to get out of A Fib.

Hello,

65 yo been having A Fib episodes (per watch) confirmed a week ago after shortness of breath and new to me sweating during chores outside in ambient temps of 80 degrees. Sweating has been with me for life but noting like this in the lasty month.

EKG was slightly abnormal. Thus far all tests of heart and lungs show no signs f clots and heart has no damage per echocardiogram. Eliquis 2 times a day.

History of treated and monitored high BP. From what I have read stressful events are a trigger and I have had my share especially since the beginning of the year.

Slated for a electric cardioversion this coming week.

New to all of this and I am particularly concerned about the sweating and shortness of breath.

Very active not obese, non smoker, moderate to heavy alcohol consumption, 3 - 4 cups of Jo in the morning both of which I have virtually eliminated.

What can I expect going forward as far as the sweating and shortness of breath.

TIA



Edited 1 time(s). Last edit at 09/27/2025 11:22PM by augam.

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augam
Slated for a electric cardioversion this coming week.

New to all of this and I am particularly concerned about the sweating and shortness of breath.

Very active not obese, non smoker, moderate to heavy alcohol consumption, 3 - 4 cups of Jo in the morning both of which I have virtually eliminated.

What can I expect going forward as far as the sweating and shortness of breath.

I would say the sweating and shortness of breath are variable between individuals in afib. A successful cardioversion (ECV) and return to normal rhythm (NSR) should mitigate these symptoms.

Know you said you've virtually elimiated heavy alcohol consumption. For future reference, alcohol can be a major trigger for many. Sometimes it is known as "Holiday Heart Syndrome" because of heavy drinking during holiday events. I was talking about afib one time with my (now late) mother's PCP doc, who was also a friend. He said that almost all the afib he saw was holiday heart related.

In studies, caffine is shown not to be a trigger. However years ago here (I've been here over 20), some said it was, but if they switched to organic coffee, it no longer was.

In 2004, my EP was talking to me about an ECV. He said, "I can convert you, but the question is what do I change to keep you in NSR?" I think this is a valid question for you to your doc.

If appropriate for your situation, an on-demand med, such as flecainide can be used to convert when you do go out of rhythm. This is the original paper on the topic [www.nejm.org] I've used this successfully for over 20 years, but after my 2.5 month episode in my first 4 months of afib, I'm in afib very little, so use it infrequently.

Thank you for the reply. Yes the cardiologist at the hospital did mention folks who were not used to throwing them back partying over weekends and would see them by Tuesday with full blown A Fib - some very young as well.

Great thought about asking the cardiologist about treatment that would keep me in NSR. Thanks for the link, I will read it and discuss with the cardiologist.

As far as the sweating and shortness of breath, that is an indication that your heart is not pumping enough blood under exertion.

Like George said, this effect varies among people.

One explanation for this response could be too high of a HR while in AFIB.
Do you know what your average Heart Rate has been while you have been in AFIB? It would say on the EKG.
If your average rate is too high, say over 90, than this can contribute to these symptoms. Are you taking any medication to control your Heart rate?

While in AFIB, if your rate is too high, then cardiac output drops, as the Ventricles do not have time to fill with blood between beats. The normal process of the Atria pushing blood down into the Ventricles is nullified by the Atria filibrating.

Afib causes a reduction of your EF (ejection fraction). Essentially, when the heart is in afib, it does not pump out as much blood to your body as it normally would. Ejection Fraction is the percentage of the blood in your heart that gets pumped out with each contraction. Even though the heart rate is increased, the amount of blood pumped out is lessened during afib. That's why getting out of breath or feeling lightheaded is common with afib, and especially if you are doing any kind of physical activity.

The sweating is a stress response akin to the 'fight-or-flight' response. When in distress, whether real or perceived, the person will secrete both cortisol and adrenalin (epinephrine) as part of the body's sympathetic nervous response. Among other things, adrenaline causes the person to sweat in anticipation, or in response to, rising and/or extreme levels of exertion.



Edited 1 time(s). Last edit at 09/29/2025 04:29PM by gloaming.

