Has anyone figured out what technique works best to stop AFib episodes

Posted by zeke2u @zeke2u, Dec 1 7:18am

I'm 68 and had a MI last year. Ever since then I get recurring AFib episodes which can last anywhere from 1/2hr to 6hrs. Most episodes happen when I'm sleeping or laying down. Coughing seems to work the best to stop the episodes but not always.

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windyshores | @windyshores | Dec 3 5:52am

deleted due to mysterious duplicate post!

windyshores | @windyshores | Dec 3 5:56am

Just want to say again, that medications and ablations are crucial for many but as I have written before, identifying and addressing triggers can, at the very least, mitigate progression.

That has been my experience and the "Afib Cure" book by Day and Bunch is a good resource for this approach. Not sure the word "cure" is appropriate but "Afib Mitigation" isn't a very catchy title!

Some of us do avoid or get off meds but those who remain on meds or have ablations can benefit from dealing with triggers as well.

mikereed1946 | @mikereed1946 | Dec 3 12:59pm

In reply to @yaya77066 "I'm on Flecainide but only started last February. I didn't know it had a work/life span." + (show)

All I know is that a former cardiologist told me that it might not be effective down the road, so I might need to change to a different medication if and when that happens. That was nearly 20 years ago, and I'm still on flecainide .

eileen11108 | @eileen11108 | Dec 3 4:50pm

I was given 25 mg Metoprolol Tartrate. I was able to take 1 tablet 2 times a day if I was in AFib. When I had episodes they usually lasted no longer than two hours. I would take one of these pills and relax in my recliner. They really help me.

Best wishes, Eileen

zeke2u | @zeke2u | Dec 3 6:02pm

Yep I’m on Metoprolol

yaya77066 | @yaya77066 | Dec 3 9:04pm

In reply to @mikereed1946 "All I know is that a former cardiologist told me that it might not be effective..." + (show)

Thank you. I was 77 when I started on it. Maybe I will have passed on by then and won't need to worry about it. I hope all stays well with you and your health.

yaya77066 | @yaya77066 | Dec 6 12:17am

In reply to @gloaming "Cardiac arrhythmias tend to progress, or to evolve into something less manageable. I use the term..." + (show)

@gloaming

Cardiac arrhythmias tend to progress, or to evolve into something less manageable. I use the term 'intractable', meaning the same thing, not easily controlled or dealt with. Because they tend to progress, especially atrial fibrillation (AF), it is always best to deal with it firmly and early. You either are willing to take anti-arrhythmic...AND....rate control medication when in AF in order to keep the rate at or below 100 BPM ideally, or you take a mechanical remediation (NOT a CURE!!, just a control measure that is done electrically, not by medication), which is catheter ablation. There are several ways to perform the ablative procedure, and they're improving on them all the time.

If you control the progression of fibrosis (which is a changing structure inside the atrium endothelial lining and below that into the muscle itself), which begets 'remodeling' of the substrate of the myocardium, you can take drugs for a very long time...in some cases. Many patients find, though, that they eventually need an upped dosage of the same drug, or that they quickly lose ground and must be placed on another drug, often a more potent drug like amiodarone (which you should only take when all else fails and you still want to live for as long as possible. You can do your own googling of 'amiodarone' and read up on it for yourself. In case you become dismayed, I was on it for ten weeks two years ago out of necessity. I'm still here..., and so are scores of others who have been on it for years. Every patient is an individual case, and that includes tolerance to flecainide, Tikosyn, Multaq, Sotalol, propafenone, and the various beta and calcium channel blockers.

So, that's a long way of addressing your question, and it can be summed up like this: many, most, cases of cardiac arrythmia, but especially when unmanaged, will tend to get worse over time. This can come about even with pretty solid control using drugs. Happened to me, and it has happened to thousands of others. I finally realized that only an ablation was going to rid me of the accursed AF and its awful symptoms. Unfortunately, even ablations can lose ground to the heart which is always looking to effect the electrical disorder somewhere else from where the ablation lesions were made during the last ablation. IOW, even ablations might need to be touched up in time, maybe six months, maybe six years. Some never have to have another ablation. I'm just past two years free of arrhythmia, but it took two ablations to rid me of it.

