Bad start on Propafenone - PVC's ? (Ronnie R U there?)

[Guest guest]

Started on Propafenone (Rhythmol / Arhythmol) on Friday 1:00 p.m. after

2 weeks in AF. After 3 pills (by Sat 10:00 am) I converted but after a

further few hours I was throwing ectopics, which got worse with time. I

got / am getting the 1-2-3-THUMP I got with Flecainide (1-2-3 = more or

less normal NSR beats).

After 5 x 150 mg pills (2 Friday, 3 Saturday) (start dose = 3 x 150/day)

this last night has been really bad - the THUMPs are really heavy and I

woke up at 2 am and have not got back to sleep. I've also got other bad

side effects - really dry mouth & nasty taste, and have to stay near a

toilet (already!). I think this drug is disagreeing with me!

Anyhow : to the question:

The thumps feel different to the mild thumps I get when in AF (or when

on disopyramide). I shall be calling the Doc shortly, but I am

wondering if these are PVC's. Ronnie's message (4012) says she can tell

between PAC's and PVC's - someone asked how, but answer there came none,

at the time.

Can anyone answer now?

- - -

The drug info says Propafenone (and Flecainide) can increase / create

PVCs. I never got these big thumps on Disopyramide. My ventricular

response has always been slow (i.e. non-fast) (being vagal, I now learn

from Johan Waktarie / Prof Camm's book) so I wonder if Flecainide and

Propafenone are that good for me, as they only prolong the refractory

period a small amount but slow AV conduction significantly, whereas

Disopyramide prolongs atrial refractoriness more but doesn't slow

conduction. My theory is the THUMPS are late A-V conductions from the

atria when they reach the ventricles. It appears the Propafenone might

work but at a low dose - this is also what happened to me on Flecainide

- v low dose sometimes worked, but higher doses were pro-arrhythmic.

Oh grrrr! I think I shall be calling the Doc and asking to come off

this. I felt better in AF !!

Best of health to me and to all,

Vicky

[Guest guest]

Vicky,

I wish I could answer your question as to the difference between PAC's and

PVC's. I'm hoping someone who has had this experience will jump in with some

helpful information. Sorry to hear you are struggling so with the new drug.

The THUMPS must be extremely disconcerting. You are very much in my thoughts,

and hope to hear soon that you have seen your dr and perhaps come off the

Proafenone. Keep us posted!

Best to you, as always,

Sandy

The thumps feel different to the mild thumps I get when in AF (or when

on disopyramide). I shall be calling the Doc shortly, but I am

wondering if these are PVC's. Ronnie's message (4012) says she can tell

between PAC's and PVC's - someone asked how, but answer there came none,

at the time.

Can anyone answer now?

[Guest guest]

I am a new afib sufferer but I have had PACs and PVCs my whole life (age 49

now). I can tell the difference because there is a longer pause and a

stronger " next beat " after a PVC. I don't normally notice a strong " next

beat " when it is a PAC. I have been watching my own ECG when both have

occurred so I knew which I was feeling. I hope that helps you.

I had only had 3 episodes of 1-2 day afib in 8 months until this last one

that lasted 12 days. I was placed on Norpace on day 10 and by day 12 was in

NSR. Except for a kind of dry mouth and a little worse than normal vision I

feel fine and am relieved to be back in NSR.......

Jack

[Guest guest]

In a message dated 8/11/2001 11:26:47 PM Pacific Daylight Time,

vmpaf@... writes:

<< After 3 pills (by Sat 10:00 am) I converted but after a

further few hours I was throwing ectopics, which got worse with time. I

got / am getting the 1-2-3-THUMP I got with Flecainide (1-2-3 = more or

less normal NSR beats). >>

Vicki,

I am so sorry to hear that you are having so much trouble. Since I am only

six days away from my last ten day afib session, I can really sympathize.

