Is there a way to get out of tachycardia without going back on antiarrhythmic

Hi, last August I had the ablation from Dr. Natale. Once in December this past year I had some tachycardia that turned into two weeks of atrial flutter. It resolved before cardioversion because the cardiologist put me back on sotalol & in the very last few days up to 120 b.i.d. and I converted.

I have been off the sotalol since last January and feel so much better not on it. Chest tightness/cough went away, sleep got better. I have been on carvedilol 6.25 mg BID. I won’t go into all the details right now, but just say that yesterday after exercising a lot and eating lunch very late around 330 and then bending over with a portable hand vac to clean the kitchen floor for several minutes, I developed a heart rate of 207 bpm and a Kardia EKG said possible atrial fibrillation. A few more times last night and first thing this morning I have taken more EKGs and heart rate is in the 122-127 range and says tachycardia. I decided to try 40 mg of sotalol at 10 pm, but this morning I still have heartbeat around 126 and I had to take a small dose of sleeping pill to even get back to sleep last night.

I really don’t want to get back on sotalol and especially now with the coronavirus going on. I am due for the Zio heart monitor in May & if all was good, I could get off the Xarelto. I did not choose the higher insurance plan to cover more of Xarelto because I was sure I was getting off of it way before this.

I am going to skip my thyroid medicine this morning (I have no thyroid) & I am going to go take 1000 mg of my Lipo Vit C - maybe that will help.

I would appreciate any suggestions you could offer before I call my local cardiologist and get in his grip again. He loves to keep me on sotalol, from the beginning he said he wanted me on it at least a year after the ablation as well as the Xarelto.

Thank you.

The tachycardia is almost certainly flutter. A cardioversion would be the obvious answer, but that's problematic right now with COVID-19.

The only things that ever terminated flutter for me are large doses of potassium (easiest way is 2 large cans of low-sodium V8 juice, guzzled all at once on an empty stomach), and sometimes exercise. The exercise had to be intense enough that under normal conditions it would raise my heart rate to 120 or higher, but it didn't have to be super intense.

Valsalva maneuvers work for some people (never worked for me).

Thanks Carey. What do you mean about cardioversion being problematic now with COVID-19? Just all the risks associated with going into hospital &/or that they might be too busy with corona pts & not even doing cardioversions?

Now, about your V8 thing & exercise - is that bec of the type afib you have (vagal?). Would the same thing do for me? How many ounces are there in the size cans you speak of? Was the exercise in conjunction with the V8 or were you speaking of doing one or the other of those? I'd be scared to try & raise my rate any more.

I remember that too much potassium can be dangerous. I had to take some at one point & I have a lot now - Klor-Con 10 mEq wh said 1 tab p.o. BID. The script was from 2012. I am not sure what you would say, but most of my former thyroid groups all said they would keep old scripts to be used later if needed. What should I do?

PS: I had been waiting on an email to see if I had a reply to my post, but none ever came. I just decided to go to the site before closing my computer tonight & saw your reply. Oh, also I talked to Shannon & he sent my Kardia EKG to Natale & he said it was flutter again

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Madeline
What do you mean about cardioversion being problematic now with COVID-19? Just all the risks associated with going into hospital &/or that they might be too busy with corona pts & not even doing cardioversions?

Yep, all the above. A HR of 125 isn't life-threatening so the ER isn't going to see you as an emergency. And the cardiology department is going to see it the same way. Cardioversion would be an elective procedure for you, so I doubt they would do it.

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Now, about your V8 thing & exercise - is that bec of the type afib you have (vagal?). Would the same thing do for me? How many ounces are there in the size cans you speak of? Was the exercise in conjunction with the V8 or were you speaking of doing one or the other of those? I'd be scared to try & raise my rate any more.

Forget that vagal stuff. We're talking about flutter, not afib, and there's no such thing as vagal flutter. There's just flutter. The potassium might help you because raising your potassium levels slows down how fast your heart recharges after every beat (just like many antiarrhythmic drugs do), and that might be enough to interrupt the cycle that flutter is, and if you interrupt it just once that can be enough to stop it. I'm not promising anything at all, just telling you what's worked for me in the past.

