What are the protocols for PIP to stop an afib event.

Hi all,

I'm interested to know the different pill in pocket protocols for stopping afib.
Is there other options besides flec. Something natural maybe.

Thanks
Colin

Only thing that worked for me to stop AF as a PIP was Flec 300mg

Colin,

I've used 300 mg flec. Jackie adds a beta or calicium channel blocker first. Her description is linked from my post here: <[www.afibbers.org]

Sometimes I've added mag and potassium, but the flec is the main actor.

George

I always took 25 mg of metoprolol followed by 300 mg of propafenone.

The metoprolol was necessary because my heart rate always went very high in afib.

Marg

Magnesium has been used, by IV infusion in a Hospital. you could try taking Magnesium pills. Start at a low dose like 400mg/day, and then titrate up to see what your system can handle. you get diarehha when you've taken too much.

PIP with Flec or Propafenone is the main two drugs.
Is dangerous should be done under Doctor's care, and monitored in Hospital the 1st time around, as taking a large doses of the drugs can cause dangerous Heart reaction.

What often worked for me was to load up on trace minerals with the potassium. I used concentrace ionic minerals. Sometimes I combined it with ionic magnesium and the potassium. If you don't have the minerals, I've also had some success with making a cucumber/ celery juice.
Hope you feel better.

Yes forgot to add, 300mg Flec + 25mg Diltiziam - seems a pretty common combination. While Flecainide can be proarrhythmic in some clinical situations, I think the requirement for hospital for the first dose mainly applies to Tikosyn.

Twenty-five years in the making: flecainide is safe and effective for the management of atrial fibrillation

[europace.oxfordjournals.org]

Colin - the PIP protocol typically works if you are in afib, but not often with a-flutter. The beta blocker or calcium channel blocker is used first to slow the heart rate so the antiarrhythmic can work as it should since the AA typically won't work if your HR is fast. The EPs I've used have all endorsed the protocol for use at home... including my recent directions from Dr. Natale. Years ago they used to caution that it should be done in the hospital, but now it's an accepted home remedy.

When I do the PIP... I always also add 300-400 mg of magnesium glycinate, a teaspoon of potassium gluconate (540 mg) and a teaspoon of d-ribose... and I eat something in case it was driven by hypoglycemia... which in the past was often my trigger.

As indicated in my previous PIP directions... take 25 mg metoprolol at the onset. Wait 30 minutes for the HR to start to slow and add the flecainide... 100 - 150 mg. Wait an hour... add another dose of the flecainide if not converted. Most often, it was not necessary to take the second dose of flecainide.

Other afibbers have reported just using the flecainide (300 mg) at the onset and because my HR is typically very elevated, I've never tried that.

Good luck. Are you asking because your heart is not cooperating?

Jackie

According to Dr Barrett (my EP) , taking Flecainide without Diltiziam or similar calcium channel blocker is not recommended.



Edited 1 time(s). Last edit at 09/01/2014 11:55AM by afhound99.

The EP blogger, Dr. John M, got afib from his bicycle riding activity. He took flecainide and commented that being prone and settled after taking the flec reduced the probability of the flec being pro-arrhythmic . I'm sure pretreating with the beta or calcium channel blocker is a safer bet, however this is the approach I've always used - take the flec as soon as possible after afib starts, chew it (awful taste) so it gets into the system faster, then go get and stay prone till I convert, usually an hour or so.

George, I thought you took ginger instead of flec now?

GeorgeN Wrote:
-------------------------------------------------------
> The EP blogger, Dr. John M, got afib from his
> bicycle riding activity. He took flecainide and
> commented that being prone and settled after
> taking the flec reduced the probability of the
> flec being pro-arrhythmic . I'm sure pretreating
> with the beta or calcium channel blocker is a
> safer bet, however this is the approach I've
> always used - take the flec as soon as possible
> after afib starts, chew it (awful taste) so it
> gets into the system faster, then go get and stay
> prone till I convert, usually an hour or so.

Hi George,

This is an interesting association with Flec PIP and being prone. In my own experience back in the day when I was prone to AFIB, I often converted when laying down and yet when I went pro-arrhythmic in Holland that early morning after taking 300mg of Flec a 4am while laying in bed and then trying to go back to sleep, I flipped into a 1 to 1 flutter about an hour or so later which was a bear of a thing to experience.

I finally got converted to a very unstable NSR after many tries of various IV drugs at the Dutch hospital in Nijmegen Holland they were just about to give me what would have been my first of what has turned out to be 16 ECVs when the EP tried an IV bolus of Amioderone which did the trick within 20 minutes and spared me that shock for another 3 months where I got my first zap at the end of my index ablation.

Anyway, in my limited experience, begin prone not only did not help me in converting to NSR after FLEC PIP in that case but it also did not prevent me from going pro-arrhythmic. So we can assume that if it does tend to help its certainly not a sure thing.