I just took a break here because, although it may be hard to believe, as I

typed the word " sympathize, " I felt the familiar tachycardia which precedes

afib for me. Now I am in afib! I guess in the future I had better type

sympathy notes only when I am already in afib since I seem to overdo the

sympathy. Oh well, I hope this session won't be as long as the last.

I don't know much about PVC's and PAC's, but I have had both recorded on

EKG's before afib was ever picked up by an EKG. As I recall the PVC's felt

like an extra beat (too soon), and the PAC's felt like a delayed beat (too

late). However, I'm not sure about this since it was about eighteen years

ago. I do know that when I am in afib, I often experience the pattern you

described of three or more normal beats followed by a seemingly ectopic beat.

This is the pattern my afib often follow just before I convert to sinus. On

one occasion when I was experiencing normal beats followed by an ectopic

beat, both my doctor and I thought was in sinus. An EKG, however, showed

that I was still in afib. I wonder if you might be experiencing afib

similarly and thinking as I did that you are in sinus? At any rate, it

sounds as if you would be wise to stop that medication if it makes you feel

worse than when you are in your normal afib. Good luck, and let us know how

you're doing!

in afib in Seattle

[Guest guest]

Vicky, I asked my doc if I could tell pacs from pvcs by the strength

of the thump, and she said no.

[Guest guest]

Thanks to all for your concern and advice.

I've now been in either AF or 123-thump for 18 days. This run is just

about to take over as the longest ever attack (20 days before, ISTR).

The Propafenone has definitely reacted badly with me. I stopped it

after 1.7 days = 5 x 150 mg pills total and it took a further 2 days to

" convert " back to AF from 123-thump. I then took just *one* 150 mg pill

(the " minimum " dose is 3 x 150 / day) on Tuesday morning and it put me

straight back to all the same symptoms! I think this low dose and long

time to clear may be because I could be in the " slow metaboliser " group

mentioned in the Rxmed monograph on Propafenone - just my theory.

I have an ECG and Doc's appt scheduled on Friday (which was the 1-week

follow-up originally for checking for any widening of the QRS complex)

so I shall take just one more pill on Thursday afternoon to make sure

I'm in 123-thump mode on Friday (!) and see if this is indeed PVC's as I

think it is. I have been familiarising myself with the traces on Mark

Hammerschmidt's excellent ECG FAQ page (see the links page), and I think

what I have is the PVC/quadrigeminy trace. We shall see.

Anyway, I feel there's *no way* this huge thump is atrial - it *has* to

be ventricular! If I am proven right, I shall then be less impressed

with those Docs who say their patients can't tell which is which.

Anyhow, " where next? " is then the question. As Flecainide sort of

half-worked before, when my digestion was still up the creek badly, and

now is easing somewhat having kept off wheat, I might re-try it.

I'll keep you all posted.

Best of health to all,

Vicky

[Guest guest]

HI Vicky

Where can I find the url for this page?

> Hammerschmidt's excellent ECG FAQ page (see the links page), and I think

> what I have is the PVC/quadrigeminy trace. We shall see.

[Guest guest]

> Where can I find the url for this page?

> > Hammerschmidt's excellent ECG FAQ page (see the links page), and I think

> > what I have is the PVC/quadrigeminy trace. We shall see.

>

it's in the 'basic information' of the bookmark sect

(http://groups.yahoo.com/group/AFIBsupport/links)

the link is

http://www.mikecowley.co.uk/markhammerschmidt/ArrhythmiaReview.htm

--

D 32, Leeds, UK - 26 hours into AF

[Guest guest]

In a message dated 8/15/01 11:20:22 AM Pacific Daylight Time,

vmpaf@... writes:

<< Anyhow, " where next? " is then the question. As Flecainide sort of

half-worked before, when my digestion was still up the creek badly, and

now is easing somewhat having kept off wheat, I might re-try it.

