Any experience with Multaq?

My EP prescribed Multaq over Flecanide, to be careful. He wants to see echo/MRI first.

Anyone has experience with Multaq?

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hds
My EP prescribed Multaq over Flecanide, to be careful. He wants to see echo/MRI first.
Anyone has experience with Multaq?

It is the mildest rhythm med. Dr. Natale commonly prescribes it after an ablation, during the "blanking period."

Here is a search on Multaq on this site: [www.afibbers.org]



Edited 1 time(s). Last edit at 04/08/2023 12:22PM by GeorgeN.

I've been on it twice. As George said, it's very mild and comes with few side effects. Its only drawback is that sometimes it's too mild and won't hold your afib at bay. But if it works for you that's great and you will be fortunate.

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hds
Anyone has experience with Multaq?

My EP prescribed it after Flecainide failed and, as others have said, it is pretty mild. It worked fairly well for about 6 months, then more and more Afib broke through until, close to my ablation, I was getting episodes every day. Natale did prescribe it after the ablation and it kept arrhythmias at bay during the blanking period, or….there weren’t any arrhythmias to keep at bay. It did bother my stomach though so I was very glad to get off it.

I started Multaq before my ablation in August 2022 and it stopped my afib cold. I took it after my ablation on 8/4 for three months but then had a bit of break through afib so went back on. In January I had 2 weeks of a holter monitor and it did not show afib according to my great EP, who said I could stop the Multaq. I am 71 but play competitive tennis and in the heat, I used to go into afib when sufficiently stressed (adrenaline rush), dehydrated, and/or overheated. So since I play 4 times a week, I am staying on it as a treat to myself after 15 plus years of break through afib! It was sorely tested on Thursday with the temperature at 87 and humidity at 70%. I played 2.5 hours against 40 plus year olds and somehow my partner (also 71) and I won in a 10 point tie breaker. No way my heart would have held as I was exhausted on my fifth straight day of hard tennis. I am staying on it through a two plus week trip to Scandinavia in July/August for peace of mind. I feel no side effects and my heart rate is slightly lower on Multaq which is an advantage I will not mention to my younger opponents!

It's so good to hear you can excercise well. I'm 6 weeks into Afib and very scared to do any exercise until this has stabilized. I'm looking forward to do my daily 5Ks again.



Edited 1 time(s). Last edit at 04/09/2023 03:57AM by hds.

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GeorgeN

My EP prescribed Multaq over Flecanide, to be careful. He wants to see echo/MRI first.
Anyone has experience with Multaq?

It is the mildest rhythm med. Dr. Natale commonly prescribes it after an ablation, during the "blanking period."

Here is a search on Multaq on this site: [www.afibbers.org]

Thank you George. Have you seen any interactions with Metoprolol On the forum? I have a low resting and sleep HR. In the mid to upper 40's. I'm worried Multaq may drop the rate too low. Messaged my doc to be sure.



Edited 1 time(s). Last edit at 04/09/2023 04:14AM by hds.

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hds
It's so good to hear you can excercise well. I'm 6 weeks into Afib and very scared to do any exercise until this has stabilized. I'm looking forward to do my daily 5Ks again.

There's no reason for you to fear all exercise. If exertion triggers your afib that's a good reason to tone it down, but stopping exercise entirely isn't necessary or healthy. No one has ever died of afib and you won't be the first.

Have you read enough here to learn that endurance athletes often end up with afib? It's very common among endurance runners, cyclists, swimmers, skiers, etc. You might want to consider backing off those daily 5Ks even after it has stabilized.

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hds
Thank you George. Have you seen any interactions with Metoprolol On the forum? I have a low resting and sleep HR. In the mid to upper 40's. I'm worried Multaq may drop the rate too low. Messaged my doc to be sure.

It is a good question. My thought is, if you go on Multaq, do you need Metoprolol? Or perhaps take Metoprolol for rate control when you are in afib, but only on-demand during the episode. Metoprolol is commonly prescribed with flecainide to mitigate atrial flutter which can be caused by flec. My low sleeping heart rate is in the low 40's, but I've never taken Metoprolol.

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hds
It's so good to hear you can exercise well. I'm 6 weeks into Afib and very scared to do any exercise until this has stabilized. I'm looking forward to do my daily 5Ks again.

For me, my exercise trigger is the product of intensity times duration. Hence long duration, intense exercise can be a trigger. However, long duration activity at a Zone 2 level (as I've linked here & nominally nasal breathing or 180-age heart rate - I'm age 67) is not a trigger for me. I can also do short term high intensity activity without it being a trigger. For example I did this on my fan bike yesterday: 3 minute warm up at 50 watts, then 8 cycles of 15 seconds absolutely as hard as I can, 15 seconds at 50 watts. Lastly 3 minutes at 50 minutes cool down. Other afibbers have contacted me via PM and confirmed this has been their experience also. My hypothesis is the long duration high intensity is catabolic and probably a lot of oxidation. The top endurance athletes do ~80% of their training at Z2. I strength train, with a lot yielding and overcoming isometrics. I alpine ski & outdoor rock climb. In my first four months of afib, over 18 years ago, I had a 2.5 month episode & I have use flecainide to convert most episodes since.

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GeorgeN

My thought is, if you go on Multaq, do you need Metoprolol? Or perhaps take Metoprolol for rate control when you are in afib, but only on-demand during the episode.

