Newbie Desperate for Answers! Scared Crapless!

Hello fellow afibbers! I was diagnosed with afib a little over a week ago and I’m scared crapless! The episode happened while I was delivering packages on my route (I’m a Fed Ex driver). I was luckily near a town, so I stopped into a small clinic and asked if they could document my episode. I was immediately ambulanced to the ER. I converted on my own in a little over 1 and ½ hours. I’ve had one other attack about 6 months before that, but it was less violent and converted within an hour. I was in a very rural area when that episode happened, so I just laid in my truck and prayed for it to be over.

I don’t know what my heart rate or blood pressure was in either episode because I was too busy trying to stay as calm as possible. I’ve had a panic disorder since my early 20’s (I’m 54), and knowing the numbers would have likely made my bad situation even worse!

The scariest thing for me right now is - I AM ON NO MEDS! When I left the ER I was told my GP could prescribe whatever I needed. However, I left empty handed at my clinic too. I was assigned a NP because all of the DRs were busy. The NP felt my condition was “out of her league”. I asked that - if she couldn’t give me drugs to lower my heart rate – that she would at least give me something stronger than the 10 mgs of Xanax I’ve been on for decades. She “didn’t feel comfortable doing that”. She did, however, make me a referral for a Cardiologist. When I called to see how soon I can get in, I was told they were extremely busy and I was on a waiting list. Right now, I’m looking for an appointment in August!!!

I made another appointment at my HMO for Monday and insisted on an MD to evaluate my condition. I am hoping to come home with something as far as medication. Can anyone tell me what meds I’d likely be put on?

I’m a little concerned that blood thinners will not be a good fit for me with my job. It’s pretty physical, and I get bruised often without thinning my blood. I also bend, lift (up to 150 lbs) and do a lot of the things that aren’t really good for my heart – but I really enjoy my job! I hope this condition does not force me to give it up.

After reading numerous posts in this forum, I’ve come to realize that my Laf is pretty mild. I also know, from reading these forums, things will only get worse. I am commited to delaying the inevitable as long as possible. Any suggestions?

Welcome, Sandra. You don't mention your location, but if it's in a warm climate, I'd suspect you might become dehydrated. This can easily cause heart rhythm irregularities with the loss of critical electrolytes and overall effects of dehydration....often exacerbated by eating salt-laden foods.

Last summer, I helped the local UPS driver calm down his arryhythmia symptoms since he frequently became dehydrated and also didn't take time for a decent food intake. When I questioned what he had just eaten for lunch, the response was a package of Twinkies and coffee...as he drove. We had a discussion about nutrition and and good hydration along with the nutrients required by the body to keep the heart's electrical conduction at a steady rate. Eating what he did often causes reactive hypoglycemia which can also affect heart rhythm.

He said that his truck was equipped with a monitoring device that tracked his every move so he didn't waste time and also was working 12-hour shifts so they didn't have to hire more drivers. I wasn't at all surprised that his heart was responding as it did. Last I knew, he had made some dietary changes; packed a nutritional lunch and healthy snacks to last for the time on the road and definitely had increased hydration with good, pure water and his heart had remained stable.

We have solid guidelines for electrolyte optimization and nutritional guidance that is very important regardless of whether you decide to use Rx drugs or not... and we are all here to help you.

Best to you,
Jackie

Getting the proper electrolytes like Jackie has posted is Way more important than getting on some medication. I've had afib on and off for almost 9 years and still take no meds. If you pester you MD for meds, I'm pretty sure he would agree, but that may not be a good thing long term. He may not even know what to prescribe. Keep searching through the site for Ideas on diet, specifically The "Strategy" , "Waller Water". I will get an ablation before I take medication long term. Also look to avoid triggers for you such as caffeine, sugar, MSG, alcohol...... Your episodes were nice and short. You may be able to catch this early if you make the necessary changes and avoid long term complications or surgery. Most of all don't panic. We've all been there and we don't like it. This site is full of very knowledgeable people who give freely of their time to help others. You are in the right place!

John

I had my first episode when I was extremely dehydrated. And I was taking diuretics for blood pressure, which lowered my potassium and magnesium levels. Then nothing for a while, then one here and there. Something that helps a whole lot is to not panic. Yup, that is a really stupid thing to say because if you have anxiety (I used to have it myself) then being told to calm down is like trying to hold back a tornado. But what can help is adapting things that can help. Meditation (don't laugh) can really help you deal with this all. It doesn't stop the fibs, but it can help you through the scary parts of this.

The biggest thing to remember is that they WILL stop. Right now you're just having an episode here and there and they're ending quickly (under 24 hours). Keep that in mind. That your heart will right itself soon.

