Pharmalogical Conversion of AFIB

Is anyone having success using Drugs to Convert out of AFIB? I know many have used Flecainide with some success.
How about other Drugs like Propapfenone, Amio or Illbuteride?

Specifically I am wondering about how people feel before they convert to NSR. I can often convert using Flecainide, but it causing a sort of drug-induced Heart Failure. I feel queasy and uneasy, have a weak Pulse, and physical capacity like walking is reduced. This is worse if I get high-rate Flutter like 135, but I notice the reduced cardiac functioning even if in normal rate-controlled AFIB while I am on the Flec. I am thinking it's not worth it, to get significantly reduced Cardiac Functioning in the process of trying to convert out of AFIB, as just getting an ECV is an option. I just went for a little Hike in Desert last week, got a 1/2 mile out from Civilization, and I couldn't go any further. Slowed down to little baby steps of 4-6 inches, but still no energy. Maybe my HR was too low, as it was in the 60-70 range, and I my BP was also low. Anyway it took awhile, but I finally got back to my car.

I had 5 years of undiagnosed afib where approximately 100? episodes converted on their own. Then diagnosed and on continual meds for 6 years before an ablation. During those 6 years on meds, I documented 190 episodes, all of which converted on their own. Rate control and blood thinner, fine, but what did the conversion drugs do for me?

My experience is with flec. I've used 300mg (which I chew) as a conversion tool since Nov 2004 (and have used it for almost every episode since then). I usually convert to a rate around 90 BPM, which then slowly (over some hours) declines to my normal resting rate (40's-50's). I don't exercise during afib or in the immediate aftermath of conversion. When I take the flec, I normally try to remain prone as much as possible till I convert. A few times I've seen rhythms that are likely flutter around 135 BPM. I also usually dump more magnesium and potassium into my system at the same time I chew the flec.

As my burden is very low, I don't use it frequently.

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GeorgeN
My experience is with flec. I've used 300mg (which I chew) as a conversion tool since Nov 2004 (and have used it for almost every episode since then). I usually convert to a rate around 90 BPM, which then slowly (over some hours) declines to my normal resting rate (40's-50's). I don't exercise during afib or in the immediate aftermath of conversion. When I take the flec, I normally try to remain prone as much as possible till I convert. A few times I've seen rhythms that are likely flutter around 135 BPM. I also usually dump more magnesium and potassium into my system at the same time I chew the flec.

As my burden is very low, I don't use it frequently.

How often do you have AFib episodes?

How much flecainide do you take? And how long does this feeling last? Does it continue even after you convert?

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The Anti-Fib
Is anyone having success using Drugs to Convert out of AFIB? I know many have used Flecainide with some success.
How about other Drugs like Propapfenone, Amio or Illbuteride?

Specifically I am wondering about how people feel before they convert to NSR. I can often convert using Flecainide, but it causing a sort of drug-induced Heart Failure. I feel queasy and uneasy, have a weak Pulse, and physical capacity like walking is reduced. This is worse if I get high-rate Flutter like 135, but I notice the reduced cardiac functioning even if in normal rate-controlled AFIB while I am on the Flec..

I convert with flecainide though, since I take it daily anyway, for me that just means an extra dose. I rarely go into Afib but when I do I am very symptomatic and I don’t think that flecainide adds to my symptoms. I usually convert in about an hour.

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katesshadow
How often do you have AFib episodes?

On average, perhaps 2x/year. Last I calculated, my AF burden was <0.004% as I recall. I've gone several years without episodes and also had them sort of bunch together. This is after my 2.5 month episode 15 years ago, prior to my working out my plan to keep aftb in remission. More recently, I've had a family member with brain cancer and the stress and also caregiving had me forgetting my magnesium dose (which ranges between 1 and 5g/day). Not taking my magnesium almost guarantees afib within 24 hours.

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GeorgeN

How often do you have AFib episodes?

On average, perhaps 2x/year. Last I calculated, my AF burden was <0.004% as I recall. I've gone several years without episodes and also had them sort of bunch together. This is after my 2.5 month episode 15 years ago, prior to my working out my plan to keep aftb in remission. More recently, I've had a family member with brain cancer and the stress and also caregiving had me forgetting my magnesium dose (which ranges between 1 and 5g/day). Not taking my magnesium almost guarantees afib within 24 hours.

It's amazing that your Afib is so linked to your magnesium intake.

