Help me make it through the night!

I am probably a typical poster on this site, long standing lone a/fib starting in my forties it had progressed to persistant a/fib over the years that followed,when I was diognised back then it wasnt taken seriously at all ,I had antenalol and that was it. it became unbearable, dark thoughts plagued me, then over the last18 months hope at last ,I have had 3 ablations, the last in May 2012 it lasted 7 months with the help of sotalol, the happiest i have been in years.

Then that drug suddenly stopped working and I have been on Metoporol 95 and diliazem 120 x2 plus magnesium &, pottassium and warfarin.

two months on and slowly a/fib is creeping back, i feel there is nothing more i can do to help myself, there are no more ablations for me

Its especially bad when I get woken by it at 3am and have to get out of bed,trying to figure what i can do to make it go back into rhythm the other night I just took more of the medication than i should and regretted it next day when i felt rough.

Im appealing to all of you reading this to give me your thoughts on what you do to get back into nsr in the middle of the night, any little tricks just anything at all that will help.

Best wishes


Janet

Janet,
So sorry to hear of your trails with this.
Seems that 3am has some significance because, I too, tend to wake up between 2:30 and 3:30, with a pounding heart that will, most times, try to go into afib. A poster on this board suggested throwing cold water on one's face when feeling an episode starting; I've splashed a couple times this a.m., once at 3:30 and upon arising. It seems to work; also tried it last week a few times with success, the drawback being the splash of cold water definitely kept me awake longer, but no afib. This morning I also just stood up from lying down when I felt it come on and that worked. Otherwise, I will prop myself up with pillows, consciously follow my breath and calm my solar plexus area. Lately I've also rubbed magnesium gel onto my skin when going to bed and sometimes at that 3 am time as well. Doing it at bedtime has helped me sleep better through the night and not wake at 3, though not last night!
Hope these suggestions might be of help.
Marty

Janet,

Taking a beta-blocker (atenolol or metoprolol) on a continuous basis when your afib episodes occur at night (vagal afib) is a really bad idea. You may wish to try taking a capsule or a teaspoon of ginger at dinner or before going to bed, preferably with a snack consisting of a rye cracker with peanut butter or butter and mild cheese - whichever you prefer. I would also suggest that you read our FAQs [www.afibbers.org].

Hans

Janet, I have the same thing at night. Do you find you have to lie on your back mostly to keep the afib at bay ? I am getting a personal monitor to wear so i can see if there is a pattern corresponding to what i eat. I have found taking an ant-acid has settled the activity at night sometimes.


Hans, why do you say its not a good idea to take atenolol ? I only take a 25 mg in the morning and 12mg at night. It also for my blood pressure, and don't have any side effects. It also keeps the heart from pounding, and softens the beat.
Do you know of anymore info on the vagal afib ? Most doctors i talk to don't take the vagal nerve serously. It would be nice to find one that knew a bit more about the link between it and the heart.

Edit: Lots of good info on this site. I see you discuss the vagal nerve and i will keep reading. Great job Hans !



Edited 1 time(s). Last edit at 02/19/2013 11:15PM by LarryK.

Hans you are right I know I shouldnt have taken that extra beta blocker but, I was desperate to stop the heart racing like it was .
I tried to remember something you posted recently about a glass of very hot water, potasium powder and vitamin c powder and I tried this first but an hour went by with no change so i reached for the pills, it took another hour before the heart returned to NSR i woke later feeling so slow and sluggished with low BP that I wont do it again .

Marty ive never tried the cold water on the face treatment and cant see how that would work, I also usually follow my breathing to calm my self down, it didnt work on this occassion so might try the cold water next time thanks.

Larry like you I have found taking an ant-acid has settled the activity at night sometimes but no luck this time, I prefer to sleep on my right side so dont know if it matters how you sleep, Hans didnt mean dont take your prescribed beta blocker he meant dont do what I did and take more than the prescribed dose, i rang the pharmacy next day to see if it would do me any harm and was told no but that it would slow everything down and I would feel really tired all day, well he was right I did.
Thanks for the suggestions everyone and anyone else like to share with me what they do when the nights turn into an a/fib nightmare?

Janet and Larry,

Just to make it clear. Vagal afibbers should not take a beta-blocker, or sotalol, on a continuous basis as doing so will worsen the autonomic system imbalance that drives their afib in the first place. Taking a beta-blocker to slow down the heart rate when you actually have an afib episode is quite OK although using a calcium-channel blocker such as verapamil or diltiazem would be a better choice. Unfortunately, most North-American cardiologists still have not caught on to the importance of distinguishing between vagal and adrenergic LONE atrial fibrillation. Probably about 80% of the afib patients they see have underlying heart disease and their afib is usually caused by an overly adrenergic (sympathetic) response. Thus they prescribe beta-blockers which is fine if you have adrenergically mediated afib, but absolutely the wrong thing to do if you have vagal afib. For more on this I would urge you to read the following two abstracts:

[www.afibbers.com] and [www.afibbers.com].

