Can a PIP be used to PREVENT an Episode

My most recent episodes have been preceded by runs of Bigeminy. These are easy to stop by very gentle exercise (like moving the legs while still lying in bed - all my episodes are shortly after going to bed - or just sitting up) but start again when I relax.

When or if these beats start again would taking a Flecainide - which I use to convert an episode - right away stop the episode occurring?

Thanks

Sam

I would say, try it and see. Titrate up the dosage, and use the lowest effective dose required. It makes sense to use Flec pre-emptively when Ectopy likely will progress into AFIB. The draw-back would be increased risk of side-effects from the higher dose used. Make sure you are tolerating the PIP dosage that you are using.

Sam,

I did that for a period of time ~3 years ago. I'd sucessfully used flec as PIP (300 mg) farily infrequently for 7 years. During my divorce, my episodes became much more frequent. And one time, they came 4 nights in a row. A cardio suggested I could switch to pretreating. Normally people taking flec daily take it 2x/day. As my episodes were all early morning, I took a loading dose before bed (300 mg). This was successful. I immediately started titrating down. From memory, my second night was 200mg, then 175mg, then much more slowly. Fairly quickly in this downward titration, I added in powdered ginger spice, also before bed. Over six or so weeks, I titrated the flec to 0 and continued the ginger. The ginger wasn't perfect as I'd have episodes about onece a month. I later concluded my increase in episodes was due to my stress eating wheels of brie & getting too much calcium as a result. Once I stopped the stress eating (& excess calcium), my control reverted to its pre-divorce excellence (without any ginger or flec). I've had one episode in 21 months (converted in an hour with PIP flec).

If you can pinpoint signs that point to an episode, I'd certainly use the flec to avoid them. Rather than start low and titrate up, I'd start at your PIP dose and titrate down. My reasoning is this approach would most likely minimize the number of episodes and amount of time in afib.

Good luck!

George

Sam - In the past, I have used PIP successfully for years when my heart would feel unsettled and I only used small doses...such as 25 or 50 mg Flec at the very first hints of missed beats or irregularity. When I would wake up in outright AF... then I'd do the full PIP protocol with both the beta blocker and the higher dose of 100 - 150 mg of Flec which would typically work in 60 - 90 minutes. On the occasions when it would not, I'd take another 150 mg of flec.

I chose the lower doses first because I'm quite chemically sensitive to drugs so for me, less seemed to be better and I didn't have the 'drug hangover' feeling afterwards as I did with the higher dosing. We are all difference and so, experiments of one, as we say.

Along with that, I'd always also take a dose of magnesium...like 400 mg and at least 500 mg of potassium and 1,000 mg of taurine... so I was never totally sure that it was the drugs or the electrolytes that worked but figured a combination of both couldn't hurt as most likely, the missed beats come as a sign of low heart energy and the electrolytes stabilize that.

Jackie

Thanks for the replies. I had the chance to try this out last night when I woke at 1.20am with PAC's and some Begeminy.

I sat on the side of bed, which stopped the symptoms, and took 100mg Flecainide. The quesion I didn't ask was how long I should wait before lying down to give the Flec time to enter the system. I sat for an hour then lay down and stayed in NSR all night.

The heart did feel a bit unusual when I woke two hours later, like it was getting tiny electric shocks, which was interesting.

Next I'll try 50 mg Flec.

Sam

Sam,

For what it is worth, when I use flec as PIP, I chew it and swallow so it goes as quickly as possible into my system (it does not taste good, but I don't care). Most of my episodes convert in an hour or so. Since an hour & 100 mg works, you can titrate back either the amount or the time, but I would not do them both at the same time. In other words, if you drop to 50mg, then wait an hour. If that works, then you might keep it at 50mg and drop the time to 45 minutes & etc.

Good luck!

George

George:

Chew it and swallow it. I would have never thought of that. That really makes it work faster? I'll have to remember that. Thanks for the tip!

Travis

I've now tried 50 mg Flec instead of the 100mg and it works just as well without the strange feelings in my heart afterward.

Sam