Yahaaay

Just wanted to let you know that I convert back into nsr. today . From being in A-fib from Friday morning to Atrial Flutter Saturday and Flutter on Sunday where I spent the day.at the hospital. Went home Sunday afternoon discouraged Flutter was still going on, and of course I had know decided that I was going to have to take a blood thinner in case I would have to be cardioverted ..At noon hour today after 3 days and 7hrs all is well NSR. Wow what a relief. Nothing different that I did, resigned myself for the worse, But sure said a lot of prayers.

My question is .. While I was at the hospital I had the Dr. that was on, ask why I was not taking the PIP method.I said I thought I needed to be hospitalized first to see how the medication would work on me. The reply was, that I didn't need to be hospitalized. But my Physician felt I would need to be . I am going to see her tomorrow specifically to ask for a PIP. Can anyone tell me what the protocol for PIP would be and what there situation was.

Thanks for listening

Hi Rosemarie,

Glad you are through your latest bout of AF.

From my experience of using flecainide as a PIP, that is the one that you need to try in a hospital setting first to ensure you don't go into pro-arrhythmia, There are other drugs you can use as PIP that I don't think come with this requirement, which maybe was why you were told two different answers around this question.

Flecainide can only be used if you have a normal, undamaged heart and is given as an IV in a hospital initially, the dose being based on your body weight. After that, you can use it when AF starts, on your own, taking it in tablet form. Again, the dose will be weight determined. I believe if rate is an issue it is sometimes suggested you take a beta blocker first to bring the rate down and then the flec. For me rate is never an issue so I take 2 flec immediately at onset of AF, crushed up so they work quicker and then wait it out. For me it takes from 1 - 7 hours, averaging around 3 hours normally. When I last ate seems to influence conversion time as my episodes are always around food.

On a few occasions over my eight years of using flec as a PIP, I have got to 8 hours and not converted so at this point I go to the ER and and get an IV of flec. This usually works within 40 minutes and I go home.

I am very grateful for this regime as it has kept me off permanent flec, which, had I been using daily for 8 years, by now well have ceased to work leaving me with very few options other than ablation. When I first suggested to my cardiologist that I try this method, which I had read about here, he said he had never heard of using flec as a PIP, but agreed as long as I took a daily 100mg aspirin.

So, it has worked for me and I am very grateful for the 8 years it has kept me off permanent meds. I have about 12 episodes a year, and I figure taking 24 tablets annually is to be preferred to the 730 my cardiologist would have had me on every year. Needless to say I carry it with me everywhere as starting as near to onset as you can seems to help. I also use the supplements recommended here.

I do hope you find a regime that works for your,

Best wishes,

Justine

Hi Rosemarie,

Here is one of the original PIP articles: [www.nejm.org]

I did not start PIP flec in the hospital. Some do require it, some don't.

I did not reread the article, but I believe the protocol is 200 mg flec for those under 70kg (154 pounds) and 300 mg for those over.

Dr. Natale gave Jackie a protocol that starts with a low dose (25 mg, if I remember) of Toporol or Toporol XL followed by the flec after 40 minutes or an hour. The idea is that the Toporol (a beta blocker) will protects against 1:1 conduction flutter. One EP I read said that lying down will accomplish the same thing.

I do not take a beta blocker. As soon as I notice I'm in afib, I take a dose (300 mg in my case), chew it up (to get it in my system faster) and wash it down with some water. I then lie down. The first time I used it, it terminated a 75 day episode in 20 hours. The next episode, a month later also took 20 hours (I may have still had some atrial stunning from the 75 day episode). Subsequently, I've used it around 13 times in 7 3/4 years. The conversion time has ranged from 25 minutes to 2 hours.

For me PIP flec is a great adjunct to my supplement program. Subsequent to converting the 75 day episode, I've been in NSR 99.94% of the time. Half of the .06% of the time I was out of rhythm, or 0.03%, was the first 20 hour conversion. I am very happy with this record and the combination of supplements and PIP flec.

George

Thanks George - I use PIP post ablation. I sure wish I had been offered it much earlier in my Afib challenge prior to ablation.

My instructions are the 25 mg Toprol XL at onset - wait 30 minutes. Take 100 mg flecainide. Wait 1 hour and if needed, take another 100 mg. flecaninide. Most of the time, I've converted within an hour or shortly after 1 hour. I've only needed the second dose a few times. I feel very reassured having the PIP available if I need it. At the onset, I also take doses of magnesium, potassium, taurine and ribose and eat a balanced snack that includes protein and healthy fat. Sometimes for fat, I take a tablespoon of Omega 3 fish oil. And always a 200 mg theanine although I'm not typically anxious... I just feel it helps me relax and allows for a fast conversion.

Just as a point of interest, before I could be prescribed flecainide, I had to do the thalium stress test and then be admitted to the hospital for 4 days to be sure that I was compatible with the drug. That was approx. 1997... I'm sure much has changed by now although some EPs may still want to be very conservative/cautious.

Rosemarie... I wish you success with however they decide. If your events are not at all frequent, I'd push for the PIP approach because taking flecanide full time made me feel awful. Best to you, Jackie

thank-you for your reply,this last episode was much longer in duration 3 days 7hrs, and it once again showed me that this condition is never predictable. I have been watching my diet , have eliminated certain foods, actually very hesitant know with what I eat,, very , very aware of sodium content and have been for many years, take my supplements faithfully. Its almost like struggling up a mountain only to come falling back down. Fortunately my episodes are not like some of the people on this board. they seem to be coming more frequently 4 to 6,8 weeks . For me that is more frequent compared to a remission of 4 years and then hit with 3 episodes in one year alone. back in 2009 .
The conclusion I have come to after seeing my Dr. today is, I will start on Pradaxa because I most certainly do not want to do the coumadin, so I will try this. The next time it happens I will go to the hospital and they will observe me an then prescribe the PIP for me in the dosage recommended for me .My family have all said that I should just get an ablation done.. But when is the time right for that. Still so many questions.
Oh well it could be much worse.
Thank-you to all the knowledgeable people we have here,We are just one big family sharing our failures and above all successes, We need to succeed. and share, our strength comes from it



Edited 1 time(s). Last edit at 07/05/2012 05:57PM by rosemarie.

My only issue with Pradaxa is that there is no 'antidote' should you find yourself in a trauma situation and bleeding badly. I was there in November and they allowed my INR to drop to almost normal before taking care of my bleeding problem by surgery. Don't know how long the Pradaxa would have delayed things but they sure do cover their butts on their television commercials.

Murray L

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Tikosyn uptake Dec 2011 500ug b.i.d. NSR since!
Herein lies opinion, not professional advice, which all are well advised to seek.

Hi Rosemarie,

I was prescribed PIP about two years ago. 50 mg. metroprolol at onset, then 450 mg of propafenone half an hour later. I was also directed to go to emergency the first time I used it. I believe it can cause heart block with some individuals. Everything went well and I have had to use the PIP a few times with excellent results. I believe flecanide and propafenone have similar characteristics. I have just recently been told to take both medications right away at onset of afib.
I would certainly give the PIP approach a try.
All the best,
Lou