Something to look for are the triggers - what is triggering an episode - and try to avoid the trigger. Look through what is called The Strategy - and pay special attention to the chapter on Magnesium. Keep in mind that taking the right kind of magnesium is important--chelated/Albion is the one to look for. I use Bluebonnet's. Try and keep your sodium intake down, watch out for sodium-rich foods, especially takeout.

I wasn't put on any medications for afib until last year (my first episode was 2000). So I wouldn't freak out too much about not getting a medicine yet.

Take care and let us know how you're doing,
Nancy



Edited 1 time(s). Last edit at 05/11/2014 11:47AM by Nancy.

Sandra, depending on what you get prescribed and by who, can be a double-edged sword. Check back with this site before you actually start taking any medication prescribed for your afib, is my opinion. Heed Jackie's, John's, and Nancy's advice. Start studying possible triggers for your episodes...keep a detailed log and you may ID triggers you can subsequently avoid, like electrolytes getting out of whack. Start taking magnesium, keep the salt and calcium intake low. You're going to get through this. - Randy

Sandra, speaking of triggers, what were the immediate circumstances when you went into afib on your delivery route? Tired, late in day? Early in day? Just sitting driving hypnotized by the road or instead during or just after some heavy lifting? Just after a meal on the road or hungry/thirsty? Etc.?

Sandra, I've found this electrophysiologist's blog an excellent source of answers on afib:
[www.drjohnm.org]

In his opinion, there are things you can do to stop afib without drugs or medication (read the above blog post) especially if you catch it early. I find reading his blog addictive: you read one article, then click on links to other blog entries of his and so on and so on. There is lots of good information on afib in there, as well as his other interests (he writes on other topics as well). I wish I found his blog sooner.

By the way, when I had my first episodes of afib, I ignored them. I was afraid to go to a doctor to find out what the problem was; afraid that I might be put on drugs the rest of my life. When I finally did see a doctor, that's what they did (although I wish I could have seen Dr. Mandrola back then; he would have advised lifestyle changes and probably recommended Flecainide as the "pill in pocket" approach to stop an AFib episode if one started). Unfortunately he lives in Tennessee and at the time I lived on the West Coast (I'm in the DC area now for a couple of years).

Drinking a lot of water or something, and bending down will trigger me, if i don't watch out.
I think when my stomach is full, and my stomach pushes up into my chest, all that pressure triggers it.
Being that you are bending down and picking up packages all day, that could be one of your triggers.
Just bend down with your knees, keeping your back straight as you can. All the work safety sessions suggest that too,
to prevent back problems. Just don't bend down after you drink anything. Probably after eating too.


Irregular heartbeats is one of the less common side effects of Xanax.
Dig a little deeper into it. You'll have to find all of this stuff yourself.
irregular heartbeats / fast, irregular, pounding, or racing heartbeat or pulse / Tachycardia/Palpitations is one of the side effects of Xanax


[www.drugs.com]

I was thrilled to see how many people responded to my post - and quickly! Thank you all so much!

Jackie, I don't think my episode was brought on by dehydration. I have gotten in the habit of bringing a large bottle of water to drink each day (filled with my well water). But I do admit that I often ate on the run - much like your UPS man. My lunch (before my A-fib scare) consisted of jelly filled rolls or a greasy slice of pizza daily. Now I try to eat a turkey sandwich or greek yogurt on the 10 minute break I force myself to take.

Can arryhythmia symptoms ever be misdiagnosed as A-fib? The clinic, ambulance and ER EKGs all showed my heart in arterial fibrilation.

BTW, I live in a pretty cold climate - Minnesota

John, Thank you! I will definitely take a look at the articles you suggested. I would love to be able to control this beast without meds. So thankful to hear of people like you who have done it!

Nancy, I liked what you said about meditation. I used to do it years ago, but quit when life became to busy. Looks like it's time to start up again.

Randy, As far as what triggered my A-fib, I'm clueless. I remember singing to a song (there were no cars around me at the time and my windows were up) then - bam! I was in full fibrillation. I don't remember doing anything different than any other day. Maybe it was my horrible singing....

I'm canceling my Dr appt for tomorrow. Tonight I will be doing some heavy reading on this site.

Because of all of your kind words, I now feel braver. Thank you!

I found what you said about Xanex interesting, Todd. I never read about any side effects I might experience using it. However, I'm not sure the 2 - 3 tablets I take a month would cause those symptoms. It's definitely a topic worthy of more research. Thanks so much for letting me know!

Thank you for the link, Diane. Just read a little bit of Dr John's blog and enjoyed it immensely! I love his style of writing; He makes everything so clear and interesting!

Nancy - I know of several people who experienced an irregular heart beat as a result of reactive hypoglycemia. Now that they have changed their eating habits and food choices, they have not been bothered since.

