How Do You End an Afib Episode?

I know the answers are somewhere on the Forum but Search didn't produce them so perhaps I could ask again.

1) Those who can convert with Magnesium and/or Potassium:-

Exactly when do you take the supplements and how much?

2) Those who use a Betablocker & Flecainide:-

a) When do you take the Betablocker and what type and strength?

b) How much later do you take the Flecainide (my episodes are not too frequent but tend to be long and I asked a Cardiologist to prescribe this last week- I'll know the strength when I collect them next week) and how long do you wait before deciding whether to take more?

Thanks for your help,

Sam

Before I had the ablation I used (as a PIP) 300mg Flec + 20mg Diltiziam to stop AF, normally within a few hours.

Sam,

Subsequent to my 2.5 month episode 9 years ago, I've terminated every episode with 300 mg flec PIP (I believe the dose is 200 mg for those under 70 kg/154 lbs). I take it as soon as I realize I'm in afib and chew the (foul tasting) flec so it will act as rapidly as possible. I will sometimes throw in a couple of grams of potassium (as bicarb powder) and 500- 800 mg of magnesium (usually as dimagnesium malate powder). Remember I take 2-3 grams of mag a day, somebody else's dose may vary. My sense is that throwing in the electrolytes help, but I can't be sure.

Here is Jackie's: "I was given the PIP protocol of taking the betablocker Toprol XL at the onset (25 mg) and wait for 30 minutes, then take 100 mg. Flecainide and if not converted within an hour, take another 100 flec. " <[www.afibbers.org]

My PIP flec usually converts me in about an hour. In the last 8 years, I think the longest time was 4 hours and shortest 25 minutes. I don't typically have the patience to follow Jackie's protocol - I want NSR ASAP! Her's is most likely safer and less likely to end in flutter.

I also normally get prone (easy since my episodes are nocturnal) and try to go back to sleep. This also helps reduce the probability of flutter. I believe I got that little tidbit from Dr. John (the EP blogger), but I can't find the reference right now. <[www.drjohnm.org]

George

George and Jackie,

I wonder why Jackie was prescribed Toprol XL. That is a time-release formulation that slowly releases the beta-blocker metropolol over a 24-hour period. It seem s to me that if you want quick action you would want to use just straight metoprolol. Any comments?

Hans

Sam - Last year when I experienced the breakthrough as a result of Lyme treatment, I was again under the care of an EP...in fact two docs.

The new protocol for the PIP with flecainide... 25 mg of the beta blocker metoprolol - wait 30 minutes and then add 300 mg of flecainide... They say to take another 300 after 6 hours, but I'm too timid to do that.

At the same time I did that, I also took 300 mg of magnesium glycinate, 600 mg potassium and 1,000 mg taurine.... along with 200 mg theanine just to be sure.

Several times it worked well...other times, it converted to A-flutter...which eventually resolved to NSR...but one time it did not so I had electrocardioversion.

Now if I get the breakthrough and the magic doesn't convert in a day- I call for the ECV date, but my previous experience was that it worked in a couple of hours.

I have also changed meds to Rythmol to use with the metoprolol PIP. I'll be posting why in a week or so...hopefully.

Jackie


Hans - that's an error on my part... I had a supply of the XL ...and did use that..but the new regimen is the regular.

They also said not to use diltiazem as the metoprolol worked better.

Jackie

About terminating afib episodes, for some years i just waited for them to stop. It usually took 12 hrs or so. Eventually i discovered that if i walked up the stairs, difficult task that it was with my heart flopping around like that, usually when i sat on the end of my bed to catch my breath, the afib would give one last big thump and drop back to blessed NSR. That still works but i found an easier way. Once while in a hospital with a bad cold that turned into bronchitis, i felt so upset by the afib i was also having that i requested some kind of tranquilizer. The attending doctor ordered some ativan injected into my IV line, and the afib immediately stopped like somebody had turned off its switch. I was discharged with a prescription for very small tablets of ativan, only 1mg, and since then whenever i get an afib episode - maybe 3 times a year - i take one or 2 of those low dose ativan pills, and it stops in half an hour or so. I have been posting about the ativan conversion method for several years now and have not seen anybody else posting that it works for them too, so maybe i am the only one.

PeggyM

Peggy,

I have used Ativan to convert. I have posted this before, but it's been awhile since I have posted regularly, here.


You are not the only one.

lisa
__________________________

So much of medicine is looking solely down the wrong end of the gun barrel, and that is really a pity for all of us---Shannon

Are you suggesting that the Ativan is acting to relieve stress or anxiety and thus converting? Or is it acting in another capacity.

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.

Lisa, thank you for telling me that ativan works for you too. I must have missed or forgotten your earlier post about it.

Murray. i do not know what the ativan does in order to convert afib to NSR. I do know there is an early conference room proceedings session devoted to ativan and afib, but i read it so long ago that i do not remember what it says. If you bring up the list of conf. rm. proc. titles, you will see that one. Maybe the explanation is in there.

