Flecainide plus beta blockers - appropriate for someone with vagally mediated AFib

To all,

I have AFib that is triggered vagally (mostly at night). After diagnosis I was put in a beta blocker (based on what I've been reading in various AFib websites the wrong thing to take). Beta blockers seemed to control it for about 4 months, then I started getting more and more breakout episodes until in March 2012 it was happening nightly. I think when it stopped after I started beta blockers, it might have stopped anyways even if I hadn't taken a beta blocker. I tried natural methods to control it (which seemed to partially, but not completely work), many of which are used by others on this list, but then they seemed to stop working completely and I was getting much more afib at night and even during the day. So I got a prescription for flecainide, and since I've been on it I've had no afib. But my cardiologist says I need to take it with a beta blocker, which I've been doing. I'm on 100mg of flecainide twice a day, and 50mg of metoprolol once a day.

So my question to the group is, will taking the beta blocker with the flecainide cause the flecainide to stop working sooner? I now believe that taking the beta blocker since I was diagnosed may have actually aggravated it and prevented the natural treatment methods from working properly.

Diane

Hi
I have been put on a beta blocker called 2.5mg Bisoprolol Fumatate, I don't think it does anything but slow my heart rate to 54 Bpm. I take 3 flecainide only when I get a afib. It stops it in about 2 to 3 hours. Before I was given beta blockers I would have periods free of any problems. I have tried cutting the beta locker by half and it seems to make no difference. I am supposed to take aspirin every day but I don't. The last 3 times I started brewing up for an afib, I have taken an aspirin it's stopped it within 20mins. I didn't think 75mg of aspirin was so potent!
Kate

I have been on the exact combination for twelve years without a problem. Unequivocally, my a fib is vagal.

I was prescribed 50 mg Atenolol plus 12.5 mg Atenolol ( 1/2 a 25 mg tablet) once a day after my vagal A-fib episodes frequency increased to several times a week . Sometimes two or three times a day , but always converting quite quickly with exercise (jogging).

I have taken it for a year or two now & the Flec works quite well , my episode frequency has improved over time .The last Afib was in early September after three months uninterupted sinus rythym . I have been taking only 50 mg / day, half the prescribed dosage & raising it back to two for a couple of days if I start to get warning ectopics that sometimes preceed A-Fib. Have tried to wean of the Flec completely, but so far the result has been an A-Fib episode within a few days of stopping the flec.

I did sleep better when off the Flec, but the deeper sleep seems to set me up for A-fib around 3- 5 A.M., otherwise I have not much in the way of side effects . My prostate gland has given more trouble since taking it , but I think this is just co-incidence as the prostate problem was there from before , and usually worsens as you age . I am 61 .

I was booked for an Ablation in May this year, but had been on a waiting list for over a year , during that year the Flec improved my A-Fib frequency & after after some thought & advice , decided to put it off & stay with the Flec. until it either stops working or side effects show up.

Ian, could you give more details of your jogging strategy for stopping your AF episodes? Roughly how fast is your heart beating when you try this? I have noticed that gentle walking after some hours of AF sometimes helps, but as my HR starts off an attack at c.150-200 bpm anything at all vigorous makes me feel ill.

I don't know for sure

The ease of conversion with exercise varies quite a bit . Usually it only takes 5 to 10 minutes & I don't have to sprint . At other times the A-Fib is more stubborn & I have to run a mile or two , or do a few 200 -300 yard sprints stopping after each sprint & feeling my pulse to confirm that the A-Fib rhythm is gone. A clean sinus may not come back right away & there may be frequent PVCs or PACS , but I can usually tell right away when the A-FIb is gone by a different feeling in my chest . Hard to explain something like moving out of a stuffy room into fresh air, or like the relief you get when your ears pop with changing altitute.