I think sweating could be also caused by a decrease circulation accompanying AFIB. I had Heart Failure for several years with a reduced Ejection Fraction as low as 20-25%. I was unusually cold in the winter, and the summer felt 15 degrees hotter than it actually was. I went undiagnosed for quite awhile, and when I played in pickup basketball games, the others players noticed how flushed and sweaty I was.

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augam
Very active not obese

In my case, chronic fitness (meaning a lot of endurance exercise) was my path to afib. This is a thread on the topic, with a book link. I personally know one of the "examples" written about in the book, a guy who had a big problem during a cross country ski race. Those where chronic fitness is the issue are a relatively small subset of afibbers.

Once I figured out what my path was, I reconfigured my training. Found out my exercise trigger was intensity times duration. Meaning I could do short duration, high intensity without issue (like Tabatas on a fan bike), but long duration needed to be limited to Zone 2 exertion, which I implemented using only nasal breathing. For me, supplementing with magnesium (to bowel tolerence), potassium (as citrate powder, in my case, 2 tsp in a liter of water consumed over the day) and taurine (1/2 tsp powder/day) also made a huge difference.

George, what is your source for taurine, pls?

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gloaming
George, what is your source for taurine, pls?

I've generally used the NOW brand powder.

Thank-you. George.

Great info and I appreciate the replies.

So in addition to a PFT and an appointment I have for a sleep study I had my cardioversion and feel 100% better. Before being wheeled into the room where the procedure was done I asked one of the nurses what I could do to keep from going back in a fib and he said make sure you do not have sleep apnea as they see many return cases due to it.

The same nurse who was in the room during the procedure mentioned that I was experiencing difficulty breathing while in deep sedation - and that it could be related to the sedation but the test would answer whether I have it or not.

The doctor at the sleep study clinic did mention that I had a narrow airway when he examined me. So the test is an at home test and that should be delivered by Monday.

I have a follow Monday up with cardiologist who works in the office with the doctor that did the cardioversion.

So many appointments, so many doctors.........lol

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augam
he said make sure you do not have sleep apnea as they see many return cases due to it.

In my case, I've been mouth taping at night for about 10 years. In 2020 (almost exactly 5 years ago as I posted on 9/30/20), I did an inadvertent experiment. Was wearing a beat to beat recording heart rate monitor, and initially no tape (it either came off or I didn't put it on). I woke up with a dry mouth, so taped up. The next day, I downloaded the data and I could see apena patterns in my heart rate without the tape and it was dramatically better with it.

My post from that time, along with images of the heart rate data are here: [www.afibbers.org]



Edited 1 time(s). Last edit at 10/04/2025 12:42AM by GeorgeN.

Thank you George. I really appreciate the information. This forum is a great resource.

I have a personal friend who is also a 20+ year afibber. He uses a CPAP machine for his apena. He also gets all sorts of data about his breathing from his device. After I chatted with him about mouth taping, he started taping while still using his machine. He told me his data look much better while taping, even though he still needs to use the machine.

From a 2004 email of his:

"I was diagnosed with apnea in 2011, but I’m sure I had it for years before. My first episode of Afib was in 2004, 7 year prior to the Apnea diagnosis. I didn’t know enough about apnea then to ask if there might be a connection and none of the docs mentioned anything. I’ve had 4 sleep studies since 2011. The most recent was in March of this year (2024). The prior studies were essentially busts. Hardly slept and collected very little data. The March study provided some solid data based on 5 hours of continuous sleep. Most importantly it showed that I have complex sleep apnea, a combination of OSA and CSA (central). CSA causing about 50 to 60% of my nightly events. Two sleep doctors, 4 studies, many masks and several oral appliances later I was still not getting consistently good sleep. I recently had a zoom consultation with a sleep tech, Polysomnologist, in CA that has 22+ years of analyzing sleep studies. He knows much more about this subject than any doc that I’ve seen. He uses OSCAR software to analyze data collected on a sd card from the Cpap machine. He geeks out on sleep and apnea conditions. He recommended changing my mask and all of the settings provided by the Sleep doc last March. It’s been transformative. My HR and breathing patterns have stabilized during sleep. I’m having an average of 1 to 2 respiratory induced arousal events per hour. Compared to 5 to 10 before, with some nights at 15. It’s very likely my CSA is therapy induced, which may subside over time with the correct settings, etc. I’ve been using an OURA ring to track my sleep since 2018. My sleep score has never been consistently optimal. A good night being 80-85. Mainly due to lack of REM sleep and restlessness, which were almost always sub-optimal. The March study indicated I have RLS. The first night I slept with the new settings my sleep score was 95 and has not been below 90 since then. REM and restlessness have been optimal every night!

