Medications thoughts and next steps

So I am 9 months post ablation and have been AFIB free for a while now. I have another appointment with my EP next week. I am still having a lot of PACs that I can somewhat control with supplements, but not always. They are annoying, but not really debilitating. They last from a couple of hours to about 5 days at a time. I am currently taking 240 mg Diltiazem CD x1, 3.125 mg Carvedilol x2, Multaq 400 mg x2 and 5 mg Eliquis x2.

I would like to get off of some of the medication and/or maybe find something else that might control the PACs better.

What I am trying to do is work out a list of questions to ask.

Do I need to take the Multaq? Since I am having PACs while on it.
Do I need to take the Eliquis? I don't mind it and will take it to prevent a stroke.
Anything that might work better or in conjunction with Diltiazem? It does make me sleepy at times.

Any other questions I should, I ask? Any input on the medications or thoughts on what I could try to change to? I know we are not doctors, just looking to gather some input from the collective here and learn some more while I am at it.

As far as the Eliquis goes, your EP won't recommend stopping that unless your CHADS-Vasc score is 0 or 1. They might even not recommend it for a score of 1. Personally, I wouldn't even ask about that if I were you. I'd just continue it.

After 9 months I don't know why you're even on all the other stuff. I'd say it's time to find out if the ablation truly was successful and stop the Multaq, diltiazem, and Carvedilol. I expect your EP will probably go along with that.

I was ready to stop the medications a while ago. I think there was confusion over the PACs and AFIB so it was continued. Probably my fault at the time, I was in persistent AFIB prior to the ablation for several years and thought it had returned. I finally bought a smartwatch (my EP suggestion) to monitor what was going on. Since February, I haven't had any AFIB and have only had PACs. My thought is to come off the medications except the carvedilol (it helps with my blood pressure) and just find something that can help with PACs when they get too intense or continue for days.

I don't mind taking medications, but I don't think I need to take them all the time right now. I can go either way with the Eliquis, but I think I would prefer to stay on it a while longer.

Sure, if the Carvedilol is for hypertension then by all means continue it. But the Multaq and diltiazem don't seem to serve any purpose.

I can't see why you would need to continue them. I tried Multaq for the PACs/SVT and didn't have much effect. For me, if a med wasn't stopping the arrhythmia, we didn't continue it. That was the whole point. So if no benefit, then no med. I would definitely check into that.

I am in agreement, it doesn't seem to be doing much right now. I think its time has come and gone for now. Like Carey said, it's time to see how well the ablation actually worked.

My perspective is that I want to know if any intervention, medication or mechanical, has the desired outcome. Clouding the assessment with other medications doesn't sound like an efficient way to assess the outcome. For example, the Holter Monitor at 10 weeks or thereabouts: what could it tell us about one's ablation if the person is still on an anti-arrhythmic drug of some description? And not apparently in any difficulty? I would much rather be off all but life-saving DOAC and maybe a statin if absolutely necessary, but nothing that is designed to improve heart electrical function.

I am in agreement as well, if the medications aren't preventing anything, I don't think I need to be on them. Of course, if things go to crap, then I will be happy to take them and work on a new plan. Currently, I am only having PACs and while not comfortable, I can deal with them and work with supplements to keep them more or less in check. I may sit down with a nutritionist and work up a better diet plan, so I get more of what I need, without supplements.

Well, I got the answer to my question earlier than planned. I am now taking this medication for PACs and PVCs.
Propafenone 225mg x2
Diltiazem cd 120mg x2
Eliquis 5mg x2

This is were I ended up after 24 hour in the hospital for my heart rate dropping to 30 and going up to 100. I have an appointment on Friday to see if we need to change anything.

Curious. I am to start Propafenone tomorrow for my 25% burden of PACs and Inappropriate Sinus Tach.

Curious indeed. I wonder how propafenone will work for you. I started out with 225 ER a few months but lowered to 150 mg short-acting twice a day - lots of GI side effects. That worked until last week when I had break through afib which turned into flutter and went back and forth for a bit with rates in the 140 range. So I am now on 150 x 3 while waiting for 325 mg ER to arrive from the mail order pharmacy. On top of everything else long acting propafenone is exorbitant at local pharmacies. GI issues are back but so far it's working to keep me in sinus. Will see how it goes. In my case, PACs and PVCs were tolerable without meds. HR in the 140s not so much.

I'm curious as well, getting ready to take the third dose, so far no PACs or PVCs. I can't say for sure the medication stopped it or not. Mine have have been coming and going for months now. While I have caught an occasional bleep in the 30 to 40 bpm in the past, it has never been as consistent as it was this time.

I know these meds rake time,.but I am.curious. I took the first dose this afternoon, hoping it might dampen my nighttime bigeminy..... No change as of yet.

It took a good 4 to 5 hours for the first dose to do anything for me. I had given up on it when it finally started working. I did have some PVCs this afternoon but just a few. I think there will be another adjustment on Friday, unless he comes up with a better plan. Good luck and try to be patient.

Anyone having problems sleeping while taking propafenone? It might be the change in the other medications, not sure. But I couldn't get to sleep last night. Still wide awake.

I slept terribly last night as well, but that may be from the continued ectopics that were not helped by the Propafenone. Will let you know what happens tonight on Day 2.

I managed about an hour of sleep then got a phone call. But it is enough to recharge a bit. Hopefully I can sleep tonight. Good luck and keep fighting the good fight.

Goodness, I am on Dose 2 of the Propafenone and feel like a train wreck. It hasn't stopped any of the PACs or the tachycardia . And I feel like I've been run over by a truck... I'm exhausted. This is unreal.....

Just read that Wellbutrin and Propafenone are related chemically. Wish I had known that. Took Wellbutrin probably 20 years ago for depression and it made me feel seriously unstable....

I am sorry to hear its not going well. I was feeling pretty bad this morning but I finally got an hour of sleep and doing better now. I think I'm on my 6th dose now. Hopefully it will work out for you.

Thanks. I'm not sure. I'm due for my third dose in a few minutes, but feel icky..... I'll try and see how tonight goes. I know these things take time....

I do understand, I just realized that certain things I drink have a metalic taste now. Hopefully I will get some real sleep tonight, I have a follow up tomorrow and I don't think it is going to fun.

Did you ever get better sleep? I'm up again in the middle of the night....not thinking Propafenone is on my happy list again.....

It has gotten better, but still not good. It seems to be messing with my rythum right now and it is easier to sleep in the afternoon than at night. But on the upside I haven't had any PACs or PVCs. Heart rate is up a few beats but still good. No drops to the 30s or jumps to 190. I guess mostly positive, but if I don't start sleeping more I doubt it will last.

Agreed. I'm not sleeping either. Not sure if it is the propafenone or the bigeminy. Either way, no fun!

I don't know, but I somewhat cheated and took a Meclizine. I was dizzy and nausea but it does make me sleepy for about 30 minutes. It was enough for me to fall asleep and stay that way for a few hours.