hubs- afib

I've been dealing with this so long and I have had other issues-- so I need a refresher for my husband to ask the docs. He has had afib a few times. He went in very early Sat morning to ER. They did not want to cardiovert there so they inpatiented. him. They had him on metroprolol. Then he went to flutter yesterday afternoon so added cardizem. they also did Mg and potassium in IV.. They took him for a TEE and cardio version this morning and the TEE actually put him back in sinus- so a vagal response I would think.

So what are the questions he needs to ask. I mean, I think he needs a blood thinner yes? And since this has happened a few times a PIP? He has never done any of those meds. Do they give that sort of thing leaving the hospital, or does that happen at a follow up visit with EP? (He does have an EP).

And vagal - since it seems to be related to that perhaps in some way, what can he do to avoid or strengthen things so that doesn't happen. Or helps stop it if it is.

His first event was 30 years ago. And maybe 2 since then. Last one a couple years ago. I think one self converted in the hosptial.

Also I think the EP could give guidelines for staying home. When he went his rate was in the 130s. And.. it was like 5 am Saturday morning. So wasn't like he was going to be able to call doc any time soon.

Thanks. I feel like a noobie- even though I personally have been dealing with it for years lol!

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bettylou4488
Also I think the EP could give guidelines for staying home. When he went his rate was in the 130s. And.. it was like 5 am Saturday morning. So wasn't like he was going to be able to call doc any time soon.

Is he symptomatic at 130? For me, that is a normal afib rate and nothing I worry about. In fact I've pushed my rate to 225 during episodes, then backed off (not suggesting this for anybody else). I've never been back to the ER subsequent to episode #1 in 2004.

As to oral anticoagulation. What is his Chads2vasc score?

What about an on demand conversion med like flec, if appropriate? Here is the 2004 study.

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GeorgeN

Also I think the EP could give guidelines for staying home. When he went his rate was in the 130s. And.. it was like 5 am Saturday morning. So wasn't like he was going to be able to call doc any time soon.


Is he symptomatic at 130? For me, that is a normal afib rate and nothing I worry about. In fact I've pushed my rate to 225 during episodes, then backed off (not suggesting this for anybody else). I've never been back to the ER subsequent to episode #1 in 2004.

As to oral anticoagulation. What is his Chads2vasc score?

What about an on demand conversion med like flec, if appropriate? Here is the 2004 study.

I believe his chad score is 0 if I am reading that chart correctly. thanks for that link. They sent him home on metropolis and eliquis 'for a month' and he has an EP appointment in 2 weeks. I would say PIP for flecanide would be appropriate and potential a PIP Xanax as well. Thanks for the links!

If you want to be sure you're not misreading the chart, use this calculator instead. Just answer the questions and it will calculate the score for you.

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Carey
If you want to be sure you're not misreading the chart, use this calculator instead. Just answer the questions and it will calculate the score for you.

thanks. He's a bit fat zero. So it assumes you have had afib and calculates from there- yes? He has had 3 or 4 bouts.. over the last 30 years. I definitely think he should consider PIP flecanide. He's on metrop- "for a month". but sees doctor in 2 weeks. Is there a reason to continue that? I have two friends that take sotolol on a daily basis- one it helps keep it away and the other it doesn't really. What is the first stop PIP usually? (Mine was flecainide as I recall... but maybe others are a better option).



Edited 2 time(s). Last edit at 11/07/2023 02:57PM by bettylou4488.

Yeah, flecainide is usually the first choice for a PIP.

With 3-4 bouts of afib over 30 years I wouldn't take any drug daily. I don't even understand the point of taking metoprolol for a month.

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Carey
Yeah, flecainide is usually the first choice for a PIP.

With 3-4 bouts of afib over 30 years I wouldn't take any drug daily. I don't even understand the point of taking metoprolol for a month.

Yes I was wondering the metropolol .. the why of it. His BP is fine. Does it help "prevent" it? EP appt in 2 weeks so he will probably stay on till then unless it bothers him.

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bettylou4488
Does it help "prevent" it?

There's some old data (20+ years) that suggests it does, but I'm extremely skeptical. It slows the rate, for sure, and does that help some people convert back to NSR? Maybe. But whatever it can do for prevention is definitely insufficient for it to be considered an antiarrhythmic because it's just not. The only beta blocker that's an antiarrhythmic is sotalol.

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bettylou4488
Yes I was wondering the metropolol .. the why of it. His BP is fine. Does it help "prevent" it?

My opinion is that for someone who has an adrenergic trigger, like when afib is initiated by heavy exertion, it may help prevent it. I have a friend in this category & I do think the beta blocker helped. For someone who has as few episodes as your husband, I think PIP flec is a much better answer.