I'm sorry about your family member's illness. That is a lot of stress. My baby sister is very sick and I stay with her a couple of times a week. She was diagnosed with early dementia at age 53, then had her colon perforate due to diverticulitus and while in the hospital for that, they discovered she had lung cancer. She was the picture of health, extremely intelligent and accomplished in her field and has never smoked or had alcohol a day in her life. It's like she was hit with 3 lightening bolts. Take care.

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Carey
How much flecainide do you take? And how long does this feeling last? Does it continue even after you convert?

When an episode starts, I just start taking Flecainide at 100mg every 8 hours. After several days I can feel the effects more as the blood concentration is rising. Then I switch to 50mg every 4 hours. So at 300mg/day total, and I have never gone over that. I am trying to get enough of it into my system to convert to NSR, while avoiding a unwanted fatal dosage. I have noticed the side effects of Flec the most at 30 min to 2 hours after ingesting the Drug, so I switched to the 50mg every 4 hours, to try and even out the Blood levels.

Years ago, I tried a single Bolus dose of 300/mg, but it literally wiped me out, as I lay incapacitated for 30 minutes unable to hardly move or speak.

I don't remember the bad effects after converting, but I always either stopped taking the Flec after Conversion, or greatly reduced the dosage.

In the last few days, I converted from atrial flutter to NSR on flecainide 150 mg 2x/day and metropolol 50 mg 2x/day. (Note that this is post-ablation...) FYI

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The Anti-Fib

How much flecainide do you take? And how long does this feeling last? Does it continue even after you convert?

When an episode starts, I just start taking Flecainide at 100mg every 8 hours. After several days I can feel the effects more as the blood concentration is rising. Then I switch to 50mg every 4 hours. So at 300mg/day total, and I have never gone over that. I am trying to get enough of it into my system to convert to NSR, while avoiding a unwanted fatal dosage. I have noticed the side effects of Flec the most at 30 min to 2 hours after ingesting the Drug, so I switched to the 50mg every 4 hours, to try and even out the Blood levels.

Years ago, I tried a single Bolus dose of 300/mg, but it literally wiped me out, as I lay incapacitated for 30 minutes unable to hardly move or speak.

I don't remember the bad effects after converting, but I always either stopped taking the Flec after Conversion, or greatly reduced the dosage.

What you describe there doesn't sound like a good use of flecainide. It's certainly not a PIP approach. If you're taking it for days to achieve conversion, I'm not even sure the flecainide has much to do with the conversion. Would it have happened anyway if you hadn't taken it? I think the answer is quite likely yes. Sitting down with your EP and talking about alternatives might be a good thing to do at this point. The way you described flecainide's effects on you doesn't sound very safe.

What you describe there doesn't sound like a good use of flecainide. It's certainly not a PIP approach. If you're taking it for days to achieve conversion, I'm not even sure the flecainide has much to do with the conversion. Would it have happened anyway if you hadn't taken it? I think the answer is quite likely yes. Sitting down with your EP and talking about alternatives might be a good thing to do at this point. The way you described flecainide's effects on you doesn't sound very safe.

Yes I am concerned about safety, thats in-part why I started the Thread. I have never Converted right away, it is at least 24 hours into an Episode, and usually the Conversion happens between 24-72 hours into the AFIB. Having the Flec on board has made Conversion more likely. Perhaps next time I will just check into the Hospital, so I can use the Flec a little more aggressively.

I only used Bystolic when I had my scare with Flec about 5 years ago, and now I use Diltiazem as well. I think I went into Flutter with a 1:1 ratio. I don't know what else would incapacitate me so much. I literally, could not speak, and only whisper, and could barely move my arms for about 30 minutes. By the time the ER staff did an EKG, I was feeling better, and was in Flutter with a 3:1 ratio.

So I have a question: If a patient is in an ER Room or in the Hospital being neglected, the patient can still call 911 for an emergency response from the Paramedics? This is what I should have done. The Nurses said I was fine based on an initial EKG, before I took the 300mg of Flec. 30 minutes later I was deteriorating fast. When I asked for help from the Nurses, they chastised me and even laughed at me, thinking I was faking the symtoms.

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The Nurses said I was fine based on an initial EKG, before I took the 300mg of Flec. 30 minutes later I was deteriorating fast. When I asked for help from the Nurses, they chastised me and even laughed at me, thinking I was faking the symtoms.

Scary! I wouldn't try the same again. Did you take a beta blocker prior to Flec?