I had an episode last night and took 1/2 Metoprolol as instructed when episodes starts (12.5mg). During sleep my HR dipped to 32 for approx. 30 minutes.

Not yet on Multaq.

I think you're spot on!

Response pending from EP.

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hds
I had an episode last night and took 1/2 Metoprolol as instructed when episodes starts (12.5mg). During sleep my HR dipped to 32 for approx. 30 minutes.

Not yet on Multaq.

If you are recording beat to beat heart rate, are there pauses a lot longer than 2 seconds (I.e. 30 BPM)?

When you don’t take Metoprolol during an episode, what is your average heart rate?
How long do your episodes last? Hours or days?

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GeorgeN

If you are recording beat to beat heart rate, are there pauses a lot longer than 2 seconds (I.e. 30 BPM)?

When you don’t take Metoprolol during an episode, what is your average heart rate?

How long do your episodes last? Hours or days?

- Unfortunately Apple Watch doesn't seem to give me this data. I tried my Garmin but it seems not be able to record HR accurately in Afib. Numbers are much lower. Currently wearing a holter ( day 2 of 7 ).

- The last episode without Metoprolol indicates approx. 110 but with peaks in the 130-160 range.

- Typically 4-5 hours. But frequency starts to increase to every other day.



Edited 1 time(s). Last edit at 04/09/2023 06:56PM by hds.

I have 4 full bottles of it and one opened bottle that's 80% full. Never did a thing for me.

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PavanPharter
I have 4 full bottles of it and one opened bottle that's 80% full. Never did a thing for me.

Sorry to hear. Anything eventually worked?

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hds
- Unfortunately Apple Watch doesn't seem to give me this data. I tried my Garmin but it seems not be able to record HR accurately in Afib. Numbers are much lower. Currently wearing a holter ( day 2 of 7 ).

- The last episode without Metoprolol indicates approx. 110 but with peaks in the 130-160 range.

- Typically 4-5 hours. But frequency starts to increase to every other day.

4-5 hours over 100 BPM (which is kind of the the cutoff for needing rate control) doesn't seem like rate control is really needed, unless the high rate is really uncomfortable for you. It is days or weeks over 100 that can lead to cardiomyopathy, one of the two big afib risks.

Your Holter should tell you about pauses during sleep.

The Heart Rate Variability Logger app [www.hrv4training.com] iOS or Android) is what I use with a Polar Strap, though any bluetooth strap should work. The author says he gets better data from the Polar H9 or H10 straps (I have an H10).

The app will export data through Dropbox, email or a cable to a computer. It can be viewed in Excel or I massage it and use an ancient Polar Windows program to display beat to beat data. This is what is shown in this post you've seen previously: [www.afibbers.org] If the Holter gives you what you need, the app isn't needed. I've been playing with Polar beat to beat data almost all of my afib "career."

I believe your watch should be able to download an ECG record in chart/graphic form that your health app would render for you...? My Galaxy Active 2 does. In fact, it was that record, attached to an email, to the AF outreach clinic that confirmed my first ablation had failed.

If this turns out to be the case, your watch WILL show your heart rhythm and it will show any pauses, PACs,etc. Mine very clearly showed the telltale missing P-wave, and all the varied intervals between the QRS complexes.

Check your Apple health app that controls your watch's output and see if there's a mechanism to transfer a recorded ECG.

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gloaming
I believe your watch should be able to download an ECG record in chart/graphic form that your health app would render

It does, but only for the 30 second of ECG data that is manually triggered.

HDS,

So you know, I had paroxymal afib for 15 plus years where afib would hit me several times a year. Held off on ablation until last August. There are so many good options now so don't get discouraged! Find a very very good EP and go from there. Good luck!

Okay, so the magic is to somehow sense when something is untoward, as has been my history with AF (I don't suffer it gladly, put it that way), and then to make your watch record a burst or five. When it happened to me, I could feel that I was in AF,. I was out walking with our toddler grandson, and had walked slowly with him for maybe eight or nine minutes. When I looked, my watch said 135 BPM, so I immediately toggled it to record an ECG. It was that record that my EP used to agree to call me and have a consultation over the phone. But, he agreed just based on that email and graphic depiction that I was back in AF.

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karin
HDS,

So you know, I had paroxymal afib for 15 plus years where afib would hit me several times a year. Held off on ablation until last August. There are so many good options now so don't get discouraged! Find a very very good EP and go from there. Good luck!

Thank you for this. My life is indeed totally upended with episodes every 2 days. Sometimes 2x per day.

Luckily I found the top EP for this in my area. Elite rating according to medifind.com. Had my first appointment last Friday.

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gloaming
Okay, so the magic is to somehow sense when something is untoward, as has been my history with AF (I don't suffer it gladly, put it that way), and then to make your watch record a burst or five. When it happened to me, I could feel that I was in AF,. I was out walking with our toddler grandson, and had walked slowly with him for maybe eight or nine minutes. When I looked, my watch said 135 BPM, so I immediately toggled it to record an ECG. It was that record that my EP used to agree to call me and have a consultation over the phone. But, he agreed just based on that email and graphic depiction that I was back in AF.

It's indeed good to have data. I suspect that not too long from now we can record ECGs continuously. Technology seems to be on the cusp of this.