I have said a lot. I can get windy, sorry, but if you need further information, please do consider doing a google search with 'atrial fibrillation and management' or something like that. Or, 'anti-arrhythmic drugs and side effects', or even 'duration of efficacy of various anti-arrhythmic drugs'.

Jump to this post

When I had my 1 and only A-fib attack I was taken to the hospital by ambulance and started on Flecainide. I don't miss a dose and will be on it for life or until my cardiologist thinks a change is necessary way down the road. He's been my cardiologist for 20 years when I only needed an annul check up.
He is the top rated cardio in Houston. No need to worry there, plus I have a great endocrinologist because Long Covid blew out my thyroid. I have enviable medical care. My heart rate has remained steady at 60 beats per minute since my release from the hospital 9 months ago. I had a heart monitor for 7 days and have my heart rate checked monthly.
My only concern was knowing that Flecainide has a lifespan, but it should not be a problem. I don't expect or want to be around at 98.

windyshores | @windyshores | Dec 6 6:50am

In reply to @yaya77066 "When I had my 1 and only A-fib attack I was taken to the hospital by..." + (show)

@yaya77066 I am surprised you were put on flecainide after only one afib attack. I have afib once a year or two with heart rate close to 200, and am still not on any meds other than "pill in a pocket" approach. Are you also on a blood thinner? Are you medicated because of other risk factors?

gloaming | @gloaming | Dec 6 10:00am

In reply to @yaya77066 "When I had my 1 and only A-fib attack I was taken to the hospital by..." + (show)

yaya77066, my own cardiologist, when I finally got to see him three months after my first episode of AF, in which I got myself to the ER and was diagnosed as paroxysmal (because mine reverted to normal sinus rhythm (NSR) shortly after they hooked me up to an ECG), told me I would be on both Eliquis (apixaban, a newer Direct Oral Anti-Coagulant, or DOAC) for life. He prescribed only metoprolol tartrate at 12.5 mg BID, so a single 25 mg tablet broken at the score into halves, and each half taken 12 hours apart. He didn't say it was for life, and nor did he put me on an anti-arrhythmic. I have only ever had amiodarone, an anti-arrhythmic, and it's a scary episode thankfully in my past.

I'm not a health specialist. I don't know your particular case and circumstances. I can't say why this vaunted cardiologist you speak of wants you on Flecainide for life...seems a bit aggressive to me, but I don't have all his/her experience. As windyshores says, often, especially if it is initially quite responsive to medication and becomes stable, you only need an anti-arrhythmic episodically...when you actually enter AF...and need some quick relief. It's known as pill-in-pocket or PIP. Literally, you keep a prescribed (!) dose tablet in your wallet/purse, and if you're looking at your credit card statement after Christmas shopping, and you're halfway through a burger at the eating area for a break, and your heart lurches into AF, that's when you wash the single pill down with a quick gulp of Coke or coffee and it will begin to work, ideally, within about 20-40 minutes.

I may have misunderstood what you meant by 'lifespan.' You needn't be on an anti-arrhythmic for life if you have an ablation that successfully rids you of the arrythmia, for example, and the drug has a shelf life, if that's what you mean, of at least one full year, but I'd bet if it's kept sealed and out of a bathroom, probably two full years. Or, if you mean the metabolic 'bioavailability', or what is commonly called half-life, I'd have to look that up for Flecainide, but my guess is between 5 ands 8 hours? You can google 'half-live of flecainide' and you should get three or four hits that way.

yaya77066 | @yaya77066 | Dec 7 12:44am

In reply to @windyshores "@yaya77066 I am surprised you were put on flecainide after only one afib attack. I have..." + (show)

Prior to COVID I always had MVP and was born with an erratic heart beat that showed up on the EKG on rare occasions. Cardiologist decided not to medicate because I'd gone 57 years without a problem. After A-Fib showed up as my start of Long Covid it then because necessary to put me on meds.
He's always keep a close watch on my and periodically I had to wear a heart monitor for a week at a time to be sure everything was normal for me, not anyone else he personally encountered.

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