I would agree that curing OSA is preferred. Does any of your research indicate that CSA can be cured with that type of protocol? In the mean time my sleep is 150% better. I’ll take it!"

From a text of his:

"The email is my history with apnea and cpap. Embarrassingly, I failed to mention a very important point, which is related to your mouth taping. I started mouth taping at the same time I changed settings, etc. I slept with and without. Big difference. Taping forced nasal breathing and essentially sealed the cpap pressure system. Even the smallest “mouth leak” creates an arousal event, which changes breath pattern and HR. Not quite the same as your experience but I found it interesting that my taping produced similar results as yours."

I go slack-jawed as soon as I fall asleep. My lips lose all tone, and my jaw will often, not always, sag open. As a diagnosed 'severe obstructive sleep apnea' sleeper, I have had to use a CPAP machine since being diagnosed with AF in 2017. The first night of use, I was awakened many times by air issuing from my mouth. My lips even fluttered a bit. I called the RT next morning with WFTF?!? She replied that it is a problem for nose cushion users, which I had decided was to be me, and that they recommend a chin strap. She added that some use surgical tape across their mouths, but that she couldn't recommend it....for obvious reasons. Well, I didn't want to lose another three nights waiting for a chin strap, so I opted for the tape, Bingo! It worked so well that I have used it every night from then on.

To continue a bit, my dad, at 88, decided he needed to get checked out as well since his two eldest sons were using CPAP machines. Naturally, he now uses one. He discussed his diagnosis and his new CPAP with his RT, different establishment, and when we got around to taping, that person said it generally is not a good idea for elderly people because they have thinner, more fragile, skin, and that it can tear easily if the tape is too aggressive. My Dad is now 95 and has been taping from the get-go. No problems.

George in my follow up appointment my cardiologist suggested I can use flecainide.

She mentioned I could either use it twice a day or when I do go out of rhythm but suggested if I elected the later that I have it at the ready wherever I was.

Sounded a bit strange to me but it sounds like that is way you are using it.

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augam
George in my follow up appointment my cardiologist suggested I can use flecainide.

She mentioned I could either use it twice a day or when I do go out of rhythm but suggested if I elected the later that I have it at the ready wherever I was.

Sounded a bit strange to me but it sounds like that is way you are using it.

Yes, I've used it that way for nearly 21 years. I would make the choice on the frequency of episodes. There is no cut and dried rule, but if episodes are frequent then it makes sense to take it daily vs. on demand. You can always start with on demand and then switch if you are using it a lot. As I've self directed my care for all these years, what I do isn't from the standard of care model as I'll explain below. While I've experimented a lot with lower doses, I want to make clear that flec is NOT a med to expoeriment with higher than recommended doses.

