Here is the body of the report that Hans alluded to when discussing the "on demand" approach to drugs for atrial fibrillation:

Marrouche, Nassir F., et al. Oral bolus of IC antiarrhythmic drugs for atrial fibrillation: outpatient versus inpatient administration. Journal of the American College of Cardiology, March 19, 2003, p. 98A

"We prospectively assessed the safety of outpatient versus inpatient administration of a large oral dose of either Propafenone (P) or Flecainide (F) combined with metoprolol or dilitiazem. A total of 600 mg of P or 300 mg of F were given with 25-50 mg of Metopolol or 240 mg of dilitiazem slow release. Patients were randomized to impatient administration under monitored conditions or outpatient administration. A total of 107 patients were enrolled in 5 institutions. Fifty-six patients were assigned to inpatient and 61 to outpatient administration of drugs."

"Termination was achieved in 34 out of 56 (61%) inpatient and in 45 out of the 61 (73%) outpatient subjects. None of the patients had Syncope. Two patients on F experienced near syncope before termination of AF. Sustained rates faster than 150 bpm were seen in 4 patients, all on F. Symptomatic Bradycardia before or after termination of AF was not observed. Transient side effects not requiring discontinuation of therapy was reported by 73 patients (63%). These included metallic taste (43 pts), gastric discomfort (23 pts),dizziness (3 pts), and tremor (2 pts). Drugs were discontinued in 1 outpatient, and 1 inpatient subjects. In 2 outpatients, and 1 inpatient subjects metoprolol and dilitiazem were increased to achieve better rate control."

"In conclusion, outpatient initiation of a large oral bolus of IC drug combined with rate control drugs appeared as safe as inpatient initiation."

I cannot tell from the text whether the dosage of Propafenoe and Flecainide were given at one time or spread out over time. I imagine that the dosage was given at one administration since they did not discuss the amount of time taken to terminate, but the dosage would then seem to be inordinately large from what I have gleaned from members' postings on the boards who have shared their experiences.

I myself tried the "on demand approach" for the first time several days ago.
I started out with 90 mg of non-time release dilitiazem and 225 mg of Propafenone. I chewed the Propafenone and swallowed with warm water. I did not terminate and after 4 hours followed up with another 300 mg dose of Propafenone. I realized an hour later I had converted. This was 75% faster than past conversions. In the past, I have normally converted on my own on average in 24 hours, and sometimes I have taken dilitiazem but the duration was never affected by it... the rate control made the AF more tolerable. I will try not chewing the Propafenone next time because it is way too nasty if swallowing the dosage will work within close proximity.

Please let me know what your interpretation of the dosages are from the report and any other insights you might have.

Thanks to all the wonderful members of this board.

Don

Don,

I have personally found 225 mg of propafenone to be too little and 300 mg to be too much (made me dizzy) so am now taking about 263 mg (1 3/4 tablet).

Hans

Don & All-- After one 30 day cardiac event monitoring session, my doc told me I was actually in afib half the time when I did not report symptoms & vice versa. I have to wonder how patients can be sure wether or not they're in afib without a 12 lead EKG. And how do you know wether or not you would have converted with or without the meds??

Wondering,
njb

correction--I meant how do you know wether or not you would have converted WITHOUT THE MEDS? njb

njb,

I had quite a bit of training with the heart related areas when I did my emt training. I can definetly tell when I am in afib, just be filling the rhythm in my pulse. I can also tell that when I am having ectopic beats by the rhythm of the pulse. I haven't been wrong yet, as confirmed by my event monitor or ekgs........
When you have been exposed to this for a time you get very hypersensative to your body's pulse, it's almost too scary.
The doctor told me not to hit the alarm bells on my afib until it was well over 200 bpm. Although this can be hard to count as your atrium is firing at such a high rate of speed!
I know that I will convert on my own, because I have so many times. Like most people on this board I hate to use meds. But I will if I have to. My rule of thumb is if I'm in afib for more than 24 hours then I'm going to worry, it hasn't happened yet.
The on demand approach seems to work for a lot of people and gives them the benefit of a shorter episode without many of the risks invovled with sustaining a med that has soooo many side effects.

fwiw,
Joe

thanx, joe