First full day off Flecainide....feeling more PACs

Hi everyone - so I had my ablation 4.5 months ago with Dr. Natale, and have been on Flecainide ever since. Dr. Barrett in NYC told me I could stop taking the Flec in mid-December, when I saw him, but I didn't want to then as I was concerned if there were a problem that it was in the middle of the holidays and it would be too much of a hassle then. I waited until after my birthday (Jan 11) to start tapering off, and today is the first full day with NO Flecainide in about 6.5 years!

I feel like I've had more "thuds" and short runs of harder beats or skips beats on and off since I started weaning myself off of the Flec. I've had some of that even while on it, mostly when lying on my left side in bed. Whenever I've recorded my heart rhythm on the Life Watch monitor, I've always been told it's nothing of concern (ie. Afib). but yes, there are some PACs.

My question is...is this typical after an ablation? And if I start getting more skipped beats or changes in heart rhythm, should I use Flec as a PIP or just "ride it out"? I have to admit, I'm scared to go off of this now, as it seems I will be lucky if I don't need a "touch up" based on all of the Afib I had and the need to do a LAA isolation.

B arb

Hi Barb, While on Flec post OHS my heart was very steady. Because of an irregularity detected by EKG i had had to discontinue Flec and begin Multag. The first two weeks off the flec were rough with two bouts of af/flutter one of which had to be electrocartioverted. Since after the last bout which converted on its own my heart has settled down quite a bit. I'm approaching about a week and a half of fairly normal rhythm. My situation might not be analogous to yours because I'M on Multag but it sure seemed like my heart missed the flec and let me know about it. So perhaps it may take a little while for your heart to maintain NSR without the aid of the flec. Make sure your are diligent with your supplementation, it makes a difference for me . See you on Saturday. Dennis

Barb - as Dennis wisely mentions, post ablation it's definitely important to keep up with your electrolyte supplementation as the ablation does nothing to correct imbalances or replete that which is deficient.

You've had more than your share of stress, Barb, and stress depletes magnesium easily,quickly and conistently, so maybe focus on shoring that up if you haven't pushed to just short of bowel tolerance. Also, be mindful of the importance of the potassium-to-sodium ratio dietary intake from foods and supplement with potassium if you need it.

I hope this resolves quickly for you Barb.

Best to you,
Jackie

Hi Barb,

Don't worry much the PACs or PVCs at this point. As Dennis noted anytime you stop a powerful drug like Flec, there can be some rearranging of the deck chairs that takes place as your physiology adapts again to the absence of the drug. And Dennis had a run of AF/Flutter as well possibly also because he was only 5 weeks out then from major open heart surgery as well for his aneurysm repair which can definitely predispose towards AFIB or flutter in its own right, even for people who have never been prone to AFIB before.

In addition the 'occasional Thud or little runs of ectopic like flippies when laying on your left side is also quite common even after a solid ablation. That issue is more of a mechanical nature, with the anatomy of ones PVs relative to the Vagus nerve and how it drapes across the outer PV sleeves in proximity to the epicardial outer edge of the left side of the atrium and heart. When laying on the left side that nerve can get pinched a bit between the heart and PVs or other anatomical structures depending on each persons unique layout, and send out some squawks or thumps and bumps like that, but it shouldn't go on to such aggressive action and trigger an AFIB breakthrough in the presence of a 'one and done' type ablation.

As you know too though, Barb, that odds of having a one and done, even with a maestro like Natale are less with more advanced AFIB. so the chances of at some point needing a last targeted touch up are probably in the 35% to 40% range to get the last remnant triggers that can be very hard to ferret out during a first index procedure when there is wide spread fibrosis and structural remodeling across much of the LA beyond just the PVs as the main trigger.

So in that light, now that it has been 5 months since your index ablation, its a good time to find out if this one will hold for the long term or if possibly a follow up should be in the plans in the coming months of half year to put a final period to the sentence on this business?

As Dennis wisely said, make sure you are staying up with solid magnesium and potassium repletion and I would invest in a Cardymeter so that you can get familiar with your own potassium cycle and intraday swings. Knowing this and also making sure you do not go too high in potassium, as Tom C also noted, is a big key to long time management of these electrolytes and keeping things within the sweet spot with your mag and potassium as much as possible will most definitely help keep those pesky PACs and ectopics at a minimum in most all cases.

