Has anyone weaned off multaq after 15 days?

Hello @bama921, I combined your discussion with your first discussion on weaning off of multaq, "Has anyone weaned off multaq after 15 days?" - https://connect.mayoclinic.org/discussion/has-anyone-weaned-off-multaq-after-15-days/ so members could see your update.

@bama921 what kind of reactions have you had after stopping Multaq?
I was on it for 2 months and stopped. Since stopping, I have been in & out of Afib. My heart rate is higher than it ever has been when I’m not in Afib even.

I also took it for 2 months and stopped. I asked mu EP and he said I could just stop. Since stopping, I am in and out of Afib and my HR is higher. Did you have any effects after stopping?

I took Multaq for a couple months. Then had PFA ablation and Watchman implant. Couple weeks into blanking had a couple short AFib episodes and took Multaq (1/day) for a week or two then stopped. No side effects noted due to that. Everyone is different of course.

Why did you stop the Multaq? Did circumstances change?

Hope you're feeling better.

@jtrasper I could not tolerate Multaq. I had diarrhea and when that subsided, I became fatigued and lethargic almost all day. Then the week before I stopped, I went into Afib. I asked my ep is I could stop and he said yes. I have had Afib on and off since stopping 3 weeks ago. I don’t know if this is going to stop on its own.

@loswalt0525 Chances are that it will only get worse. It's a progressive disorder, unfortunately, and for most people it progresses to permanent, full-time, AF. This is when the heart is most vulnerable to morphological changes that affect its function and efficiency. Right now, today, is the best your heart will ever be going forward. I would urge you to very carefully research 'catheter ablation' and consult an electrophysiologist about having that procedure. It is the 'gold standard of care' for AF patients. The treatments, all of them, lose efficacy as your heart progresses toward more advanced forms of AF. So, my urgent advice is for you to learn about catheter ablation, if you haven't yet, and then to seek the services of a good EP.

@gloaming thank you for that advice. I have had a PFA ablation 6 months after I first got Afib. It helped a lot but I still had Afib 8-14% of one week out of a month. My EP wanted me to either have another ablation or start Multaq so I did. Now, that Multaq was not tolerated and had to be stopped, I had 44% Afib last week. I told the EP I would do another ablation instead of dofetilide. That’s the only other medicine I am a candidate for. He told me I could take amiodarone 200 mg daily until the ablation. After talking to him, I decided I don’t want to take amiodarone. If my Apple Watch shows less percent of Afib this week than last, I want to wait it out and not take amiodarone. What would you do? I was going to try to talk to my EP again but they are all busy. Lots of Afib and not a lot of Electrophysiologists. The ablation is probably a few months out.

@loswalt0525 Thanks for your reply. Firstly, I have been on amiodarone. My first PVI failed. I was in the local ER six days after the procedure with a chaotic heart rhythm. My attending actually managed to get ahold of my EP, they talked, and they agreed that amiodarone was it. So, against my druthers, I reluctantly agreed to trial it. It worked well and converted my rhythm during sleep that night (loading dose of 400 mg BID for one week, followed by 200 mg BID until the expected taper at 5 weeks). I knew what amiodarone was and its reputation and potential problems, and voiced them to the internist, but he said it was the right choice, big hammer and all. Fortunately, I didn't suffer any effects. I WAS grateful to finally be off it, as you must understand by now. Then, AF breakthrough two months later and the EP agreed to try again. Second attempt has me in reliable NSR for 3.5 years to date.

Symptoms are the biggie. If they don't seriously degrade your QOL, and you can stomach the odd episode when it comes (and ideally, goes...), then you don't really need an AAR like Tikosyn. (Requires hospital admission for 2/3 days while they load you). You have no experience, apparently, with either flecainide or propafenone, but they may work for you, especially with a prescribed 'PIP' protocol, or pill-in-pocket, to be taken when you want help to bust a new episode. Lots of patients exist, and do well, indefinitely that way....years.

Have you experimented with magnesium supplementation? It might be worth a careful trial. By careful I mean you wouldn't want to be silly and ingest two or three grams of the stuff, especially the citrate formulation which WILL cause gastric upset and very loose stools....really loose. But maybe a 200 mg capsule every other day after a day's loading of 400 mg? This is not advice, just getting you to think of other potentialities that you might wish to learn about, ponder, and then to trial. You should probably run it past your family doctor or a cardiologist first. I doubt they'd disagree.

What would I do, you ask. I was symptomatic. Fortunately, my heart gave up and went to bed at the same time I did, and this was 100% reliable every single night until my second ablation...within three/four minutes I would find my heart in NSR and it was good for the night. A blessing, I know....trust me. But, when conscious and doing things during the day, I was anxious and unsettled, and I felt weird in my chest. It did begin to affect me. Friends told me I looked grey. Oddly, an AAR was never offered to me. My cardiologist just put me on a statin (he suspected ischemia), a DOAC (apixaban, to minimize risk of stroke when fibrillating), and on metoprolol to nub my typical 135-180 HR when fibrillating. Further, my episodes were infrequent....two, three a month at most, and they self-limited inside of a few hours. It was when they went five/six hours that I sought relief at the ER, which was only to monitor and to give me a bolus with yet more metoprolol. I went home at least twice with a prescription for a shrug and told to wait it out. I reverted to NSR every time, usually within another hour or two....probably due to the increase metoprolol.

This is getting long....sorry, I'm windy. Last thing...you say you're in AF lots. That's not great. It runs a higher risk of morphological changes, damaging ones, to your heart's substrate and to the valves, not to mention LA thickening or 'enlargement', which is normally something they measure with advanced AF patients. The greater the enlargement, the more unlikely an ablation is to stop your fibrillation. The greater the enlargement, the higher probability of mitral valve problems....which nobody wants. So, do get in line for a re-do if you can, and hope it works. That you are still in AF after an index ablation, doesn't matter what method was used, means you were not fully ablated, or that your heart is finding new pathways to take over the atrium's rhythm....meaning it's progressing. A successful ablation slows the progression almost to zero, at least for a few years.....if done right.