When the intracellular levels of critical electrolytes... magnesium, potassium, sodium, calcium and chloride become imbalanced, very often one symptoms is the tendency to have an irregular heart beat...whether or not it is or becomes diagnosed as Afib depends on the severity and consistency of the imbalance. This should be a priority focus for you.

Jackie

Sandra,

It sounds like your afib is very symptomatic. This is likely due to a very high ventricular heart rate. In afib, the atria beat very fast ~300 BPM. The atrial "signal" goes to the ventricles through the AV (avo ventricular) node, which puts a slight delay in and transmits to the ventricles. In afib, the AV node lets through a random % of atrial signals. This results in a ventricular beat that 1) usually "feels" very irregular in the radial pulse, and 2) can result in a ventricular rate that is either low, high or somewhere in between. In your case, I'm guessing the ventricular rate is high.

So I would suggest exploring getting a prescription for an on-demand rate control med such as a beta blocker. Having an episode every six months, it would be overkill to take this all the time. If you had a rate control med available, you'd likely feel much better.

If your episodes start lasting more than 90 minutes, you might also ask for an on-demand (also called PIP or pill-in-pocket) anti-arrhythmic med such as flecainide or propafenone to shorten your conversion time.

As to anticoagulation, you should asses your CHADS2 or CHA2DS2-VASc score to see about your stroke risk <[en.wikipedia.org]

George

An on-demand rhythm-control agent would seem preferable if your afib turns out to be "lone" (rhythm control might not be recommended for some with other cardiac comorbidities). Both rhythm-control and rate-control agents have their pros and cons and some people may be able to tolerate one but not the other. Also, rate control is allowing the continuance of an unwanted phenomenon: afib, albeit at a lower, but still aberrant, heart rate. And while in afib the progression mechanisms are being reinforced to a greater degree with rate-control than when in NSR which is the aim of the rhythm-control agents, whether PIP or daily-dosed.



Edited 2 time(s). Last edit at 05/12/2014 09:00PM by morpheus.

Here is an abstract that reports a comparison of the CHADS2 and CHA2DS2-VASc that George mentioned:

[www.ncbi.nlm.nih.gov]

OAC= oral anticoagulation

"CONCLUSION:

Compared with the CHADS2 score, in our AF ablation population, the CHA2DS2-VASC score markedly increases the number of AF patients for whom OAC is recommended. It will be important to determine by randomized trials if this major paradigm shift to greater use of OAC using the CHA2DS2-VASC scoring improves patient outcomes."

The complete article is here: [www.ncbi.nlm.nih.gov]



Edited 2 time(s). Last edit at 05/13/2014 01:29AM by morpheus.

He is actually in Louisville, KY. I had the pleasure of having a couple of appointments with him and meeting. very nice guy and very interesting. I love reading his blogs. He has actually experienced Afib once himself so I thin he undestands some of our stuff!

Hmm, now I'm getting very confused .... should I go see a Dr for medication, or not? I was under the impression that I should try vitamins and diet/lifestyle changes first. I read "The Strategy" per Nancy's (and other members) suggestion and found it very interesting! I would really like to see if there's some vitamin deficiency that needs to be addressed before living a lifetime on pills I may not need.

I took a look at the NCBI site and found I score 0 pts on the CHADS2 chart and 1 pt on the CHA2DS2-VA (because I'm female). The ER folks didn't give me anything when I was discharged - not even an aspirin - so I'm under the assumption that they didn't think I was a stroke/heart attack risk. I had a complete heart scan and stress test done 4 years ago when I had a debilitating panic attack with chest pain. I passed all the tests with flying color then. I guess (like with everything else) I'm assuming that my heart is still healthy. The ER ordered no tests for me either.

GeorgeN, I like your idea of an "on-demand" Beta Blocker. Is there such a thing? The Drs had discussed putting me on a regular Beta Blocker during my hospital stay, but decided against it because my mean heartbeat during sleep was 50. It was feared the Beta Blocker would slow it down even more.

Sandra, having a mean heartbeat during sleep of 50 without pathological cardiac involvement, suggests that you might be a normal-weight and highly athletic person experiencing a possible side-effect of intensive training over a period of many years.

Among the other possibilities are low-functioning thyroid which can manifest in lowered heart rate, weight gain, fatigue, dry skin, constipation, and so on. Getting a full thyroid panel that includes Hashimoto antibodies, TSH, free T3, free T4 and so on, will give you valuable information that might be relevant to your afib.



Edited 3 time(s). Last edit at 05/14/2014 12:59AM by morpheus.

Sandra:

It is difficult to know just what to do, everybody has some different ideas---a number of years ago I was given atenolol (beta blocker) for my afib, I became hypo, the beta blocker can cause blockage of the thyroid hormone, I was taking synthroid at the time, my thyroid had been nuked because of Graves disease (Hyper thyroid) which made me hypo and necessitated taking the synthroid.

