Our newest patient A-Fib story is told by a retired nurse from Arizona. (Coincidently, her husband had A-Fib, too.) Both are now A-Fib free. Her story begins in an all too familiar way.
I Woke at 2 AM with an Urgent Need to Urinate
My first episode started in September 2006 when I woke up at 2 AM with an urgent need to urinate. My heart was beating so hard that I thought it would come out of my chest. My pulse was irregular, I had chest pain and was dizzy. I was anxious and scared. At the emergency room, just before I was scheduled for a cardioversion, to my great relief, I went back into sinus rhythm.
I was discharged with a ‘pill-in-a-pocket’, Flecainide 100 mg, if I got another episode. I thought I would be free from other episodes. But 10 months later I woke up at 1 AM again with an urgent need to urinate. My heart was beating out of my chest and my pulse was over 130 per minute.
But this time I took Flecainide 100 mg and was back in sinus rhythm at 2:15 AM with a pulse of 68.
My cardiologist instructed me to eat salty foods such as chips and nuts while in A-Fib
Why Did I Urinate 10-15 During an A-Fib Episode?
As my A-Fib became more frequent, I wanted to know why I urinated so many times (10-15) during an A-Fib episode. Apparently, when in A-Fib, the “atrial natriuretic peptide hormone” in the atria kicks in and acts as a diuretic to lower the blood pressure and regulate the calcium and salt in the body.
My cardiologist instructed me to eat salty foods such as chips and nuts while in A-Fib and drink plenty of water so as not to get dehydrated. I was also told that my A-Fib episodes were vagal… .
To read more of Lise’ A-Fib story and how she beat her A-Fib for more than three years, go to: Retired Nurse: Over 3 Years A-Fib Free (Husband Had A-Fib, Too).
A-Fib Patient Story #78
By Jeff Patten, Ashby, MA, January 2015
My A-Fib started about fifteen years ago.
That warm September day in 2000, I was tired, had a lot of coffee and was trying to finish a heavy shrub transplanting job. Sweating and breathing heavily, I noticed my heart was not doing what it should.
Alarming! Dehydration?? A couple of hours in ER and it normalized on its own.
After a couple more brief episodes, I decided to get back in better shape – slowly and judiciously! I’d always been active and couldn’t understand why the ole’ ticker was failing me now. They called it lone paroxysmal atrial fibrillation, so there was nothing else wrong.
Flecainide “Pill-In-The-Pocket,” Propafenone, Then CryoBalloon Ablation
The next decade saw no more episodes.
Then, in 2010, my father-in-law died. The recipe of emotional upset, high summer heat, stress (there was a lot of heavy “estate” to handle), and―as they tell me―accumulated age put me back on the A-Fib merry-go-’round.
My A-Fib was very symptomatic with erratic chest pounding, weakness and breathlessness. I took Life easier, and the A-Fib eased―until that autumn’s bout with appendicitis!
My EP put me on flecainide as a pill-in-the-pocket. That seemed to work for a while―until it didn’t
In December 2012, I had a pulmonary vein isolation (PVI). My EP used the newly approved CryoBalloon catheter.
Recovery: A-Fib free, but Pradaxa “Alimentary Torture” and Burning Diarrhea, Switch to Xarelto
After my ablation, I was put on a double dose of the proton pump inhibitor omeprazole (Prilosec), which is done on the theory it will help prevent the very unusual but deadly side effect of PVI known as atrioesophageal fistula by reducing erosive inflammation.
Since my INR numbers on warfarin were hard to control and there was concern about warfarin’s deleterious effect on vascular calcium through its action on vitamin K, I was put on dabigatran (Pradaxa) as an alternative.
Pradaxa comes in a special container to control moisture. The pills must be tossed if not used in four months once opened. They are awkwardly large. They must be taken twice a day. They are formulated with tartaric acid to help absorption. Everyone who takes Pradaxa must contend with all this.
Pradaxa was alimentary torture. Burned on the way down. Burned in my stomach and belly. Burned with diarrhea on the way out.