Hans

fwiw my EP said to always use Diltiziam with Fleccainide, for some technical reason I forgot, but he wasn't recommending taking Flec alone.

Hans,
I am really mad! At myself, at my cardiologist; I've taken a beta-blocker for at least six years and my afib is definitely of the vagal kind. It also frightens me that my afib is worse, and will be so, because of the length of time taking this medication. Presently cutting the dosage down to zero, but still on flecianide, and from what I'm reading it may not be a good idea just to be taking that alone (I asked about this in another post; thanks for your reply). My cardiologist has never mentioned a calcium-channel blocker, ever!
Marty

Hans

you are worrying me now, I have had a/fib for years and spent 10 years on Antenalol -remember it wasnt a recognised complaint then.

If its true that vagal afibbers who were prescribed non-recommended drugs like beta blockers were more likely to progress to persistent or permanent AF then thats what happened to me .
But after reading your suggested articles I am more confused than ever, I have had 3 ablations, none have worked, I do have underlying ischemia as well so have never taken flecianide but have taken Amiodarone and Sotalol at different times which didnt help at all.
how do I know if the years of beta blockers have caused adrenergically mediated afib as well as vagal, in a few words you have managed to throw my mind into a tail spin
Are you telling me I should not be on metoprolol but only on verapamil or ditiazem, and everything will be alright if i pop a beta blocker when i have a/fib episodes at night.

Marty, you should really be seeing a cardiological specialist called an electrophysiologist, or EP for short, not an ordinary cardiologist. EP's are specialists in the electrical disorders of the heart, sort of like an electrician, while regular cardiologists are more like plumbers. Afib is an electrical disorder. Get your local phonebook and look for the number of the local medical society, and they will refer you to one.

PeggyM

Janet: If you've developed a permanent habit of onset of middle of the night terrors and your change of afib treatment doesn't solve the problem it may be time for another medication to interrupt that cycle; perhaps some LTheanine, 5HTP, Melatonin or even an Ambien or Ativan OCCASIONALLY to sort of restart your system.

Over the years, quite a few lone afibbers have reported on this Board that a benzo has helped them get back into NSR, perhaps because it significantly slows the body's production of adrenaline which accelerates the heart rate.

Worth a try. Good luck.

Gordon

I have high blood pressure (all my family has it) and was on Diovan for 4 years then started having lots of PCVs then progressed to racing heart at night . The Diovan had reduced the potasium down low over time and the ER doctor took me off diovan and suggested Atenolol for my heart and BP. He also gave me potasium pills for 2 weeks.

Since on the Atenol (9 months) i havn't had the racing heart but it hasn't done much for the PVCs or Atrial flutter at night. But i definitly need BP meds because when my BP is high (180 /100) i feel pressure in the right, top side of my head and can get dizzy. Thats also why i am afraid of taking warfarin because of bleeding. I do take 81 mg aspirin every day.

Is there a clinical study that shows Atenolol makes Vagal Afib worse ?

I also don't have any side effects to atenolol. When i was on Diovan 160mg, i was in a fog alot of the time.

When I first got AF, I was prescribed Atenolol/day, I am on a thyroid hormone drug and didn't realize (neither did the dumb doctor) that beta blockers interfere with the uptake of the thyroid hormone. I became hypo, taking the beta blocker made me so tried I couldn't walk very far. Long story short I got a heart block, when going back into NSR, I would almost black out, so I had to have a pace maker. I had read my chart when I was at my doctors office and it said that the beta blocker probably caused my heart block.

So, I would listen to Hans, he is one smart dude.

Liz

Janet,

I am sorry if I confused you. I would suggest that you see a competent electrophysiologist (EP) that knows the difference between vagal and adrenergic atrial fibrillation. He should be able to put you straight regarding the optimum medications in your specific case.

Hans

Well now I'm all up in the air too! I am vagal, have been on metoprolol for several years, still take 100 mg/day SR. Also take levothyroxine (only 25mmcg), and flecainide PIP (fortunately not needing that now but was doing it). Something to talk to Dr. Melton about. I don't tolerate the ACE drugs well at al; no side effects from Metoprolol that I know of. Don't tolerate Rythmol.

Neroli - another detrimental effect with the BB is that they tend to cause insulin resistance eventually. That happened to me after several years of using and it was tough getting that reversed. Eventually, I just went off metoprolol totally and just used the flecainide alone and eventually, after that, with enough of the magnesium, potassium, taurine etc, I was able to wean way down on the flecainide dosing as well... to 50 mg daily which the doctor said was more like 'placebo' than drug effect.

Jackie