I was hypo and on a beta blocker, my energy was drained, the beta blocker led to a heart block, eventually, this led to a pacemaker because when going back from AF to NSR I would almost flat line for a few seconds. If I hadn't been hypo at the time, the beta blocker may not have caused my heart block Anyway, as George says you could use the beta blocker on demand, when your heart rate goes too high, also, in my opinion, if your heart rate goes down around 50 or below, I agree with your doctors, not a good idea to take a beta blocker everyday if your heart rate is low.

It is always a good idea to eat healthy food and take some supplements that are recommended on this board.

Liz

Jackie,
Can you elaborate on what you said about "reactive hypoglycemia"? I think I may have experienced that yesterday, but I'm not sure. Can you explain how that goes? Thank you.

Duke

Beta blockers are contraindicated for vagal or mixed-but-primarilly-vagal, afibbers. Determining whether you are vagal, adrenergic, or mixed can influence the choice of appropriate medications needed/desired, if any.

The fact that you report a low sleeping heart rate may be reason to put a checkmark in the vagal column when you are in the process of collating facts with the aim of categorizing your afib type.



Edited 3 time(s). Last edit at 05/14/2014 02:15AM by morpheus.

Sandra,

"GeorgeN, I like your idea of an "on-demand" Beta Blocker. Is there such a thing? The Drs had discussed putting me on a regular Beta Blocker during my hospital stay, but decided against it because my mean heartbeat during sleep was 50. It was feared the Beta Blocker would slow it down even more."

Yes, that is true, however there is a difference between rate control when in afib and all the time. Using an on-demand anti-arrhythmic like flecainide, it is fairly standard to pretreat with a beta blocker, wait a bit for the heart rate to slow down, then take the flec. My heart rate in afib has always been fairly low, however, I asked for and received a beta blocker prescription when I was going to be trekking far away from medical support. I've never actually taken it. I just wanted it in case my rate went ballistic and I had no quick way to get help. An on-demand beta blocker is not something your MD will likely suggest. You'll have to lay out the case for it - 1) you have a low resting heart rate and a BB won't be good all the time, 2) you are symptomatic and lowering your afib HR will make it much more bearable, 3) your afib episodes happen infrequently so taking a BB all the time makes no sense.

As to meds vs supplements. The ideal is to figure out an electrolyte supplement plan that keeps your afib in remission. My suggestion of meds were for the times when that doesn't work. In your case, you are symptomatic, and slowing your afib rate down would likely mitigate those symptoms. With episodes lasting 90 minutes, an on-demand anti-arrhythmic like flec is not warranted as it would likely take that long to convert you anyway. Hence, my comment to pursue this if you end up with longer episodes.

I've had afib for 10 years. The first 4 months included a 2 1/2 month episode, along with others before that that lasted 6-9 hours and occurred every 10-14 days. My treatment plan for ending the 2 1/2 month episode and for keeping the afib in remission subsequently has been of my own design and not something that the docs created. During the 2 1/2 month episode, I saw here the reports about on-demand anti-arrhythmic meds. My EP suggested that I stay out of rhythm. I suggested a plan "B" of a) terminating the on-going episode, b) attempting to keep myself in NSR with electrolyte supplements and c) a on-demand flec prescription for the times when b) did not work. The EP agreed with the plan and prescribed the flec. I used it to terminate the 2 1/2 month episode and created and iterated to a supplement program. I've followed this with pretty good success. The first six months after the 2 1/2 month episode, I had 3 episodes, all terminated with flec. The next seven years, I averaged about 1 episode/year. Then I had a difficult year where I had much less afib control. It was a year when I ended up getting divorced, but I later figured out that excess calcium from diet was a bad actor for me. It was a little over a year ago, when I figured out about the calcium and it has now been a year since my last afib episode.

The point of my story is to say that the drug approach and the supplement approach can complement each other. I try to minimize the use of the meds, but I'm grateful to have the on-demand flec when the other approach has failed.

George



Edited 1 time(s). Last edit at 05/14/2014 09:27AM by GeorgeN.

Sandra,

When I was having afib episodes I had an extremely high heart rate - as high as 220. I took an on-demand beta-blocker (metoprolol) and anti-arrythmic (propafenone) as soon as the episodes started. The beta-blocker helped to get the heart rate down and the anti-arrythmic helped to bounce me back into normal rhythm. When I first got the prescription, my cardio just gave me the anti-arrythmic. I knew I should also have a beta-blocker and asked him about it but he said, no, the anti-arrythmic was fine, it had something in it which would slow my heart rate. Well it wasn't. The anti-arrythmic slowed my heart rate enough so that my ventricles could keep up with the atria and I went into flutter. This was the first that I had flutter but once I got it, I had it several times. When I eventually got to see my EP he told me that not taking the beta-blocker first to slow down my heart rate before the anti-arrythmic kicked in was what had caused the flutter.

