Metoprolol, Diltiazem, AND propafenone for PACs after SVT ablation?
Hi everyone! I’m new here. 26 year old female. I have a pressing question. Has anyone been prescribed Diltiazem 120 mg, metoprolol 50 mg, AND propafenone 150 mg x2 for PACs and sinus tachycardia after an ablation for SVT?
I had my ablation done not too long ago, July 2025, and have been having frequent PACs since then. At first I was only taking Diltiazem 120 mg once a day but was having bad side effects so they reduced it to 60 mg once a day. Well my PACs got so bad I ended up in the hospital again. In the hospital they changed my meds up and put me on Flecainide 50 mg twice a day and 120 mg of Diltiazem again. A few days after starting the Flecainide, it had started causing me to have increased PACs and a higher heart rate for at least an hour after I would take it. So the doctor is now attempting to put me on Diltiazem, metoprolol and Propafenone to try to control the PACs. It seems a little too intense of a route to take with medication to me for PACs and sinus tach and I am very anxious to take this combination. I am wondering if anyone else has taken this combination before and their experience with it?
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Wow. Welcome Brittiny,
I have a short window of opportunity to respond. I wish I could give you some newsworthy advice, but, your cardiologist or electrophysiologist is your best bet. My cardiac ablation was 2 years ago. My experience was that I was able to stop Multaq and Amiodarone but now having SVT'S and PCVS. The 2 drugs metoprolol and Diltiazem were unsuccessful as they seriously dropped my BP. The cardiologist says that going back on Amiodarone is my only option. I am deciding against it as the drug has side effects that I can't compromise myself with. But, in the past Amiodarone was a life saving drug for me years ago, twice over. 2 cardioembolic strokes and CAD along with mitral prolapse regurgitationetc etc etc. Lol... doing well but I hope you can get some helpful answers or at least good questions you can ask your doctors. Be well-! Keep posting!
I'm somewhat surprised they didn't just put you on amiodarone, even if just for a few weeks, to let your heart calm. I had an index ablation and was in hospital six days later with a crazy arrhythmia. The attending internist actually got ahold of my EP and the two agreed between them that I would probably be best if placed on The Big Hammer. It worked very quickly, after one 400 mg dose, over night. But, I needed to continue another five days of 'loading' at 800 mg per day. Metoprolol was immediately stopped. Cold.
Your EP must know what she/he is doing. You're a unique case, and it must be that what you are now taking is right for you. If you feel unwell, and not just bummed because of the turn of events, then let them know. Your most recent ECG and other tests should tell them, and ultimately you, if you are responding appropriately.
The diltiazem has weak anti-arrhythmic properties, but the propafenone would complement it and the two appear to want to work in concert. I'm not in the health professions, so I don't know why metoprolol and diltiazem would be prescribed at the same time unless the EP wants you blocked for both beta-adrenergic and calcium channel at the same time...just for insurance..?
The team looking after you must have figured this out. Personally, I roll my eyes at any prescription, but at my age, and my lack of medical learning, I take their prescription. It's my responsibility to make it clear to them if I begin to go downhill.
There is another drug called Tikosyn (dronedarone) that is the second biggest hammer after amiodarone. It must be started under supervision, including a hospital stay for at least two days and nights. The reason, just like flecainide, is that it can sometimes cause adverse reactions, quite serious apparently. Not in my experience base, just what I have read and seen people post about anecdotally. Tikosyn may have been discussed for you, or maybe it works the wrong way for your particular heart condition.
One caution about the diltiazem and metoprolol combo: keep a sharp eye on your BP and heart rate. Some people are asked to remain on metoprolol, as an example, for a few weeks after an ablation to help the heart to beat more calmly, not as fast or as strong as it may want to given its irritated state. They find that they get dizzy when they're in normal sinus rhythm (NSR) and their pulse has gone way down, under 40 BPM. This is potentially dangerous. I'm must passing this on for you to be careful and to let your care givers know immediately if you start fainting, falling, blacking out, getting short of breath, tingly feeling on your scalp or the back of your neck...anything unusual.
Just diltiazem