Multac vs Flec and other questions

Hey all!

Met with one of my potential EPs today. He works under Dr. Chinitz @ NYU (who I saw in the halls briefly).

We discussed my situation. He said at my age with a healthy heart, all of the treatment options are on the table.

He suggested that if I were to try drugs, that I try 50mg of flec 2x daily, as i've had 4-5 confirmed episodes and 8 supposed episodes in 10 months. He said he's not supposed to recommend OAC's because my CHADS score is 0, but that if it were him, based on cases he's seen, he'd probably go on them, as the risk of bleeding is as low as the risk of stroke, and the stroke outcomes are usually worse then the bleeding risks. He also said, I should try the drugs, and when they fail, just move to ablation, as most people my age have the best outcomes just getting ablated sooner, rather then later, since you can't be on drugs for 50+ years.

I guess my questions for the gang would be

1) I'm primarily a vagal afibber, what have peoples experiences been with Flec vs Multaq? He said either would work for me.

2) Do you guys think I should try the blood thinners? I'm still nervous about them for some reason

3) Or, should i just keep losing weight and stick with the "protocol" for another 6 months and see how things go? I haven't been integrating magnesium into my diet finally, and so far so good, up until this past week, I only have been using ginger and potassium.

If I didn't have a 5 month old baby at home, I'd just have the ablation and be done with it. For whatever reason, with her around, I want to make the "right" decision, and it's giving me paralysis.

Thanks

-Eric

I meet with Dr. DiBiase next week (hopefully. His assistant is out until next Monday) !! Excited about that too.

Erich,

How about PIP (on-demand) flec to convert quickly when you do have an episode? In my case, it usually converts me in around an hour, 4-max. I think this would put you in the zone where anticoagulation is really not warranted. Meanwhile you could play with supplements and things like ginger to see if you can stretch out the time between any episodes.

This approach would minimize the usage of meds on an ongoing basis.

George

Hi Erich,
Back in late june my paroxysmal fib came for 5 hours then went away then two days later I was persistent 24/7 and drugs did not help. I called my cardio immediately and went to see him and he started me on anticoagulant Pradaxa. Before the Pradaxa I was taking a full strength aspirin and 4000 FU of Nattokinase daily. When my fib really kicked in, I took more aspirin and nattokinase. Didn't want to take any extra chances. After two weeks on Pradaxa, I had an electro cardioversion that worked for three days. That is when I switched from pradaxa to xarelto per my MGH cardio EP.

Why not ask if you can start aspirin since your CHADS is 0. Or, just start on one of the new anticoagulants other than warfarin.

I am 61 yrs old, but you are younger and don't want to deal with the anxiety of throwing a clot, maybe ablation is in your very near future.

Cheers,
RalphL

When I took 300mg Flec PIP it would sometimes take 20 hrs. Worth trying but everyone is different

Thanks for the replies everyone.

George: The EP I saw said that if I was having them monthly, he'd suggest taking the drug daily, but that PIP is an option too. what dosage did you take?
Ralph: Thanks for the comment, I'm already on baby aspirin, I think I might want to kick things up a notch.
afhound: thanks. 20 hours would be so long, I'd almost just rather use blood thinners.

Eric,

I take 300 mg. I believe the general prescription is 200 mg under 70 kg (154 pounds) 300 over.

The reason I'd do PIP rather than daily is so you could tell if your other strategies (supplements, ginger & etc) are working.

Hopefully the time between episodes would lengthen. I'm guessing the EP's don't consider this possible.

As I've posted here before, during my divorce, my worst afib time was 4 nights in a row (all converted with flec). I started flec all the time, initially at 200 mg then titrating down. I quickly added ginger and was able to titrate the flec to 0. Under the ginger, I had ~monthly episodes till I figured out it might be my stress eating wheels of cheese adding material amounts of calcium to my system. I quit the cheese and was afib free for 15 months. I did have an episode recently. It may be related to A to Z swings in my diet as I test and try to figure out what my ApoE4 gene means. In any case, not taking flec regularly allows me to see whether I'm doing better or worse with regard to afib.

George