So I would make sure to have both types of medication on hand as PIP and take the BB first by about 15 minutes - especially since your heart rate seems to be very high like mine was.

Marg

The effects of beta blockers don't selectively end with the termination of an afib session. Depending upon the half life of the particular medication the PIP effects may last untill, and beyond, that period in which you retire for the night.

Metabolic rate decreases during sleep. If your heart rate drops below a certain trigger threshold you might transition into afib. With a residual effect of PIP sotalol alone, for example, it is likely that you will reach a trigger point when you might not have done so otherwise. Being driven into low-heart-rate-induced afib by PIP sotalol, for example, is a distinct possibility, considering the usual caveats.

PIP flecainide alone, for example, won't have a residual effect of slowing the heart rate. Flecainide does lower the heart rate in the sense that it may return you to NSR from afib. Flecainide is less effective in preventing bradyarrythmias which you might have considering your mean sleep heart rate of 50. The mechanism by which the 50 BPM heart rate is being manifested needs to be determined.

Duke - I'll dash through this quickly... excuse the less than technical explanation... I'm in a rush but wanted to respond.

Several examples... in the morning, after all night with no food, then eating a high carb/ high glycemic breakfast of cereal, toast, muffin...OJ etc... floods the body with glucose (sugar) which then requires an abundance of insulin to manage that. Often, too much insulin is produced and it takes the blood levels of glucose down too low. When that happens, the body goes on alert because the brain's fuel is glucose and our built-in protective mechanism to protect the brain at all costs is stimulated into action by an adrenaline response...which is meant to get you to do something about the low blood sugar quickly. When the adrenaline kicks in... symptoms include feeling, hot, shaky, sweaty, palpitations, light headedness all the typical symptoms of a panic attack. (and often afib) To rememdy that, people typically get out of trouble by eating more sugar. It works temporarily; then you can rebound and begin again.

However, when that pattern becomes habit, then Insulin Resistance sets in and that propels the same cycles/scenarios when a high glycemic diet is the norm.

To reverse the trend, the treatment is to always have a meal that contains at least 5 - 6 ounces of or more of protein. Eliminate severely high glycemic foods and beverages. Eat frequent small, balanced snacks througout the day to maintain a steady blood glucose level and never go longer than 3- 4 hours between meals. Eat a small balanced snack 2 hours before bed. Balanced meaning: protein, healthy fat, and minor carb content. Example: 2 TBS Almond butter on half of a green Granny Smith apple...which is very low sugar. Celery with almond butter.

People with hypoglycemia and insulin resistance need to avoid starchy carb foods, sugar and natural sugar from fruit.
Low glycemic fruit can be used in very small servings... like half of the Granny Smith apple; small servings of berries, cantelope. There are tables online showing the glycemic index and glycemic load of foods but the easiest thing is to eat a generous amount of protein with each meal and snack. and lots of low carb veggies. No fruit juice as that concentrates the sugar.

Hope this brief description helps.

Jackie

Morpheus,

The half life of metoprolol is 3-7 hours. I would not get the XL version. While you are theoretically correct, that the BB could have an impact at bedtime, I've never seen any report of this for on-demand use. Also, many paroxysmal afibbers seem to have a "safe" period after an episode where one is unlikely to occur again. I'm sure this "safe" period has some underlying biochemical explanation, I do not know what it is.

If it were me, with highly symptomatic afib, I'd take the BB to reduce my rate and see what happens.

George

Hello everyone,
If the rate while in Afib gets up to low 100's, or even say 120, would beta blocker on demand a good idea? or is that rate is NOT too alarming to worry about?

This is what I experienced at times with my Afib episode (not sure if it's Afib, but it's arrythmia for sure. I'm still not sure what the definition of an Afib episode is). It starts out with ectopics (skipped beats, PAC's or PVC's?), then it becomes irregular beatings, then the heart rate may increased to high 80's, then back down, then back up to 90's, and then might slow down, then back up to low 100's and at times up to 130's. These rates are measured from the Iphone app and pulse oximeter. I guess when we refer to these rates, these heart rates are not actual atrial rate, correct? The actual atrial rate is much higher than that if I understand it correctly. The actual atrial rate may be as high as 300's?

Anyway, back to my question: Would the beta blocker and Flecainide on demand a good idea for my case? I noticed so far, I self converted 3 hours max on my own, but most of the time 1 hour or less. I'm not taking any meds at all although my EP did prescribe Flecainide, I just do supplements (Magnesium,Taurine,Coq10,Fish oil and some time potassium gluconate). Oh, also, I have a pacemaker as well that is set up for 60 beats per minute minimum. I appreciate any comments. Thank you all.