After six days I called for help and was switched to rivaroxaban (Xarelto). This is a small pill. Tiny, really. No particular moisture issues. No unusual expiration. Once a day. No burning. But the diarrhea continued for more than a couple of months.
Lymphocytic Colitis: From Taking Omeprazole (Prilosec) and/or Pradaxa?
As soon as my ablation was deemed ‘successful’, meaning that I was able to come off my doses of propafenone and Xarelto and omeprazole, I had a colonoscopy to check out the continuing diarrhea.
Diagnosis: lymphocytic colitis. I did a bit of research on this and discovered that very little is conclusively known about this increasing public problem. It is understood that there is an association between this colitis and the use of proton pump inhibitors among other meds such as non-steroidal anti-inflammatories. The diarrhea gradually subsided.
This Pradaxa/omeprazole story is one anecdote. No scientific conclusions can be drawn. I know what I personally conclude about it, however!
Ectopic Beats Turn into Flutter, RF Ablation
The ectopic beats following the ablation got worse.
PACs and PVCs are supposed to be normal and benign. Sometimes mine seemed to string themselves together for a bit. Then in July 2013, they didn’t quit. A heart rate of 130 at rest sent me to the E.R. where I got a diagnosis of atrial flutter, a successful cardioversion, and an appointment for another ablation.
An ablation in August addressed three flutter ‘circuits’. Careful electrical mapping was used this time, and RF-energy was used to break the ‘circuits’. Apparently flutter such as this often follows on the heels of an A-Fib ablation. Not fully understood. Yet.
So far, so good. I’ll let you know if anything more of interest happens.
Pradaxa and Stomach Problems: It’s unfortunately not unusual to experience the intestinal tract problems Jeff had when taking Pradaxa. Pradaxa’s own fact sheet states the common side effects of Pradaxa include:
• Indigestion, Upset Stomach, or Burning
• Stomach Pain
In Pradaxa’s clinical trials, nearly two out of five people (35%) could not tolerate Pradaxa, which is a high rate of adverse reactions. In an earlier post I wrote “Based on the clinical trial data, there is a danger that Pradaxa over time may cause long-term damage to the gastrointestinal system.” (See The New Anticoagulants [NOACs], 2013 Boston Atrial Fibrillation Symposium). This may be what happened to Jeff when he developed lymphocytic colitis, but we can’t say this for sure.
It’s unusual to be put on a double dose of omeprazole (Prilosec).
Switch from Pradaxa to Eliquis or Go Back to Warfarin: I’d recommend to anyone taking Pradaxa to switch to a different anticoagulant or go back to warfarin if it worked for you. Not only is Pradaxa associated with intestinal tract problems, but it’s been associated with people bleeding to death in the ER. There’s no reversal agent or antidote for Pradaxa as there is for warfarin. (See Stop Prescribing or Taking Pradaxa). Eliquis tested better than the other new anticoagulants and is safer.
With the new anticoagulants (NOACs) now available, no one probably should be taking warfarin anymore. Warfarin produces arterial calcification, and also puts patients at increased risk of osteoporosis and bone fractures. (See Stop Taking Warfarin [Coumadin]!!! Switch to Eliquis [Apixaban].)
Flutter after A-Fib ablation: Many EPs include a Flutter ablation along with an A-Fib PVI. It’s relatively easy to do compared to a left atrium PVI and only adds around 10 minutes to the ablation procedure. It involves making an ablation line in the right atrium (Caviotricuspid Isthmus line) either before or after entering the left atrium. But other EPs are reluctant to make any ablation burns in the heart that aren’t medically necessary. If someone isn’t in right atrium flutter, they wouldn’t do a Flutter ablation. (Personally if I had a choice, I’d ask the EP to do a right atrium Flutter ablation as long as they were already ablating inside my heart anyway.)
However, Jeff had three Flutter circuits which probably meant that some of these Flutter circuits did come from the left atrium. Flutter can develop after an A-Fib ablation or be found later after the inflammation of the ablation scarring settles down. That’s why Jeff needed a second ablation which was RF rather than CryoBalloon.