I'm a big fan of "minimum effective dose." The standard max dose/day is based on weight and is usually 200 mg/day (or for an on demand dose) if you weigh 154#'s (70kg) or less. 300 mg/day if you weigh more. I was initially prescribed 300 mg for my on-demand dose. At the time I weighed about 205#'s. I was fit but still carried the weight from when I played US football in college. One of my afib remission strategies was to decrease training intensity for long duration activity to what could be sustained with nasal breathing (i.e. "Zone 2"). I started to put on weight with the decreased intensity, so I changed my diet and over time dropped back to around 170#''s, where I remain today. While this is still above the 154 # cutoff, the flec would have a tendency to convert me to flutter (NOT 1:1 conduction flutter). I have a monitoring setup that allows me to record every heartbeat for many hours and I could see this in the data. As flec doesn't convert flutter to NSR well, I'd have to convert myself back to afib from the flutter and then the flec would convert me to NSR. As an aside, the most reliable way I found to do this was to soak in 50 deg F water for 25 minutes, then I'd convert back to afib during the rewarming period. Then the flec would convert me to NSR in fairly short order. Anyway, I found that if I cut my on-demand flec dose to 200 mg from 300 mg, I did not have the flutter issue.

I have had a few periods where the daily intake of flec made sense. As my risk time was in the evening or early morning, I did not dose the flec twice a day, but once in the evening. One of the periods where I took flec daily was after getting CV19 vaxes. I had a 15x increase in afib and I ultimately learned I needed to have not had a vax for 8 months for this issue to go away. A friend with connections to one of the best EP centers in the US told me that center was well aware of this issue. In any case, I found that 50 mg/day and then 25 mg/day flec was sufficient to keep the afib at bay. At these minor intake levels, I still had plenty of "headroom" if I did have breakthrough afib and needed an on-demand dose to convert (though this was a very rare situation). In the case of the vax issue, I would periodically stop the daily flec dose and see if I still had breakthrough afib. If I did, I'd restart taking flec daily. As mentioned, for me, 8 months was the duration needed. I won't take those vaxes again.

In the case of flec, I've noticed over the 21+ years I've been on this site that, for some/many people, the efficacy of flec seems to wear off over time. My logic is that the less it is used and the smaller the doses, the less likely this is to happen.



Edited 6 time(s). Last edit at 10/13/2025 10:52AM by GeorgeN.

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GeorgeN
I want to make clear that flec is NOT a med to expoeriment with higher than recommended doses.

I'm a bid fan of "minimum effective dose." The standard max dose/day is based on weight and is usually 200 mg/day (or for an on demand dose) if you weight 154#'s (70kg) or less. 300 mg/day if you weigh more.

I want to second that from personal experience. My EP started my on 50 mg twice per day but over the years whenever I had a breakthrough of Afib, she insisted on raising the dose. I told her that I was uncomfortable taking a high dose due to only weighing 125 lbs but she insisted that it was necessary and perfectly safe for me to take 150 mg twice daily. It was NOT! I went into complete heart block. I also have a genetic variation that makes me more sensitive to certain drugs--CYP 2D6 and Flecainide is listed as a mediication that I should only take at a half dose because of that. I had also told me EP this but she didn't listen. So while Flecainide works well for most, it is a drug to be respected. Many people have the CYP 2D6 variation.

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Daisy
I want to second that from personal experience. My EP started my on 50 mg twice per day but over the years whenever I had a breakthrough of Afib, she insisted on raising the dose. I told her that I was uncomfortable taking a high dose due to only weighing 125 lbs but she insisted that it was necessary and perfectly safe for me to take 150 mg twice daily. It was NOT! I went into complete heart block. I also have a genetic variation that makes me more sensitive to certain drugs--CYP 2D6 and Flecainide is listed as a mediication that I should only take at a half dose because of that. I had also told me EP this but she didn't listen..

Member susan.d also had an EP suggest over 300mg when she weighed about the same as Daisy. It literally nearly killed her. She'd previously used flec successfully at the appropriate dose for her weight for 15 years without issue if I remember correctly.

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GeorgeN

I want to second that from personal experience. My EP started my on 50 mg twice per day but over the years whenever I had a breakthrough of Afib, she insisted on raising the dose. I told her that I was uncomfortable taking a high dose due to only weighing 125 lbs but she insisted that it was necessary and perfectly safe for me to take 150 mg twice daily. It was NOT! I went into complete heart block. I also have a genetic variation that makes me more sensitive to certain drugs--CYP 2D6 and Flecainide is listed as a mediication that I should only take at a half dose because of that. I had also told me EP this but she didn't listen..