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The Anti-Fib
So I have a question: If a patient is in an ER Room or in the Hospital being neglected, the patient can still call 911 for an emergency response from the Paramedics? This is what I should have done. The Nurses said I was fine based on an initial EKG, before I took the 300mg of Flec. 30 minutes later I was deteriorating fast. When I asked for help from the Nurses, they chastised me and even laughed at me, thinking I was faking the symtoms.

Calling 911 from an ER would certainly get you plenty of attention but there's nothing the paramedics would be able to do for you. When they arrived to find you in the hands of a qualified ER physician their job would be complete. The only way they could do anything for you would be if you first refused care from that doctor and all the nurses. At that point the paramedics would be legally able to take you to another ER, but I can guarantee you that everyone in that room, including the paramedics, would be questioning your mental stability and that questioning would carry over to the next ER. In fact, it's possible you would be judged not mentally competent to make medical decisions for yourself due to drug effects. It could get ugly. That's just not something I would recommend that anyone ever do.

I can't imagine nurses chastising and especially laughing at a patient who says he's in distress. If they actually did that, a letter to the ER director, hospital CEO, and department of health should have followed. Trust me, such a letter would get attention.

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Carey

So I have a question: If a patient is in an ER Room or in the Hospital being neglected, the patient can still call 911 for an emergency response from the Paramedics? This is what I should have done. The Nurses said I was fine based on an initial EKG, before I took the 300mg of Flec. 30 minutes later I was deteriorating fast. When I asked for help from the Nurses, they chastised me and even laughed at me, thinking I was faking the symtoms.

Calling 911 from an ER would certainly get you plenty of attention but there's nothing the paramedics would be able to do for you. When they arrived to find you in the hands of a qualified ER physician their job would be complete. The only way they could do anything for you would be if you first refused care from that doctor and all the nurses. At that point the paramedics would be legally able to take you to another ER, but I can guarantee you that everyone in that room, including the paramedics, would be questioning your mental stability and that questioning would carry over to the next ER. In fact, it's possible you would be judged not mentally competent to make medical decisions for yourself due to drug effects. It could get ugly. That's just not something I would recommend that anyone ever do.

I can't imagine nurses chastising and especially laughing at a patient who says he's in distress. If they actually did that, a letter to the ER director, hospital CEO, and department of health should have followed. Trust me, such a letter would get attention.

She was a younger Nurse, but she did briefly laugh, and an older Nurse scolded me that Flec did not produce those side effects. I fool people because I look Physically fit. They said the ER Dr. looked at my EKG said I was stable. That is true, but the effects of the Flec had not kicked in yet. I should have called the Paramedics, if they would have even talked to me they would have seen I was in distress. Just feeling my Pulse or putting an Oximeter on my finger would have shown that something was wrong. The Attention may have gotten the "Charge Nurse" on the scene. If the Paramedics show up, and I can only wisper to them, and barely move, what would they do? I had little to lose at that point.

The other thing was that I was all alone. If I had someone else there to advocate for me, it would have probably helped.



Edited 1 time(s). Last edit at 07/28/2019 04:24AM by The Anti-Fib.

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The Anti-Fib
If the Paramedics show up, and I can only wisper to them, and barely move, what would they do?

They would ask the ER doc what was going on and follow his or her directions. You can't call 911 and expect them to overrule a physician. They don't have the legal authority to do that and they won't. At best you're going to get a lot of attention for yourself and maybe someone will recognize that you're in distress, but at worst they're going to conclude you have mental issues.

What I would suggest is that you need to stay away from flecainide. I don't understand why you would take it at all after such an experience.

This is from Wikipedia, [en.wikipedia.org]. And I am reading similar things elsewhere.

"Because of the negative inotropic effects of flecainide, it should be used with caution in individuals with depressed ejection fraction."

"Negative Inotropic Effects" is a fancy medical way of saying that the Heart Beats weaker and with less contractile force. I can definately feel this just by feeling my Pulse with my Finger when I am on the Flec, particularly with a larger dose.

The short term usage of the Flec makes more sense to me than the long-term daily usage. If Ejection Fraction (EF) is decreased while using Flecainide, then Stroke Risk would increase.



Edited 1 time(s). Last edit at 08/01/2019 09:47AM by The Anti-Fib.

Millions of people have spent years taking flecainide daily without problem for several decades now. Flecainide is contraindicated in people with structural heart disease such as heart failure and prior heart attack for the reasons you mention, but for everyone else it's a relatively safe drug. It doesn't substantially reduce EF and it doesn't create a stroke risk.