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I remember that too much potassium can be dangerous. I had to take some at one point & I have a lot now - Klor-Con 10 mEq wh said 1 tab p.o. BID. The script was from 2012. I am not sure what you would say, but most of my former thyroid groups all said they would keep old scripts to be used later if needed. What should I do?

I would not take any prescription potassium meds without medical guidance. Stick to food sources such as LS V8 juice.

Carey, I looked online and saw the LSV8 came in 11 1/2 ounce cans - does that sound right? I was used to when you said large, the great big bottles. So I will try and drink two of those as fast as I can back to back, refrigerated or room temp? Then I still want to ask you was this supposed to be followed by intense exercise? Can you give me an exercise example? Or maybe you could call me so we could talk about it. Then I could also ask you some questions about the sotalol.

I meant the 11-1/2 ounce cans, not the big jugs. Cold or warm is your choice, but cold tastes better. If you combine it with exercise, all the better. Maybe wait an hour after drinking it. I used to do things like jog up and down the stairs at home, or walk briskly up a steep hill. Nothing really intense, just enough to get the heart rate going. I'll give you a call later today.

I use the 5.5 ounce low sodium cans from Amazon so you don’t have to risk being exposed while shopping. They sell a 24 and 48 pack. 48 is cheaper per can. You save up to 15% off by placing a subscribe and save.

My AF cocktail was 2 small cans plus a Valium. I usually would convert. Two 11oz cans like Carey suggested would had probably been better in those cases when I didn’t convert. Since my ablation I have been drinking 3 cans when my heart acts up. I also drink one can a day for the potassium and small amount of magnesium.

Thank you, Susan. I tried Carey's method last week, about the 4th or 5th day of my flutter, but it did not work for me. I will take into mind though the maintenance doses you suggested for preventive effects. I did end up being able to get an ECV with return to NSR. It is my 1st cardioversion, and I am hoping it will hold for a while. Now I have to get the touch-up ablation Natale talks about bec this was my 2nd time since way after the blanking period of having flutter. However, I will say I was able to go most of that time without antiarrhythmics. COVID definitely presents problems with when to schedule this ablation now.

Regarding LS V8. It is just V8 spiked with potassium chloride. You can buy potassium chloride powder and spike anything you want. This can be found with salts at the grocery store. For example Morton Salt Substitute. NOW brand makes a larger container available at a supplement store or online.

I understand that potassium citrate powder is a better choice for the stomach (the chloride can cause irritation) and less likely to cause kidney issues (be careful with potassium if you have kidney issues). It is what I use. Carey has pointed out that concentrated intake of potassium will be urinated out quickly for those with healthy kidneys. I buy bulk potassium citrate powder and put 2 tsp (along with 1/2 tsp of table salt) in a liter of water and drink over the day - my version of timed release. 2 tsp of potassium citrate powder is about 4 grams potassium. The 1/2 tsp of table salt is 1 gram sodium. This gives my understanding of the paleo ratio of potassium to sodium of 4:1.

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Madeline
COVID definitely presents problems with when to schedule this ablation now.

Don’t I know it. I was scheduled for a second Natale ablation later this month and I canceled it. I read all elective procedures, unless necessary, should be postponed. My local EP told me to stay home. It is 36 days so far. I had a missed call from Natale‘a office today. Maybe it will be the new date for the ablation? But when is a safe time? In the meantime my local EP (with Natale’s NP permission) put me on Tenormin. My constant PVCs are tapering off so I can wait it out for now unless my flutter returns for any long duration. I’m getting 5-6 fast beats once or twice a day. Not long enough to capture on Kardia. My heart feels like a wild animal caught in my chest. I can’t even imagine how concerned I would be if I ever needed to visit an ER during this virus. And it’s not just for a cardiovert. I was cutting veggies using a new Swiss knife and I cut my finger very deeply. I am lucky it didn’t get infected. In a non covid19 time I would had stitches instead of having the flesh just hanging...and healing.