Duke

Duke,

In the PIP flec studies, most converted in 2-8 hours. In my use, I typically convert in 1-4 hours with 1 being the norm. 9 1/2 years ago, I had a 2 1/2 month episode, so don't want to risk that again, so I take the flec every time. In your situation, typically converting in an hour on your own, with some going to 3 hours, I probably would not take the flec.

If you are not symptomatic at your rates and for the length of time your episodes last, I would not take the BB.

You are correct, the rate measured by your iPhone app is the ventricular not atrial rate.

George

George and all,

I am symptomatic at all my episodes, skipped beats, high rates, irregular, etc.
and I wish I can go for a few months without an episode like most of you. I get an episode in every few days, and if lucky 2 weeks.
I break my brain trying to figure out what the triggers are, what and how much to eat and not to eat, etc. and when I thought I figured out a certain way/method to keep me in NSR, the beast would appear and slap me in the face and I'm back to feeling hopeless again.

I'm really thinking about ablation now as I'm somewhat tired of trying to guess this and that.

Anyway, back to our original discussion. So, you don't think Beta Blockers and Flecanides on demand are good idea for my case? Just ride it out and let myself self converted each episode? You don't think the rate of 130's is harmful if I self convert in about 1 hr to 3 hours?
Thanks again.

Duke

George, et al.

If you go to [www.drugs.com] a page for sotalol, and then find the "Interactions" tab and click it, you will be brought to the page [www.drugs.com]

On that page you will see "A total of 903 drugs (5533 brand and generic names) are known to interact with sotalol." under that you will see a red stop sign for which there are "202 major drug interactions (754 brand and generic names)"

If you click the hypertext link "202 major" which is in blue you will be taken to [www.drugs.com]

If you then click on "F" in the given alphabet of hypertext letters you will be moved down to the "F" drugs in which you will see "flecainide" a hypertext link

If you click on it you will be brought to this page [www.drugs.com] that page will display the injunction of sotalol-flecainide usage.

For a more technical explanation you can click "Switch to professional interaction data" to get here [www.drugs.com] If interested, check out the references given on that page:


References

"Product Information. Norpace (disopyramide)." Searle, Skokie, IL.

Yamreudeewong W, DeBisschop M, Martin L, Lower D "Potentially Significant Drug Interactions of Class III Antiarrhythmic Drugs." Drug Saf 26 (2003): 421-38

"Product Information. Vascor (bepridil)." McNeil Pharmaceutical, Raritan, NJ.



Edited 1 time(s). Last edit at 05/14/2014 05:22PM by morpheus.

Whether metoprolol or sotalol, both can contribute to bradycardia. It's the bradycardia effects of beta blockers that might result in the induction of afib for those with an already lowered sleeping heart rate, such as Sandra reports.

[www.drugs.com]

"Using metoprolol together with flecainide may have additive effects. Contact your doctor if you experience dizziness, slow or irregular heartbeats, fainting, or palpitations. You may need a dose adjustment or special tests to safely use both medications. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor."

"dose adjustment" implies daily usage, perhaps not PIP--which might deliver substantially higher amounts of the drug.



Edited 5 time(s). Last edit at 05/14/2014 08:27PM by morpheus.

Morpheus,

It is standard practice from Natale and others to prescribe a modest dose of metoprolol in advance (30 minutes) of PIP flecainide. Others, including Jackie, have reported satisfactory results from this protocol.

When I chatted with a cardio requesting a metoprolol prescription for PIP use in case of a high rate, he suggested that it would not take a large dose for the rate control purpose, 25 mg as I recall. Also he suggested the standard, not timed release or XL version so that it would wear off quickly.

I would not suggest any vagal afibber with a low resting heart rate take a BB on a regular basis, for just the reason you write - it could precipitate an episode. However, if I were in Sandra's position, with high rate, symptomatic afib, I would certainly try it as rate control during the episode. I would perceive the risk of the BB, used in this way, of precipitating a follow-on afib episode as minimal, both because of the short half life of the BB as well as the situation that NSR after an episode, in a paroxysmal afibber usually lasts a while.

George

Duke Wrote:
>
> Anyway, back to our original discussion. So, you
> don't think Beta Blockers and Flecanides on demand
> are good idea for my case? Just ride it out and
> let myself self converted each episode? You don't
> think the rate of 130's is harmful if I self
> convert in about 1 hr to 3 hours?
> Thanks again.
>
> Duke

Duke,

I'm not sure your particular situation, but for what it's worth, I'm 36, get an episode every week or two, self-convert between 15-120 minutes, and my heart rate is usually 130 or lower, sometimes as low as 80 during afib.