I used to wear a heart rate monitor , it was not totally reliable , but could usually confirm when I went into A-Fib usually with a resting pulse moving up to the 108 -120 level ( from my normal 60BPM or so) & it was not much good for giving a reliable reading when I was jogging. I also have a tread mill & have tried to use this to find how fast my heart goes on exercise in A-FIb. It too is not reliable with an irregular pulse, but it has read out readings of 140 ,160 even 190 .Also talking my pulse while in A-Fib does not work as some of the beats are too faint to pick up

Once a few years ago when I was getting episodes every week or two I was on a two day Holter montitor hoping for an episode so that it', & the conversion could be documented . On day 2 at about 6:30 pm I went into A-Fib,an atypical time of day & it was one of the hardest to get rid of .I ran on the tread mill on & off for about an hour and a half resting & then resuming with a sprint to try & get rid of it. Finally after a sprint it was gone . The recording showed my heart rate briefly going up to 220 on at least one of these sprints , and subsequent conversion to sinus . However the tracing was "noisy" likely because it was not possible to keep the monitor still during the sprints. If I had to guess it would be that conversion usually takes place at the 145-160 BPM level.

I feel O.K. exercising in A-Fib, but have often wondered if it is dangerous. I think in some circumstances it might be , and would not do this if made me feel bad , there was structural problem with my heart or I was not otherwise in good shape .

I have also used exercise to get rid of my AFib. Bike riding always seemed to work (although sometimes it took an hour, but usually worked within about 10 minutes). I discovered later that brisk walking worked, but not as reliably as biking. Lately, the walking seemed to stop working, and that's when I decided to go on Flecainide, because my AFib was happening nightly and not going away during the day. Since I've been on Flecainide, I've been AFib-free (2 weeks so far).

Even I, couch potato that i am,fat and slow, have found that exercise in the form of stair climbing reliably converts longish afib episodes to good old NSR . An emergency room doctor once told me that if he were to allow me to go climb a staircase as i had proposed doing, i would either have a heart attack or a stroke or both. I then left that hospital still in afib, against his very earnest advice, went home in a taxicab, climbed the stairs to my bedroom, converted at the top, and went peacefully to sleep in my own bed. It's been several years now, and still no lightning bolt.

PeggyM

I too was ravaged by night time afib episodes. The beast would visit at about 3AM and lasted until close to 6AM. I lost many, many nights sleep because of them. I have almost none of these events now. The big difference is in what I eat, in fact in my case it is the sole cause of the night time events. I took a food sensitivity test and found that I am intolerant to a number of foods with the worst intolerance being gluten. I have to be very careful with what I eat now. Over the years, possibly because of a long standing gluten intolerance, my gut was damaged. In the words of my doctor I have Vilas attrophy - that is the tiny hairs in my small intestine that are responsible for absorbing nutrients have become sick, and my gut wall has become porous and my body is now treating some foods as invaders.

If anyone is still suffering at night, please consider taking a food sensitivity test from your alternate or complimentary health care provider. (be aware that these kinds of tests are a threat to the pharmaceutical anti acid business so you could get negative feed back from mainstream doctors)

Hi, what is the scientific explanation behind why sprinting/exercising stops Afib?
- Does this only work for vagal Afibbers?
- When exercising works, does that mean the person had low cell voltage? If so, does the exercise increase the voltage?
- Does the exercise release certain hormones/chemicals that improves the "underlying substrate" and increases the refractory period? If so, do we know what hormones/chemicals are released? Can we supplement with them?
- Does the exercise simulate an Afib episode (from a biochemical standpoint)? I ask because I get temporary relief from exercise as well as an episode ONLY in the sense that if I can get back into NSR after exercise, or when I get back into NSR after a long episode, I'm usually okay for at least a few hours until the next attack. What's happening during that "lull" time? Is my heart just tired? Or has it produced something that improves the substrate? Or, has it depleted something that was negatively impacting the substrate, therefore the deletion improves the substrate?

I'm sure there's a link to this somewhere, I just don't know where to look...

Thank you!

Stephen