I'll keep you all posted. >>

Vicki,

Do keep us posted on your condition. I've wondered how you were doing. The

Flecainide might be worth another try if you don't have any heart problem

other than afib. My cardiologist said, as I mentioned before, that drug

would be his choice for me as a next treatment if my current drugs fail to

control the afib. He said also said that Flecainide is statistically more

effective in women than some other drugs like Sotalol.

You and (26 hours) both have my sympathy as I enter my 80th hour of

afib. As usual I am feeling no symptoms, but my pulse tells me that the

elusive sinus has escaped me yet again. Good luck, and let us know what you

decide.

in afib in Seattle :-(

[Guest guest]

Thanks, .

I am indeed thinking of going back to Flecainide, the thinking being

that it half-worked before, and now I know it is pro-arrhythmic at

higher doses, I shan't try that again. In fact my first days on Flec I

got this same 1-2-3-thump (unsurprising in retrospect as Flec and Propaf

are the same class). I brought up the thump with my Cardio at the time

and he seemed unconcerned (or maybe didn't know what it was?), but I am

far more concerned now I think it is PVCs.

In fact I'm quite cross, in that I spent years, literally, messing about

with Flecainide but only now (after this Propaf experience) do I begin

to understand. My " heart " originally *told* me the instant I had taken

the *first* Flecainide pill that it was pro-arrhythmic. I will always

remember a trip to A & E/ER that first evening where they just told me to

up the dose !!!

What are these guys FOR if not to know this stuff and pass it on

?!?!?*£$%* & !!!

Anyway, I steel myself for one more Propaf pill this afternoon to get me

back to 123-thump for tomorrow's ECG, then that's IT !! I actually

*feel* a whole lot better today, even though back in " proper " AF, but

with that damned thing just about out of my system.

Best of health to all,

Vicky

[Guest guest]

> Thanks, .

>

> I am indeed thinking of going back to Flecainide, the thinking being

> that it half-worked before, and now I know it is pro-arrhythmic at

> higher doses, I shan't try that again. In fact my first days on

Flec I

> got this same 1-2-3-thump (unsurprising in retrospect as Flec and

Propaf

> are the same class). I brought up the thump with my Cardio at the

time

> and he seemed unconcerned (or maybe didn't know what it was?), but I

am

> far more concerned now I think it is PVCs.

>

> In fact I'm quite cross, in that I spent years, literally, messing

about

> with Flecainide but only now (after this Propaf experience) do I

begin

> to understand. My " heart " originally *told* me the instant I had

taken

> the *first* Flecainide pill that it was pro-arrhythmic. I will

always

> remember a trip to A & E/ER that first evening where they just told me

to

> up the dose !!!

>

> What are these guys FOR if not to know this stuff and pass it on

> ?!?!?*£$%* & !!!

>

> Anyway, I steel myself for one more Propaf pill this afternoon to

get me

> back to 123-thump for tomorrow's ECG, then that's IT !! I actually

> *feel* a whole lot better today, even though back in " proper " AF,

but

> with that damned thing just about out of my system.

>

> Best of health to all,

> Vicky

Vicky:

Your bad experience with Propafenone just underlines how quirky

this AF thing is. For me it has thus far been a godsend. I say this as

I celebrate the 80th AF-free day, the last AF-free stretch being 42

days, followed by a short 4-hour session of AF, and the one before

that about three weeks. About 12 hours total of AF since I started

Propafenone on March 10th. This after episodes of 12 - 60 hours every

two or three days, would seem to be improvement. Yet I'm not

surprised; one person's blessing - another's poison! I can understand

how frustrating it must be. I keep praying for this respite, (for

that's how I see it) to go on for a year or more. Because when this

med runs its course I'll be back to Square One. I feel a little less

energetic because of the Metoprolol I'm also on, both it and the

Rhythmol (prop) in small doses - 25 mg./da. of Metop. and 2 x 150

prop..

Hang in there - there's something around the corner for you too.

Lawrence.