EP Visit Update

I met with my regular EP today. It was REALLY good and informative. We talked a long time. He said that looking at my ECG, he suspects that the PACs and SVT are coming from the left atrium. He said that it is a 'disease' of the ion channels and that they are designed to pass calcium, potassium, sodium through to allow a charge or not, and the channel becomes problematic and allows a charge through when it shouldnt.

We talked about the meds, he was puzzled by why the Bisoprolol worked and the Sotolol isnt. He suspects it is dose dependent. He wants me to either try a higher dose of Sotolol for 3-4 days to try it. After that, he wants me to try Ivabradine and make my own Bisoprolol concoction, as you all were suggesting. He thought it was a great idea to make a mix.of the Bisoprolol and take a lower dose.

We talked, at length, about supplements including theanine, potassium, magnesium, etc. He was really excited to hear that I have tried many of them. We talked about inflammation.

I mentioned my consult with Natale and he was really excited to hear what Natale has to say. He said, "It doesn't matter to me what EP lab you go to, as long as it gets fixed. I just want you to be better". That was really encouraging.

Ultimately, his plan: 1. Tentatively try a higher dose of Sotolol, knowing that it may not work. 2. Try the homemade lower dose of Bisoprolol with or without Corlanor. 3. Discuss another EP study either with him or Natale and do the EP study with the end goal of fixing it by any and all means. He said we could consider admitting overnight to get ECG and ablate based on P wave mapping. We could get to the EP lab and induce prior to catheterization, since catheterization often stops the atrial tachycardia. He also mentioned trying IV caffeine, in addition to the Isoproteronol, or consider other induction agents that are less common, like Calcium.

He said he would take me to the lab (or consult with Natale) with an attitude of 'not taking no for an answer'. The end game COULD mean a pacemaker. But he would want to see everything possible tried to induce the pesky rhythm.

All in all, it was a great visit. I feel hopeful. My consult with Natale is on April 29th.

Fantastic report! You lucked out with an understanding cardiologist who doesn’t take no as an answer.

It is good to have options available, hopeful something in the mix will work for you. Just keep positive and fighting for the end goal.

Good EP you've got there. Go see Natale but keep him involved.

As a side note, it was interesting because I was having tons of PACs and bigeminy when I was in the office. The machine read the ECG as normal. I questioned it and he took a closer look, determining that I was, in fact, having an abnormal EVG and probable left atrial ectopy. Just goes to show you that machines don't tell the whole story.... I'm glad I questioned.

It's wonderful to see that you are heard, Megan, and the gentleman sounds like he's a winner. No ego running before him in his mission of service. He's willing to collaborate with Natale and be his aid in YOUR recovery. He's the consummate professional, and as I already characterized him, a true gentleman. Now, we pray for advancements and improvements for you.

As others have said, a grreat EP!

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MeganMN
He also mentioned trying IV caffeine, in addition to the Isoproterenol, or consider other induction agents that are less common, like Calcium.

Interesting as I've never seen calcium mentioned in this way. While, for me, excess calcium intake isn't a trigger, per se, it does modify the environment from which afib arises. It makes afib much more likely to occur and the general trigger "threshold" is much lower. Hence things that are not commonly triggers can become triggers with excess (for me) calcium in the system.

I just had the PFA with Dr,Natale on Tuesday. I have been in NSR since November but have had lots of other arrhythmias since then. I asked him if I had afib whilst having the ablation and he said for a very short amount of time. So I conclude that they must have induced it whilst under, at least that is what I was told prior to the ablation.Also looking at the list of meds given through iv suggests it was probably induced. He is a very nice amenable man, you won't have any problems with him. He is also very proactive in stopping afib early on in the journey as it is so much easier. I was surprised that he found a tiny amount of rogue cells in the left atrial appendage which he zapped, as well as the other two standard areas. My other arrhythmias have calmed down but have not yet gone away but that is completely normal for the first three months. Good luck with your appointment, and stick with Dr.Natale as he is the best at what he does. I don't even have any bruising in the groin area, my iv stick has a bigger bruise!!

