daily a-fib attacks

Thank you so much for your support.

Recently, I went from having a-fib attacks from 1-2 a month to daily. Sometimes 2 attacks a day.
They usually last 1-1.5 and I convert on my own.
I am very symptomatic so its starting to affect my job as a producer. I travel abroad a lot and a bit worried to do so with daily attacks.
I have an ablation scheduled in 2 months with Dr. Natale. He does not want to raise my medication.
Is there anything I can do? A bit scared to loose my job due to my attacks.

A little about myself:
45
diagnosed 2,3 years ago
On Flecanaide (100mg) and Metropolol (25mg)
Magnesium.

Nothing in my lifestyle or diet changed.


Thank you.

newyorker, I'm sorry about your troubles, Ive been there in the same spot several times. Id say just the anticipation of your ablation coming up etc prob has you a bit worried. My episodes were increasing to about ev other day before my last ablation 19 months ago. Keep in your mind that if you are having problems it is the best thing possible for your upcoming cure with NAtale. I know that doesn't help the fear, I'm very symptomatic also. Hopefully Shannon will have some input here he is very knowledgable and a huge asset to all of us. Contact your assigned nurse at Natales and explain.

Tim

Tsco, thank you very much for your answer. I am not even really scared of upcoming ablation YET. Not sure what such a huge increase in attacks be due to.
How are you feeling since you ablation 19 months ago?

I am similair to you at age 43. I'm about 3.5 months out from my 4th ablation, 1st with Natale and Afib free since. I too was barely functioning and flecainide was no longer working. We tried Tikosyn and Multaq in the month leading up and nothing worked with my prior EP. In hindsight I would have just stayed with the Flec as both worked worse and the Tikosyn took 3 days in hospital to load and made me feel worse.

Not sure how your rate is, I was at 150BPM almost always and was having a hard time on job too. We used additional metoprolol and calcium channel blocker to get rate down but not a lot. I just had to tough it out for the 1.5 months leading up to Natale. A couple weeks out I was in permanent afib on the Multaq and just stopped since it was doing nothing.

The last year leading up I had best luck though hardly ideal with 150mg x 2 Flecainide and an addtional 100mg PIP that would seem to give me 2-3 days between episodes. So I was on the 150mg twice a day and then at episode onset I'd take another 100mg and I think the extra would keep it at bay for a couple days. This was less than ideal but it kept me going somewhat until I fired my prior EP and got to Natale.

If you truly can't function I bet Natale might let you try 150mg twice a day perhaps? I don't know. Maybe even 100MG 3 times daily might help you in short run, you'd have to ask? You will have to stop it all 1 week before procedure anyways. If a bit extra right now made the next two months more livable, I'd ask for a good reason why not.



Edited 1 time(s). Last edit at 01/16/2018 05:50PM by Fibrillator.

Newyorker, I'm recently having more problems for some reason. Natale is the best he did what I consider an index ablation on my afib and I prob see another in my future. Had a local Ep do the first left side ablation and Natale found everything reconnected. That was the Ep that did all four of my right atrium ablations early on when I had svt. Flecainide is very effective also very problematic. In some no issue but for me it causes left bundle block and other issues. I take 50 one time a day now, but have been on the 150 2x scheme, just don't to,erase it at higher dose. I know it is a great pain. Do what you have to just be strong. I'm 19 months out from my ablation and right now it seems that's about what I get from every procedure about 2 years, I hoping more on this one. I have only had one true afib episode this time at 11 months self converted 40 min. But like I said other activity goin on recently

Tim

I also have several attacks a day, but my medication seems to shorten and dampen the severity. I am on Sotalol.

What is your AFIB HR? As Fibrillator eluded too, if your HR is high, it looks like you might be able to do more to bring your AFIB HR down, which should lessen the Symptoms. Leave the Flec alone, and add a Calcium Channel Blocker. If that doesn't work, maybe increase the Metropolol. Natale said he doesn't want you to raise your Medication. Was he talking about the Flec or the Metropolol,?
or both?



Edited 1 time(s). Last edit at 01/16/2018 11:16PM by The Anti-Fib.

Hi Newyorker,

Most of us can certainly empathize with having very active and highly symptomatic struggles with the beast, as Anti-AFIB asked, what is your maximum and minimum HR on the rate control drug doses you are taking? If your AFIB HR is high, as above 135 to 140 range, talk to your EP about trying a mix of a very low dose Beta blocker such as 12.5mg sustained release metoprolol and a higher normal dose of a calcium channel blocker ... either Verapamil if you could also benefit from a bit of extra blood pressure control or Diltiazem if your normal BP is either normal or on the low side. ... not too low though.

The key thing here for you is to not drive yourself too bradycardic in the process and since your episodes even though happening a couple times a day now, are mercifully at least short lived at 1 hour to 1.5 hour duration. The formula I noted above is primarily for those where persistent or near persistent highly aggressive paroxysmal AFIB to try to keep the rate below 100bpm, if possible, until your ABL date with Dr Natale which will be here sooner than you think!

