PAF

I have PAF every couple of days. The heart rate is around 70 but irregular. I am also on propanol 120mg. It mostly lasts only several hours but makes me shaky and weak. I Tried flecainide 50 2/d but it did not matter much. Should I try PIP starting with 100mg or increase the daily dose to 100. Will go to see the cardiologist next week

I would wait and talk to the cardiologist. You're on a pretty low dose now, so you've got plenty of room to go up. The max dose is 300 mg/day if you weigh over 70 kg (154 lbs) or 200 mg otherwise. If you want to try using it as a PIP, the usual dose is the daily maximum taken all at once, preferably by chewing the tablets and washing them down with a glass of room temp water.

By the way, is your cardiologist an electrophysiologist (EP)? If not, you might want to find one and get a second opinion. PAF every 2-3 days is a pretty hefty load.

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alfrae13
The heart rate is around 70 but irregular. I am also on propanol 120mg

The propranolol is likely keeping the rate low. Before propranolol, was your afib rate over 100?

"It mostly lasts only several hours but makes me shaky and weak."
I presume you mean the afib?

"Should I try PIP starting with 100mg or increase the daily dose to 100. Will go to see the cardiologist next week"
Don't try anything different with the flec without discussing with your cardio. An increased dose would be something to discuss.

"increase the daily dose to 100."
Assume you mean to 100 twice a day?
Note, the max daily dose of flec is 200 mg for those < 70 kg (154 #'s) and 300 mg for those weighing more.

If your afib only lasts a couple of hours, PIP flec is unlikely to shorten it by much.

Things to chat with the cardio about. If your episodes only last a few hours, do you need the propranolol, even if the rate is higher (unless a higher rate is debilitating to you)? There is some thought (though this is controversial) that giving a beta blocker to someone with a vagal trigger (which I have no indication you are or are not) might provoke more episodes. On the other hand, sometimes a beta blocker for someone with an adrenergic trigger might reduce the number of episodes.

{edit} just noticed Carey responded while I was writing this



Edited 2 time(s). Last edit at 02/05/2022 05:46PM by GeorgeN.

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GeorgeN
If your afib only lasts a couple of hours, PIP flec is unlikely to shorten it by much.

That's a good point.

I have had hi blood pressure for the last 40 years and been on beta blockers for all that time. Most posts talk about AF 3 or 4 times a year at high bpm. This is not my case and I am looking for someone who has a similar experience and what they are doing.Will talk to my cardiologist next week. He wanted to put me on amidiarone which I declined

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alfrae13
I have had hi blood pressure for the last 40 years and been on beta blockers for all that time. Most posts talk about AF 3 or 4 times a year at high bpm. This is not my case and I am looking for someone who has a similar experience and what they are doing.Will talk to my cardiologist next week. He wanted to put me on amidiarone which I declined

There are many people here who experience AF episodes far more than 3-4 times per year, and some of them don't have high heart rates. I was experiencing multiple episodes per week at one time, but I'm unlike you in that my bpm was always very high.

My experience was that AF went from a 1-2 episodes per year lasting a few hours to an increasingly common episode lasting longer and longer. That's what AF does. It progresses and eventually becomes persistent. Once you're at the persistent stage, your choices change significantly. Ablation becomes more difficult and has lower success rates, and antiarrhythmic drug therapy becomes totally ineffective. Since you don't experience high heart rates, rate control isn't an issue for you, so if your AF becomes persistent, it's likely your only choices will be ablation or just living with it. Have you seen an EP? If not, I strongly recommend you do.

Wise choice to decline the amiodarone.