Member susan.d also had an EP suggest over 300mg when she weighed about the same as Daisy. It literally nearly killed her. She'd previously used flec successfully at the appropriate dose for her weight for 15 years without issue if I remember correctly.

I think I weighed 121 or 122 pounds. Just because an EP is licensed and has a practice doesn’t guarantee he is not reckless or in fact good. You want someone knowledgeable and not a maverick. I had a second opinion by an EP at a high tier hospital and he insisted on a 5 day experiment of 300mg/day and I was foolish to listen to him against my trusted EP who had warned me by only saying “no” without an explanation why.

My story is below along with a link to someone else who almost died. Flecainide is not a drug one experiments with. It’s a black box label drug. It ruined my heart and I almost died.

Thanks George for reminding our readers about the dangers of Flecainide.

[www.afibbers.org]

So is flecainide completely safe taking 200 mg daily?

When I try to reduce I have afib. My thyroid is usually to blame but not always. My last episode was at the end of June this year and that is when I increased flecainide from 100 to 200. My FT3 and FT4 have been normal for a while but TSH is still slightly low. I don’t know how many people here have thyroid issues but I’ve been dealing with it for over 20 years. I’m taking 5 mg methimazole daily. My EPs NP wants me to stay on 200 mg flecainide until my thyroid is stable. My endocrinologist is satisfied with my recent results but I don’t know if it’s good enough to lower the flecainide. And I don’t know which doctor to ask!

If it’s completely safe to continue taking 200 a day maybe I should. “Black box label drug” can’t be a good thing though.

Pam

Box warning definition:
[www.ncbi.nlm.nih.gov]
(Mentioned drugwatch so I’m sharing their definition as well)

[www.drugwatch.com]


AI overview:
A "black box" label, or boxed warning, is the FDA's most serious warning for prescription drugs and medical devices, highlighting potentially life-threatening side effects or risks. The name comes from the thick black border used to make the warning stand out on the product's labeling. These warnings are not a reason to avoid a medication entirely, but rather to alert healthcare providers and patients to serious risks so they can make informed decisions about its use.
Purpose: To draw attention to serious or fatal side effects, such as injury, hospitalization, or death.
Reason for issuance: A drug is given a black box warning if there is sufficient data to indicate a significant risk of serious harm, such as addiction, suicidal thoughts, or serious health complications.
How it's used: The warning is prominently displayed on the drug's package insert and sometimes on promotional materials. A doctor will review the risks and benefits with a patient before prescribing the medication.
What it doesn't mean: A black box warning does not mean the drug is unsafe or should be avoided, but that its use requires careful consideration by a healthcare professional and patient.
Examples: Hundreds of medications carry these warnings for risks ranging from antidepressants and opioids to other drugs that may have risks for specific populations like children or older adults.



Edited 1 time(s). Last edit at 10/12/2025 03:15PM by susan.d.

Thanks Susan. Do you know if any of the bad side effects can happen after being on the drug for a few years? Or are they usually right at first? I started on it while hospitalized two years ago.

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susan.d
These warnings are not a reason to avoid a medication entirely

I think that needs to be emphasized. Hundreds of drugs people take commonly and safely come with black box warnings.

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Carey

These warnings are not a reason to avoid a medication entirely

I think that needs to be emphasized. Hundreds of drugs people take commonly and safely come with black box warnings.

Exactly right. The majority don’t abuse the drugs and hopefully their doctors respect the caution of a black box warning by not being reckless when prescribing the strength by staying within FDA guidelines of black box recommendations.

I have been on this forum 21 years (2004) and remembered there are many who took Flecainide safely. I was fine for 15 years being on flecainide. My past EPs took flecainide serum lab tests to confirm I was safe on my dosage. It just took one reckless EP to change this.