If you tend to run a normal to low HR and normal to lowish BP with only two or 3 short episodes a day you might talk to your EP or Cardio about trying a calcium channel blocker at more medium dose with or without the low dose sustained release Beta blocker and see which combo works best for keeping your HR at least more managable these next 8 weeks.

Also, this is a time to not let the fear part of AFIB run away with your mind. Stay on the positive side of the tracks as much as possible, you are not going to die and just hold on to that time honored cliche ‘This too shall pass’ and suck it up knowing with confidence that in just a matter of a few more weeks you will take, by far, the single biggest step of your life toward eliminating the beast for good!

I’m serious, with a case like yours the vast majority are at least 95% finished with their AFIB history after the blanking period is over from your index ablation with Dr Natale, and very likely 100% finished, though we always tell everyone to expect 2 procedures with Dr Natale and just be happy as a clam if you turn out ‘one and done’ as increasingly we see happen. Plus, the vast majority of time when a touch up is needed after an Index procedure with Dr Natale, and other elite operators, the 2nd one is truly a minimal touch up and no big deal at all.

Keeping these facts in mind can really help you preservere though these short handful of weeks left before your AFIB meets its match and cries ‘Uncle’, regardless of what your AFIB HR might be at times over the next 8 weeks.

I recall my aggressive persistent AFIB battles with non-stop HRs at times as high as around 170 hitting to 180 Flutter on occasion (my highest ever documented Flutter hit 235-240 bpm prior to being shocked one miserable day with a 1-to-1 Pro-arrhythmic Flutter cased by FLEC PIP when living in Amsterdam. And even flying back and forth a couple times a year to and from Honolulu from Amsterdam which is basically half way around the world on a few miserable Flights before learning of these low dose B.B. combined with higher normal dose calcium channel blocker routine that droppped my high rates below 100bpm for the last 6 weeks before my Index ABL with Dr Natale.

But do NOT try this combination B.B. and CCB without discussing first with your EP or Cardio as they will have to prescribe the doses for you individually.

Finally, make sure you have optimized your Magnesium/potassium repletion program based on The Strategy protocol found as the tenth article down from the top in our AFIB Resources list of invaluable articles you can find in one of the six yellow bar links at the top of this forum page. And which I’m assuming you have already done?


Cheers!
Shannon



Edited 2 time(s). Last edit at 01/17/2018 09:08AM by Shannon.

Thank you so much for writing to me. He said to leave both medications alone until my ablation on 3/15.

Shannon, you are blowing my mind a little bit. You are so amazing. Thank you for writing this out and making me feel better. I am starting to get used to the twice daily episodes and you are right, the fact that they last 1.5 hours and I convert on my own, is a blessing already. It was just a huge jump from "once a month", so it shocked me a little bit. I have a trip coming up to Japan/Thailand/France/Italy for work. Debating wether I should send someone else (lots of volunteers). It would of been great to take my mind off ablation, but I am not sure fibbing in Japan will be wise.
My heart rate does not escalate pass 120 when I am in fib. Actually, most of the episodes, I am around 100-110 range. But the beating is very chaotic and makes me complete weak, miserable, "can't function" kind of fool.
I will stop complaining and just keep counting down until my date with Dr. Natale.
You have no idea how much I appreciate you. and...install that "Donate" button already. You know what I am talking about.

Newyorker, man I’m telling you I had the same or very similar experience. A couple years ago my work ordered me to japan at the time my episodes had become frequent. I didn’t know what to do. Just the stress of deciding made me miserable. I had no options but to go. The terrible plane ride then a three hour train ride, no sleep I was at the end of the rope went in and out of episodes but they didn’t stick. I made it thru to the last day and then on the train I had an episode. It was really uncomfortable. I just pretty much didn’t care if I died by then. Luckily it broke after 2 hours. My rate is usually 130-150 and erratic. I was with Japanese clients and it was so hard to sit there and not let on. But I did. My opinion is take care of your health. If you can handle it go if not then stay. I worked for an engineering firm and honestly they didn’t care about my health I was a body.you need to take care of you. I am glad I went, it was a great experience but I had been before and I could have lived without it (hindsight). We deal with a lot with this condition if you can make your life easier....do it. Natalie will put you on the right path

Thank you Tsco. What a story. I hear what you are saying. Its hard not to tell people that you are in afib. Its just such a weird, messed up feeling that you feel that you should let somebody know. Plus, my symptoms are so bad, even after 2,5 years of going in and out of fib, I still think I am going to drop dead every time a new attack strikes. Fortunately, I have an amazing boss, who basically told me to do as I feel right and take care of my health first. Japan is not going anywhere and I rather enjoy it in NSR, which I pray will happen after ablation.
In a way, I am so scared of the ablation that I feel like God gave me afib attacks every single day now (instead of once a month) simply so I will not be a chicken and change my mind.
52 days to go.
Just wondering....how are you feeling these days?