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May 02nd, 2016
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I have PAF and use PIP for once a month episodes, my pip is 100mg flecanide, I had conflicting advice from EPs, one said I must take a beta blocker or calcium channel blocker before taking the flecanide to avoid 1-1 conduction and flutter, the other EP said no need to take, I would rather take the flecanide alone, because I have bradycardia, resting heartbeat in 40s and would like to avoid any unpleasant symptoms, I know patients who do that, is it ok to take flecanide alone to convert to nsr?

2016-04-04 Answered By : Dr. Y Madhu Reddy, MD, FACC, FHRS

Answer:We generally recommend taking AV node blockers (beta blockers) or calcium channel blockers with Flecainide even when using it a PIP to prevent the risk of 1:1 conduction. Having said that, if you are having resting bradycardia, and if your heart rates are not in the tachycardia range when you are in Afib, the likelihood of you going into flutter with 1:1 conduction is very low. Since its only PIP approach, it would generally safer to take at least one dose of a low dose, short acting AV node blocker and it should not be impacting your rates for too long.

I have paroxysmal afib and will be undergoing ablation soon. Will I continue on Tikosyn and Eliquis after the procedure?

2016-04-04 Answered By : Dr. Y Madhu Reddy, MD, FACC, FHRS

Answer:Typically yes for the first 2-3 months. Immediately post ablation, due to irritability of the heart, pts tend to have atrial arrhtymias which may or may not mean a whole lot in the long term. So we generally continue antiarrhythmics (Tikosyn) in your case for at least 2-3 months. After that based on how you do, we generally discontinue it. Eliquis is typically continued for the first 4-6 months. Long term Eliquis would be based on you stroke risk as defined by CHADS2Vasc or CHADS2 score.

I am a 65 y/o male diagnosed with Afib 2 weeks ago after visiting a local ER. I am very active and have long history of athletics. I played D-1 college basketball, ride bikes, snow ski, etc. I had not been sleeping well for 2-3 nights and after my routine 3Xper week mile swim I went to ER. Diagnosis of Afib, treated with Metoprolol 50mg qd and Eliquis 5m qd. I went home after the ER visit and saw a Cardiologist the next day. 3 days later I had an Echo and although I don\'t have the exact report available the Cardiologist said my heart was very strong and all my valves were good. The left atria was enlarged. I am waiting 3 weeks to have a Cardioversion. I have lots of anxiety and uncomfortable feelings in stomach and can feel irregular beats. I hate the Metoprolol side effects. My pulse has been in the 60-80 BPM range and blood pressures in the 110-130 /60-80 range. Not sure I am comfortable with the Cardiologist I saw but he could be ok. He left on a scheduled vacation the week after I saw him. I am scheduled for office visit in a week and then cardioversion the next day. Any advice would really be appreciated this problem really has me worried. Thank you, Ken Krell

2016-04-04 Answered By : Dr. Y Madhu Reddy, MD, FACC, FHRS

Answer:Im sorry about how you are feeling. AFib is the most common arrhythmia and athletes have a slightly higher risk of having it. You clearly have symptoms from Afib. Your cardiologist did what we normally do for evaluation and treatment. Typical management includes short term and long term. For short term we recommend cardioversion. But since you may have a blood clot in your atrium, we do one of the 2 things. 1) we anticoagulate for 3 weeks and consider outpatient cardioversion. 2) We can consider TEE (ultrasound through the food pipe; an invasive procedure like an upper GI endoscopy) and cardioversion to make sure you do not have a blood clot. This can be done sooner than 3 weeks. Long term management would be based on how enlarged your atrium is and how likely you will have recurrent AFib. If your LA is enlarged, you are at a higher risk to have it again and may benefit from anti-arrhythmics which you have to be for long term (to decrease recurrent AFib). Other option is to consider AFib ablation. Sometimes this can be considered prior to failing any arrhythmic drugs also. However the risk benefit supports the procedure only if you have recurrent symptomatic AFib. Discuss with your cardiologist the long term options for your Afib.

I have about 2 episodes of Afib per month. Each time I have polyuria with the episodes. My doctor says its due to Naturetic proteins. What can I do to stop the Polyuria? It is dehydrating me.

2016-04-04 Answered By : Dr. Y Madhu Reddy, MD, FACC, FHRS

Answer:Typically its does not dehydrate you. Its a natural response to you going into AFib. Afib increases pressure in your hearts upper chambers (atria) which releases hormones controlling the fluid levels in your body/blood vessels (called atrial naturetic peptide) and as a result you end up urinating more. Generally you urinate the extra fluid you retained when you go into Afib. So you are less likely that you are getting dehydrated. Its how your body controls fluid retention.

Good morning sir. My mom having atrial fibrillation,now she in hospital.How she will be ok, thanks for your time.

2016-01-04 Answered By : Dr. Sacha P. Salzberg, MD, PhD

Answer:with this information i cant help you.

I am 50 years old female.In past 20 years had food poisoning twice, both times experienced vomiting. Become irregular heart rate and per a minute up to 230 beats, irregular beats and also pace(230). I have been converted with adenosine.Is this increase of AFib?

2016-01-04 Answered By : Dr. Sacha P. Salzberg, MD, PhD

Answer:I need more information to help you.

I had a silent heart attack. For 6 years have been on Atenolol Now develloped Atrial Fibrillation,i do not get a stroke? How to control this. Am carpenter, retired in 1985. We live in San Jose I do use a sleep Apnea machine at every night.

2016-01-04 Answered By : Dr. Sacha P. Salzberg, MD, PhD

Answer:As long as you take your anticoagulation you will be protected from a Stroke.

i have a beta blocker but still speeds up my heart beats and misses beats.why my doctor do not have clue

2016-01-04 Answered By : Dr. Sacha P. Salzberg, MD, PhD

Answer:a 24h Holter will provide your doctor with more information

my mom heart beat reaches 120 every day she has atrial fibirllition and her Dr keeps admitting her to the hospital and he trying so many bills on her but when she goes home it goes up again.No one know to me am affried that he will die by a strock

2016-01-04 Answered By : Dr. Sacha P. Salzberg, MD, PhD

Answer:if she takes her anticoagulation she will be protected froma stroke. Ask your doctor.

Which US hospitals are considered experienced atrial ablation centers?

2016-01-01 Answered By : Dr. Sacha P. Salzberg, MD, PhD

Answer:sorry i can only give you advice on european centers. but the website http://www.stopafib.org/ has all relevant informations. Best of Luck!

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