If you do have one AFIB breakthrough, be sure you let Dr Barrett and Natale know, but just one doesn't for sure mean you need to set up a touch up. However if it happens a second or more times then by all means get on the schedule again for a follow up procedure as soon as practical so you won't have to deal with it any longer than necessary.

Hopefully you are already home free in this ablation process, but it there needs to be one more step, then by all means bring it on and be done with it. But in the meantime don't fret about simple PACs.

Cheers!
Shannon

Hi Barb,
I'm seven months post ablation and think I have something like what you are describing. It started after stopping the rhythm drugs. I have short runs of Tachy along with lots of couplet PACs. They are sometimes triggered by the same things which used to trigger afib but now there is NO afib. This causes me to be short of breath sometimes. I'm trying to keep cool about all this and take lots of magnesium and watch my diet. It's like we are playing the lottery here.
Best wishes for NSR,
Betty

Hi Betty,

Make sure you are paying at least as much attention to your potassium intake as to your Magnesium. both are equally important and you first must have enough IC mag on board and then insure your daily potassium needs are met.

even though I am quiet as a mouse now, I still take hefty topical magnesium and oral time released Albion chelated magnesium in addition to one 20mEQ tablet of time release Potassium Chloride as well as almost always one teaspoon of potassium gluconate in the evening and check things periodically with my Cardymeter, though by now I pretty much know buy feel and if my HR creeps up or I feel a random PAC here or there when I need to eat an avocado, have a coconut water drink ( one lf the better organic brands that have to remain frozen or refrigerated in transit are the best) or take some added K Gluconate powder from NOW brand available in our IHerb vitamin link above in 1 pound bottles of powder.

Just Magnesium along will not often do the trick in helping to quiet down this kind of ectopic activity. If after you really address this area and I also suggest doing an EXAtest as well to get a baseline for where your IC Mag and IC Potassium as well as IC calcium levels really are relative to one another. That could be very useful as well.

If after you have done all that you are still having too many flippers even though they are not frank arrhythmia, then speak to Dr Natale about it and get his input too, but first at least confirm that you do not have too little or too much Potassium and not too much Calcium either and that your IC Magnesium levels are good. Do you take supplemental Calcium by the way?? Keep in mind that just taking some Magnesium pills is no promise that you are getting anywhere nearly enough Mag absorbed and into your cells to help quiet this whole thing down in combination with enough daily supplied potassium.

Best wishes,
Shannon

Hi Barb,
I had my ablation eleven months ago. I was told to take 150 mg of propafenone twice a day at first. I started tapering off the propafenone after six months. I was fine when I cut the pills in half and kept that dosage for two weeks. Then I cut back to a quarter of a tablet bid (37.5 mg) and that was when I got runs of tachy, which I was sure were aflutter, since it would go on for an hour sometimes, and then cut out suddenly and I would get dizzy when it did, just like when I was in aflutter before the ablation. So with advice from Shannon, Lisa and Jackie, I realized I had to cut back more gradually. I stayed on 75 mg until the end of September because I had a lot going on at the time, then started shaving the pills down gradually. I am now down to a little less than 37.5 mg bid with no problems. When I start getting impatient and cutting down more quickly, I start getting tachy again, so I slow down. There really is no rush and our bodies can be sensitive to changes in such strong medication.

Marg

Hi all - thanks so much for your input - I'm reading it all with great interest. I did actually taper down the Flec, even though Dr. Barrett said that I could just stop it cold turkey. That just didn't sound OK to me. I am now 2 full days without Flecainide and doing alright. Feeling a bit like the "old days" when I used to wait for the next Afib attack, knowing it was coming - but this time, hoping it really won't.

I have never had a Exatest and don't remember how to get one - I know it's not from our doctor... Also don't have a Cardyometer. I do take a well absorbed vitamin with magnesium, but I'm pretty sure I'm taking in more sodium than potassium. That needs to change.

I've been hesitant to supplement with potassium as I take Spironolactone sometimes (my cardiologist said I don't have to take it every day as my BP is often fine...but sometimes it's a bit high)..and I know I can't supplement potasium when I'm taking that.

I will look into the Exatest and also the Cardyometer - if it isn't too expensive - and work on my diet more..something I need to do anyway.

Looking forward to seeing you at the Conference in Saturday, Dennis - but how will we recognize one another as we've never met? Hmmmm..maybe I should wear a feather in my hat? Suggestions?

Thanks everyone - I appreciate your help on this. ~ Barb

Hi barb. I sent you a pm. I'm not sure it was sent successfully Let me know if you don't get it. Dennis