If you read the thread link from 2020 I shared, I gave a link of an excellent site that listed supplements (that competes with the CYP enzymes) that could affect your absorption of Flecainide and other drugs and possibly act as inhibitors. AI best explains it “ Drugs can affect liver enzymes by either inhibiting or inducing them. Enzyme inhibitors, such as cimetidine and erythromycin, slow down the liver's ability to metabolize other drugs, potentially leading to higher levels of those drugs in the body.”

Here it is again:
[www.mayoclinic.org]

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PamelaJean
Thanks Susan. Do you know if any of the bad side effects can happen after being on the drug for a few years? Or are they usually right at first? I started on it while hospitalized two years ago.

I was perfectly fine while on Flecainide. I had no bad side effects from 2004-2019. It gave me back my life by remaining in nsr for 5 years without an episode until I got dehydrated and threw up. I got converted and stayed in nsr for another 5 years until I had another episode during chemo. A 5 year span in nsr was a gift. Flecainide works very well until it stops working.

I only had one mild side effect. It was insomnia.

Since my last ablation 5 years ago, I have had a few episodes of afib in which I did the PIP, 200 mg of flec chewed up with no issues. I weigh 165

I have been on and off Flecainide for 45+ years. Between ablations and before ablations were invented. Probably the longest consumer of that drug on this forum. It was a game changer for me at 30 years old when there were few drug options. Still use it at a low dose for PAC/PVC post last ablation. Works well for some, not so much for others. Tylenol has a black box warning, so does Aleve, etc.

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sldabrowski
Tylenol has a black box warning, so does Aleve, etc.

People think Tylenol is such a safe drug but they couldn't be more wrong. If acetaminophen/paracetamol/Tylenol were invented today, it would almost certainly be prescription only (along with aspirin).

Tylenol was until recently the #1 suicide drug of choice in the UK until they changed laws and reduced the package sizes available in drug stores. It's the second most common cause of liver transplantation worldwide and the most common cause of liver failure in the US.

I've seen it myself. One sad case in particular I remember from the early 2000s stands out. A young girl, 14 as I recall, took an entire bottle of Tylenol in a suicide attempt. She didn't tell anyone until more than a day later, and then she admitted it was more of a plea for help than a real suicide attempt. Unfortunately, it was too late by then. Her liver was destroyed. She was placed on the liver transplant list but a little over a week later she was gone.

This make me anxious. I have bone-on-bone arthritis in my knee and some severe spinal stenosis in my lower back. Because of the Eliquis all I can take is acetaminophen. I take it twice a day, occasionally three times. Never more than that. So less than the allowed dose. Safe or not?

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PamelaJean
This make me anxious. I have bone-on-bone arthritis in my knee and some severe spinal stenosis in my lower back. Because of the Eliquis all I can take is acetaminophen. I take it twice a day, occasionally three times. Never more than that. So less than the allowed dose. Safe or not?

You're perfectly fine if you stay below the maximum allowed dosage.

Thanks

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Carey

Tylenol has a black box warning, so does Aleve, etc.

People think Tylenol is such a safe drug but they couldn't be more wrong. If acetaminophen/paracetamol/Tylenol were invented today, it would almost certainly be prescription only (along with aspirin).

Tylenol was until recently the #1 suicide drug of choice in the UK until they changed laws and reduced the package sizes available in drug stores. It's the second most common cause of liver transplantation worldwide and the most common cause of liver failure in the US.

I've seen it myself. One sad case in particular I remember from the early 2000s stands out. A young girl, 14 as I recall, took an entire bottle of Tylenol in a suicide attempt. She didn't tell anyone until more than a day later, and then she admitted it was more of a plea for help than a real suicide attempt. Unfortunately, it was too late by then. Her liver was destroyed. She was placed on the liver transplant list but a little over a week later she was gone.

Aspirin is horrible and needs better supervision. I personally knew someone who at age 18 months saw his pediatrician for some GI issues and was Rx heavy heavy dosing of aspirin. He had to get all his intestines except for 6” removed because aspirin just destroyed his lining. He spent 5 years at children hospital laying on his stomach on a cot with a hole cut off collecting dripping feces into a basin because they didn’t have an ileostomy bag his size. That doctor screwed up.