PeggyM

Thanks. Maybe someone else knows the pharmacology. In the meantime I will do a search. Thanks for the info!
I do not take Ativan but used to. I now take chlonazepam if I need help sleeping.

Murray L

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

I now have Rhythmol 300 mg IR to take at onset and another 6-8 hrs later if needed and if that doesn't work to call the EP to discuss ECV to get it over with; was doing fine for 2 months then 2 days ago I had some afib--with no identifiable trigger. Started off as felling like big burp in my throat but then began to do the flip-flop dance but not tachy at that time. I took .125 mg xanax, came home and checked rate--got to 115- then down to 90 then 130; waited an hour then took a Rhythmol and within half hr or so converted. I also took Magnesium (Natural Calm) in Easy Now tea (Traditional Medicinals), low Na V-8 and took another .125 mg xanax.

I think I am going to ask about low dose beta-blocker to take at same time with PIP or maybe just BB--would also take place of the xanax since the BB made me feel sooooo mellow.

Initially I was only on BB and took 2x/day with an extra when breakthrough. That worked, too.

Karen

Wow Jackie, 600 mg of flec in 6 hours. That's a bit. I'm suspecting you don't weigh that much, so a doubly large dose for you!

9 years ago, my 2.5 month episode converted in 20 hours with 300 mg flec. I started my supplement protocol and did have an episode about 1 month later. I recall it also took 20 hours to convert and I think I added some more flec around hour 12. This far removed, I'm not 100% sure, but I think it was just another 100 mg, I don't think I added 300 mg. As I recall, I was nervous just adding the 100 mg then. Fortunately all the episodes subsequently resolved in 4 hours or less and I've never had to repeat.

George

Here is the Ativan Conference Room session: <[www.afibbers.org]

In it, Hans quoted his first book,

Quote
- Page 99. The tranquilizer lorazepam (Ativan) has been found to decrease parasympathetic (vagal) activity significantly while increasing heart rate by about 8% (6 beats per minute)(2). This change in autonomic system balance may be enough to prevent vagal episodes that begin after going to bed...

Ginger seemed to have the same effect for me though I never used it to convert, just to prevent.

George

PeggyM Wrote:
-------------------------------------------------------
> About terminating afib episodes, for some years i
> just waited for them to stop. It usually took 12
> hrs or so. Eventually i discovered that if i
> walked up the stairs, difficult task that it was
> with my heart flopping around like that, usually
> when i sat on the end of my bed to catch my
> breath, the afib would give one last big thump and
> drop back to blessed NSR. That still works but i
> found an easier way. Once while in a hospital
> with a bad cold that turned into bronchitis, i
> felt so upset by the afib i was also having that i
> requested some kind of tranquilizer. The
> attending doctor ordered some ativan injected into
> my IV line, and the afib immediately stopped like
> somebody had turned off its switch. I was
> discharged with a prescription for very small
> tablets of ativan, only 1mg, and since then
> whenever i get an afib episode - maybe 3 times a
> year - i take one or 2 of those low dose ativan
> pills, and it stops in half an hour or so. I have
> been posting about the ativan conversion method
> for several years now and have not seen anybody
> else posting that it works for them too, so maybe
> i am the only one.
>
> PeggyM


This also works for me.

Great replies, everyone, just what I was looking for!

Thanks very much

Sam

Anyone care to suggest the pharmacology of the Ativan?

Murray L

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

For the first 5 years of Afib, when it was getting to be a daily occurence, I could stop Afib 100% of the time with a brisk walk. I might have to vary my speed, and get it up to a strong clip, but soon after I did that, I would convert back to NSR. As I got Afib so often, this clearly was no coincindence (like one EP tried to tell me). I probably did this over the course of 5 years, about 400+ times. As I believe that I was a vagal afibber, exercise was a good thing for me.

Not sure if anyone else has done it that way, but it sure worked for me. When I went on Flecainide, I stopped trying to convert that way, as I heard that might not be so good for your heart (Flecainide was trying to calm and regulate the heart, and I would be revving it up and making it go a little crazy before converting). As least that was my understanding.

Yesterday marked my 1 month anniversary since having an ablation, and..so far, so good!

Sounds like you have a number of responses to consider, Sam. Best to you ~ Barb

Murray,

Here is the reference to the article about the effect of lorazepam (Ativan) on heart rate and autonomic nervous system balance. [www.ncbi.nlm.nih.gov]

Hans

Barb,

I could do that early on, before my 2 1/2 month episode 9 years ago. Obviously it didn't work for that one. After I converted it with flec, I've used flec for every episode since. Over the years, there have been a number of vagal afibbers who've posted about being able to convert with exercise.

For the adrenergic afibbers, the converse, a vagal maneuver may work. This would include a valsalva maneuver, carotid artery massage, bearing down (like for a bowel movement) see: <[www.webmd.com]

George

Hello Ralph, thank you for telling me that.

PeggyM