Definitely a Sotolol fail..... Try again...!!!

Yeah, that's not success. My first thought was you've got quite a salad of -geminy going on there. Bigeminy, trigeminy, quadgeminy, and so on. But looking at it more carefully I think that's just plain old afib with 1.2 second pauses sprinkled in randomly. It's not any sort of -geminy at all.

That is pretty much what my ECG looked like before my ablation. Hopefully you will find something that works for you!

Thanks. We will get there eventually. I am going to self-compound Bisoprolol next for a lower dose. And hopefully have another ablation scheduled soon.

I seriously lucked out today. I went in for my follow up Sotolol ECG and the tech is someone I used to work with in the ED. She ran an initial ECG which was normal, even though I was feeling some serious ectopy. I told her about it and she ran another ECG along with a continuous strip and caught an awesome amount of my arrhythmia on a twelve lead. Yay!! That is the first time that we have been able to catch it on an ECG! I am so excited that he can now study that to see if he can better determine where the ectopy is coming from!!!!

Who sez connexions don't count? Happy for you, Megan.

Took my first homemade Bisoprolol slurry tonight. The EP was totally fine with my homemade concoction to try a lower dose. . By by the way, dissolved Bisoprolol tastes disgusting..... am trying 1mg twice a day....

Meg

Get some bottles of flavored seltzer water and use that. My wife loves them (Polar brand). They're just carbonated water and flavoring so they won't affect the med.

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MeganMN
By by the way, dissolved Bisoprolol tastes disgusting...

For nearly the whole time I've used flecainide on demand, I've chewed it to get it into my system faster. It is not exactly a delicacy!

I do what I need to do.

Thanks everyone. Its not too bad. I'm trying he equivalent of 1mg twice a day but might even back down to 0.5 or 0.75 for a bit because I am super sleepy. So far so good.

Almost ready for my consult with Natale!! I have been taking the liquid Bisoprolol and enjoying heart rates in the 70s, which is pretty awesome. I am still in almost incessant Atrial Bigeminy with runs of SVT, but it is still an improvement. Hoping for the best.

I'm amazed that a mg or less per day is working for you. Hurray that it is! But you must be incredibly sensitive to the effects of beta blockers.

Thanks Carey. I am definitely super sensitive to Beta Blockers. The challenge, of course, is that they also seem to stop being effective within a time. But for now, it is definitely a win. My heart seems to be more and more irritable, with near incessant Atrial Bigeminy, but that will make it easier if I have to go for an ablation. I've enjoyed walking up the stairs without being short of breath and a heart rate in the 140s!

Ugh, and a day later.... Back into tachycardia and SVT.... So I'll up the dose of Bisoprolol. My heart just wants to beat fast....

Are you only taking it once per day? The half-life of bisoprolol is 9-12 hours, so instead of upping the dosage why don't you try bid dosing instead?

Twice a day...

Titrating with tinctures is a hit-n-miss thing. You have to have absolutely homogeneous solutions so that any portion of it taken will be identical to the rest left behind (from which subsequent doses are to be taken). Then, measured doses taken in roughly the same circumstances, so on the hour, ideally. And then you've got to figure out how to titrate up if the desired effect isn't realized...without overshooting.

Thanks, Gloaming. I have pretty good tools at my disposal as an ER Nurse. Unfortunately, my heart seems to break through almost any beta blocker eventually. My SVT/Atrial Tachycardia has broken through Propranolol, Metoprolol, and Sotalol. So it is not a surprise to me that I would have to increase the dosage. My challenge is that the dose I need to stop the SVT makes me incapacitatingly dizzy.

If we cannot get it ablated, Tikosyn is the only thing left according to my EP. Will be anxious to hear what Natale SATs tomorrow.