My cardiologist said that an afib around 120-130 is no problem at all, it's 150-160+ where she would be worried. I don't think she's a afib specialist, so take that with a grain of salt, but I just wanted to let you know I don't take drugs either, just a baby aspirin.

That said, I'm curious what other people think as well. At this point for me, the side effects of the afib (excessive urination, defecation, and lethargy post-attack) is the most annoying part of the afib experience.

HTH,

-Eric

Eric - I'll complete this comment later today... I've got an early appt. this morning... but I have several comments on my experiences using beta blockers that I want to share with you. Stand by.

Jackie

George and Morpheus,

I also assumed that Sandra's heart rate was high in her episode. She said she had a very violent attack and was immediately rushed to the hospital by ambulance. That suggested high heart rate to me.
Worrying about residual BB in your system after an episode is over seems a bit overcautious to me. I usually took 50 mg at the beginning of an episode. My episodes occurred at night, sometimes at the beginning of the night, sometimes early morning. My heart rate was normally low and just shot up during episodes. I didn't have a problem with lower heart rate after the episode was over.

A few months ago, I had to have a CT angiogram to check and be sure all was well as part of my followup after my ablation. The 50 mg of BB they gave me at that time reduced my heart rate sufficiently after an hour so that they could proceed with the scan. But there were others there who had to take 150 mg before their heart rates slowed. They were told after to drink lots of water to wash it out of their systems afterwards. So perhaps just drinking a few glasses of water before going back to bed would be a good precaution to take if, as Morpheus suggests, the BB could cause too low a heart rate after the episode is over. Although it seems to me that we must wash a good part of the drugs out of our systems anyway, with all the peeing we do during an episode!

Marg

Morpheus,

I'm assuming Sandra's afib rate is high, because her afib is so symptomatic. She has not said. It is a reasonable assumption.

My meter is from these guys <[www.aw-el.com] I've had it for a long time & would have to fire up old, DOS-based computers to use it, or see if I could make a USB to serial conversion work. I have very infrequent need of it and have not used it in a long while.

George

Morpheus,

I'd guess 180-220 ventricular rate. Most folks with this kind of rate feel pretty bad - and the high rate is usually where the symptoms come from.

Not everybody with a high rate knows they are in afib. I know a man who didn't know he was in afib and remained at a high rate for quite a while. This caused cardiomyopathy. Even after they got it controlled, his ejection fraction was very low (18-20 as I recall). The upshot is he had to quit practicing law and go on disability. He was in his 40's. Later his EF increased, but was still not normal. As far as I know he is still disabled 10 years later.

George

George,

A heart rate of 180-220 does sound "high" [www.youtube.com] but I guess that
"high" can be somewhat of a subjective determination [www.youtube.com] .

Duke, for example, reported: "It starts out with ectopics (skipped beats, PAC's or PVC's?), then it becomes irregular beatings, then the heart rate may increased to high 80's, then back down, then back up to 90's, and then might slow down, then back up to low 100's and at times up to 130's."

So, Duke might have been symptomatic at the lower heart rates that he mentions in comparison with higher rates that others report, unless he serendipitously happened to be looking at his Iphone app and pulse oximeter at the time and noticed the arrhythmia without having had experienced the typical symptoms.

It might be the case that some people whose afib heart rate falls into the range of high 80's into the 130's, for example, are symptomatic, much as Sandra was symptomatic, but, unlike Sandra, their symptoms appeared at these relatively "lower" rates. Hence my post about Sandra's "high" rate. But, perhaps females can tolerate rates such as Duke's without being symptomatic, and once the rate reaches the 180's, say, then they will experience symptoms? Or maybe it's true that being symptomatic at various rates is neither age nor gender specific but is totally individual-specific?

Definitely a sad story about the ex-lawyer, certainly a case in which that afibber probably would have wished to be among the afibbers who were symptomatic.



Edited 4 time(s). Last edit at 05/15/2014 10:33PM by morpheus.

Morpheus, George and all,
Like I already described, during the episode, my heart rate would go from 80's and oscillating up and down erratically to 130's or 140's and I can tell I'm having these arrhythmia episodes (irregular heart beat episode). I'm not sure what you would call it (Afib?), all I know is that the beats are not in sync. As a matter of fact, what is the "Afib" episode like anyway? Yes, for sure I'm symptomatic about it because it's not comfortable at all, even at somewhat at "low" rate. It's not a coincident that I measured my heart rate while I'm in the episode. I measure it because I know I'm in the episode.

Duke

Duke, did you happen to notice an absence of a p wave? Not totally indicative of afib, but suggestive.

Duke, in an earlier post you wrote:

"And after wearing the monitor for a few weeks, they told me that I have bradycardy, SVT, SSS, Afib and suggested a pacemaker."