Oct 2015: FDA Aproves Reversal Agent Praxbind® for the Anticoagulant Pradaxa
The FDA granted “accelerated approval” to Praxbind®, a reversal agent (antidote) to Pradaxa®. Praxbind is given intravenously to patients who have uncontrolled bleeding or require emergency surgery.
If you find any errors on this page, email us. Y Last updated: Sunday, July 17, 2016
Atrial Fibrillation patients often search for unbiased information and guidance about medicines and drug therapy treatments. These are answers to the most frequently asked questions by patients and their families. (Click on the question to jump to the answer.)
11. “I am on Coumadin (warfarin) to thin my blood and prevent A-Fib blood clots. Do I now need to avoid foods with Vitamin K which would interfere with the blood thinning effects of Coumadin?” UPDATED
12. “The A-Fib.com web site claims that an A-Fib stroke is often worse than other causes of stroke. Why is that? If a clot causes a stroke, what difference does it make if it comes from A-Fib or other causes? Isn’t the damage the same?“
16. “I have to be on aspirin for stroke prevention. Which is better—the low-dose baby aspirin (81 mg) or a high dose (325 mg)? Should I take the immediate-release (uncoated) or the enteric-coated aspirin?”
17. “I don’t want to be on blood thinners for the rest of my life. I’ve had a successful catheter ablation and am no longer in A-Fib. But my doctor says I need to be on a blood thinner. I’ve been told that, even after a successful catheter ablation, I could still have “silent” A-Fib—A-Fib episodes that I’m not aware of. Is there anything I can do to get off of blood thinners?“
21. “I”ve read about a new anticoagulant, edoxaban, as an alternative to warfarin (Coumadin) for reducing risk of stroke. For A-Fib patients, how does it compare to warfarin? Should I consider edoxaban instead of the other NOACs?”
Last updated: Wednesday, May 25, 2016
2. “Is the “Pill-In-The-Pocket” treatment a cure for A-Fib? When should it be used?”
The “Pill-In-The-Pocket” treatment refers to taking an antiarrhythmic med at the time of an A-Fib attack.
One approach is to take 100 mg of flecainide up to three times at 20 minute intervals to stop or shorten an A-Fib episode.
Another approach is to take Rythmol 300 mg and Inderal 20 mg, wait three hours, then take Inderal 20 mg, wait three hours, then take Rythmol 300 mg and Inderal 20 mg again. (Other meds and dosages are used depending on the needs of the patient).
Another variation of the “Pill-In-The-Pocket” treatment is to take an antiarrhythmic med on a regular basis, then take a higher dose at the time of an A-Fib attack. A-Fib patient, Reg, writes he takes 300 mg of flecainide, and 2 hours later goes back into SR. He normally is on a loading dose of flecainide 100 mg in the morning and 50 mg in the afternoon.
However, not everyone can tolerate antiarrhythmic meds on a regular basis. The “Pill-In-The-Pocket” treatment is an excellent, welcome option for A-Fib patients who feel bad when taking antiarrhythmic meds every day.
(When the author had A-Fib, he never tried the “Pill-In-The-Pocket” treatment. He welcomes comments and corrections to this opinion.)
The “Pill-In-The-Pocket” treatment should probably not be considered a “cure” for A-Fib, but more of a help to get one out of or shorten an A-Fib attack. For more, go to our Treatments page and look for “Pill-in-the-Pocket”. Read about two different approaches in Marilyn Shook’s personal experience story: “Pill-In-The-Pocket” Approaches—Both Turn To Catheter Ablation For A Cure.
In my opinion, the ideal use of an antiarrhythmic med is to take it on a regular basis to keep one from having an A-Fib attack. Taking an antiarrhythmic med only when one has an A-Fib attack is like trying to put out a fire after it has started. From a patient’s perspective, it’s better to keep A-Fib from starting in the first place—to be proactive rather than reactive.
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