and never require a hospital visit, or any treatment at all actually until they get to be a very heavy burden (20,000 per day, or about 14 per minute every minute of the day). Even a full-blown afib episode doesn't require a hospital visit unless your rate is over ~200 or you're experiencing more severe symptoms like feeling dizzy or passing out. This is mainly a mental thing you're going to have to learn to deal with if the flec doesn't work. Learn to quit checking your pulse and ignore the ectopics as best you can. I know it's easier said than done, but it's the hand you were dealt, like you said. If the anxiety is just too much for you, ask your doc for an anti-anxiety med like Xanax. Just be aware that benzos are addictive so you need to manage your use of them carefully.

Flec starts working in about 20-30 minutes, but to achieve full effect takes a 2-3 days. You're on a pretty low dose, so unless you're a very petite person there's room to increase the dosage if needed.

Enjoy the Keys!