Have a relaxing Labor day!
Shannon

Eric,

"George, I thought you took ginger instead of flec now? "

I have used ginger as a preventative, but never to convert. For ten years, I've used PIP flec to convert. There was a period, a couple of years ago, where my normally excellent control got exceptionally worse. After one week where I had afib 4 nights is a row (all converted with flec), I was ready to get in the Natale ablation queue. I started taking 200 mg flec nightly at bedtime, then started titrating down. It was then that I added in ginger at night. I was able to titrate to 0 flec and only ginger after about a month. With only ginger, I had episodes approximately monthly (converted with flec). After 4 or 5 months, I realized that the massive quantities (wheels) of cheese I'd been stress eating during my divorce added a material quantity of calcium to my daily intake. Figuring this could be a negative for my afib control, I quit the cheese and my formerly good control returned. I no longer needed ginger, only my normal magnesium to bowel tolerance (3-5g/day), 1 g potassium as citrate and 4 g taurine to maintain NSR - no flec no ginger.

Very recently, I learned I have a single copy of the ApoE4 gene. A single copy of this gene gives one a 2-4x increased chance of heart and Alzheimer's disease (a double copy is 13-15x!). I've been doing A-Z testing of diet to see how my blood lipids react (fasting to Carb Nite {carb slams}). This has made my electrolytes a bit unstable, so I had my first afib episode in 15 months (converted in an hour with PIP flec). For those who wonder why I'm doing such a thing, my body reacts very differently. In one study I saw, normal subjects fasted for 10 days saw LDLs<, TG and HDL stable. In my case, fasting for 36 hours or more, my TG's double or triple, my LDLs increase by 50-90% and my HDL's drop by 30-40%. After a Carb Nite, my TG's are <50, LDLs <100, HDL's in the 60's or 70's. The Carb Nites are all vegan, which may be a clue. ApoE4's don't do well with animal fat, perhaps even my own! As an aside, the ApoE4 is considered a Simeon gene in that our primate cousins have it. The ApoE 2&3 human genes are not seen in primates. About 25% of the Caucasian population has at least a single copy of the 4 gene, 2-3% have two copies.

George

Thanks for clearing that up George.

It's funny you bring up the gene stuff. I noticed that my cardiologist's office had me down as "black" even though I never told them that, and I asked her how that affects testing, because while my father is in fact black, my mom is actually scandinavian, and my "aches and pains" mimic the aches and pains of my scandinavian uncles, whereas my sister has more of my father's family issues (obesity, diabetes risk, etc).

I also read somewhere that tall athletic scandinavian men are prone to afib, and while that may be conjecture, the point is that if that were true, technically from a gene perspective, I probably am mostly that, moreso then whatever african-americans are prone to, and my cardio may have not even considered the idea I have Swedish and Norwegian genes and that coupling that with the fact I'm 6'5" and athletic, I'd fall into that bucket.

and now I have a daughter who is 5 months old, and her mom is Chinese American, which makes her 50% chinese, 25% caucasian and 25% black. Who knows what the doctors will have to do to figure her out!

Hi Jackie,

Over this year I have been getting afib every 6 to 8 weeks no matter what I do or take.
Which are lasting 6 to 8 hours, so thought I would try and reduce the duration some.

I have reduced taking ginger to just one capsule a day, midday now and am taking 500mgs of curcumin morning and night. It is a very good anti inflationary it also reduces fibrinogen. DOCTORS BEST have a curcumin capsule which is more easily absorb and is called.
Doctor's Best, Curcumins Phytosome, Featuring Meriva, 500 mg,
It has eliminated the pain in my hips and has fixed my carpal tunnel.

My plan is to manage my afib by reducing the duration and hopefully reduce any remodeling and reduce my fibrinogen level. Eliminating the need for warfarin.

Colin



Edited 2 time(s). Last edit at 09/02/2014 01:40AM by colindo.

Hi Eric,

I think tall & athletic gives you a propensity for afib, no matter what your ethnicity. We did an informal survey around 2007. Here are the results:

<[www.afibbers.org]

#Responding Athletic Tall Both M/F 
       15       11     7    7  Female 
       19       19    17   17  Male
       34       30    24   24  Total

Interestingly, the ApoE4 gene almost died out in the fertile crescent - with 2-3% of the population having one or more copies of the gene. As you go north or south, the proportions increase with Scandinavians having 30% and black Africans 50%.

On the humorous side, one of my friends is of Chinese descent. He married a Caucasian woman with the maiden name of Black. When their daughter is asked of her ethnicity, she replies, "I'm half black and half Chinese."

George

Thanks Colin for the details. Glad you are having results with the curcumin. It's one of my favorites as well although to lower fibrinogen, I do like the fibrinolytic enzymes...which, unfortunately, we can't take much of when on the anticoags.
You've done remarkably well to reduce your events down to relatively short duration and frequency.

Good luck with your project.

Jackie