The bradycardia could be associated with your fitness. It also can be a symptom of SSS. The afib diagnosis confirms/suggests that you do, indeed, experience afib sessions. If the bradycardia was a result of fitness and/or SSS then because you have a pacemaker that, presumably, won't allow low heart rate, it's possible that any current arrhythmias are associated with either the SVT or afib diagnosis. Apparently you “break my brain trying to figure out what the triggers are” without success. PG-13 or maybe R-rated animated gif, click at one's own risk: [stream1.gifsoup.com]

Do you uniformly detect arrhythmias that occur, or is it the case that your Iphone app can detect aberrant behavior that you're unaware of? I'm not familiar with that app, but I would think that if it doesn't record waveform data then it doesn't have the degree of utility that would be more preferable to have. Can the app record data when you're asleep?

Morpheus,

Here are monitoring apps I use:

I have an iPhone app, HRV Logger, that communicates with a blue tooth Polar H7 chest strap transmitter (and other blue tooth transmitters, too). You monitor long time series of HR vs time, r to r or beat to beat. The app will output an RR file to Dropbox in CSV format. You can sum the RR beat length times in ms to get the x or time axis. You can also convert the RR times to HR and plot in Excel (the app also outputs a heart rate file, however it appears to sample once a second - this leaves out the anomalies you are looking for). I usually take the RR values and put them in a Polar HRM file format and look at them in their Polar Precision Software that I got with their old S810 monitor. It is more convenient than Excel as it will easily window the data with a few mouse strokes & I can zoom in and look at individual beat signatures. The data look like the S810 or newer RS800 monitor watch data see <[www.afibbers.org] and <[www.afibbers.org] for examples. You can easily spot afib, PAC's & PVC's. The newer cloth transmitter straps are less prone to artifact than the older ones, but I still have a preference to monitor when I'm asleep or meditating and not moving.

I've also used another app, Stress Doctor (~$5 US), that uses the built in camera & flash. It shows pulse waveforms. It is not good for long term monitoring (counting PAC's) but you can see afib in the irregular waveforms. I used this during the time when I was having more frequent episodes. I'd wake at 3 AM and think I'm in afib, by feeling my radial pulse. However I always would have this thought, "is it really afib or do I just think I'm in afib." "Should I take a flec dose?" I'd get up and look at the app output for a minute. It would be unmistakeable afib, so I'd take my flec and go back to bed. A free app by the same company, Stress Check, gives the same info, but not as clearly.

I also use the AliveCor ECG device, which does give actual ECG readings. Again, it is not suited for long term monitoring.

I have a friend with a Holter monitor that I've borrowed a number of times. It is the most accurate, but also the most hassle. A former frequent poster, had his own Holter. His issue with it was skin irritation where you affix the electrodes if used frequently. Holters, with software, are available on eBay for $600-$700US last time I looked.

George

Thanks for the info, George. If you're familar with Lotus Improv (no longer available that I know of) you know that it can facilitate data analysis natively with a lot less hassle than Excel. There currently is available a program similar to Improv: [www.quantrix.com] that until a few years ago could be had for $495, unfortunately the company was bought out and the current owners now charge a lot more for the modeler. It would seem to me that that would be a perfect way to analyze data from many different perspectives. I snapped up 3 copies of Improv from ebay a few years ago at $10 each, great deal!



Edited 1 time(s). Last edit at 05/16/2014 12:29AM by morpheus.

Morpheus, George and all,

It's a free app on my iphone. It's called "Instant Heart Rate". It's kind of similar to what George is talking about. It uses the camera flash to detect your pulse, I guess. You simply put your index finger at the flash light and it tells you what your heart rate is, and it does give the signals in wave forms. It's really basic and can not record or analyze data or anything like that. Regarding your question about P wave, I have no idea what you're talking about. I have to admit, I don't know anything about the technicalities of those ECG wave forms and how to identify what wave forms belong to what type of arrhythmia, etc.

Duke

In afib, the p wave will be missing [lifeinthefastlane.com]

I've heard that beta blockers dont' work well for vagal afibbers

Erich,

They don't work well when taken regularly because they lower heart rate. Vagal afibbers tend to have a low heart rate already, in fact, many suspect that the heart rate dropping low is what triggers the afib. But when vagal afibbers have episodes which include high heart rate, beta-blockers are very useful in lowering it to a manageable level and helping the heart kick out of afib.

Marg

Thanks!

Erich, Marg is correct about the BBs, for specifically Vagal AFIB they are generally not the preferred rate control drug, instead when you do have a high HR associated with an AFIB episode and you have Vagal triggering or are known to be Vagal from heart rate variability testing you should try a calcium channel blocker such as Diltiazem or Verapamil. Both will lower GR pretty reliably without the risk for the more pronounced bradycardia that can happen with Beta blockers in a person with an already low typical resting heart rate,

Shannon