Terminating Afib and Norpace

[kevtt]

I and other afibbers on another board have noticed that sometimes eating a snack or meal or immediately doing some mild activity such as a fast walk or slow ride on the stationary bike after eating would terminate an afib bout. What is it about the eating process that would cause the afib to stop?

Also, you listed the side effects of amioderone, are there any long term side effects for norpace? Is there any reason why a cardiologist would recommend amioderone before trying norpace?

Thank you.

Kevin

[CCF-M.D.-RCJ]

Kevin,

Thanks for the post.

Q1:"What is it about the eating process that would cause the afib to stop?"

Great question, with a controversial answer.  I believe, as do many other cardiologists, that their is a fair amount of credible evidence to suggest that some people develop afib episodes that are triggered by either (1) sympathetic activity, or (2) parasympathetic (also called vagal) activity.  Some notable cardiologists diagree.

For the people who develop afib only (or usually) with activity, these people likely have sympathetically-induced afib.  For the people who develop afib after meals (or during sleep), these people likely have parasympathetically-induced afib.

Furthermore, performing activity blunts the parasympathetic response.  So walking, or riding a bike, after a meal may blunt the parasympathetic response associated with eating, and thus decrease the chance for afib developing.

Q2:"... are there any long term side effects for norpace?"

There are no long-term cumulative side effects for norpace (sotalol) as it does not accumulate in the body's tissues like amiodarone.

Q3:"Is there any reason why a cardiologist would recommend amioderone before trying norpace?"

Yes, norpace may not be safe for patients with heart failure or certain EKG findings, like a prolonged QT interval. Amiodarone, however, is usually safe in these situations.

Most electrophysiologists do not use amiodarone first-line in otherwise healthy afib patients.  

Hope that helps.

[DottyCece]

Norpace is not sotolol...at least I never thought so.  Sotolol is a beta blocker and Class II antiarrhythmic.  I don't think norpace acts in that fashion (in fact, I think it is a Class I antiarrhythmic) and it does have more side effects.  One has to be careful with sotolol with a prolonged Q-T interval and in pts. with CHF. I did well on sotolol but I would never take Norpace.

I was treated with sotolol first with atrial fib and then switched to amiodarone by the electrophysiologist who followed me through the open heart surgical experience. Interestly enough, I stayed in sinus rhythm when I was on sotolol and since I have been on amiodarone post maze procedure, I have had atrial flutter five times...so wonder what's what.

My atrial fib is often induced with exercise and stress and fatigue (I might add.). Then it seems to reorganize to atrial flutter which persists until I am cardioverted.  This has occurred 5 times in past year.

[DottyCece]

Norpace is not sotolol...at least I never thought so.  Sotolol is a beta blocker and Class II antiarrhythmic.  I don't think norpace acts in that fashion (in fact, I think it is a Class I antiarrhythmic) and it does have more side effects.  One has to be careful with sotolol with a prolonged Q-T interval and in pts. with CHF. I did well on sotolol but I would never take Norpace.

I was treated with sotolol first with atrial fib and then switched to amiodarone by the electrophysiologist who followed me through the open heart surgical experience. Interestly enough, I stayed in sinus rhythm when I was on sotolol and since I have been on amiodarone post maze procedure, I have had atrial flutter five times...so wonder what's what.

My atrial fib is often induced with exercise and stress and fatigue (I might add.). Then it seems to reorganize to atrial flutter which persists until I am cardioverted.  This has occurred 5 times in past year.

[DottyCece]

In our community, I do not see Norpace being ordered or used.  There are usually better alternatives.

[bigmick]

Norpace is indeed dysopyramide and is NOT sotolol. Over on the afibbers board modulated by Hans Larsen, there are quite a few vagal afibbers (including a medical doc) who have found great relief from AF with Norpace (along with a more benign side-effect profile than Flecainide). The Norpace has, once a satisfactory regimen has been found (up to 1g per day in regular divided doses (including a larger dose in the evening)), provided several vagal AFrs on the aformentioned board with little or no AF for up to 3 yrs and who knows how much longer besides.

I am not a doc and the above is only my own opinion as per gleaned from the posts and comments of others.

(3 cheers for Hankstar of this board - his posts are most helpful for those of us concerned about our ectopy and arrythmias.)

[CCF-M.D.-RCJ]

My apologies!

Hank you are exactly correct ... I read the "pace" at the end and confused myself.

Sotalol is betapace.

Disopyramide is norpace, which is a Class IA antiarrhythmic with vagolytic properties, meaning that it may be beneficial in patients with vagally-mediated atrial fibrillation.  This use is in fact the most common reason I prescribe this drug.

To revise my previous answer to Q3:
Norpace may not be safe for patients with structural heart disease, like heart failure or coronary artery disease. Amiodarone, however, is usually safe in these situations.

Thanks for the help!

Bigmick, can you give me the site of the afibbers board please?  I'd love to see the information present there.

[bigmick]

Thanks for the confirmation regarding Norpace, and for the enquiry as regards the afibbers forum modulated by Hans Larsen (a former chemical engineer who has also written a book about AF - details via link from following web address).

The bulletin board for the site can be directly accessed at http://www.yourhealthbase.com/forum/list.php?f=3

There are some very knowledgable and supportive individuals on this forum for those of us who are blighted with LAF (and I'm a lucky one 'only' having had 6 episodes in the last 7 years - all kicking off at 3 am or so and converting (no meds) 3 or 4 hrs later). I also frequent this (also excellent board) since I get 20-100 ectopics and one or two short runs of the same most days as well as the aforementioned VLAF (12-lead ECG, stress treadmill, and echo all check out A-OK).

I'm impressed that you are interested in visiting the afibbers forum: then again, maybe I shouldn't be so surprised given Cleveland Clinic's excellent reputation as a heart health center. Dr Natale is talked of with more than a little reverence over on the afibbers board as regards his expertise with pulmonary vein ablations for AF. Many who frequent the board are seeking non-invasive (surgical) solutions to the LAF puzzle via nutrition and lifestyle changes, whilst many others have, or are contemplating, going down the ablation route.

Kind regards,

BM

[jamo52]

After an 8 year depressive bout with inderal when my a-fib first started, my Dr. put me on Ethmozine.  For the next 8 yrs I think I had only 10 bouts of a-fib, and most were less than 48 hrs.  But the docs i've spoken to lately seem to think that flecianide is the wonder drug.  Been on it for less than 6 months and have had 3 bouts, one lasting 3 days.

Could anyone tell me the good and bad of Ethmozine and why they are not using it anymore than necessary?

Ethmozine was really the best anti a-fib drug i've taken and do highly recommend it when inderal and the like do not work.

[Chrisanne08]

A related discussion, to drug or not to drug was started.

[zingo]

A related discussion, Antiarrhymic medication survey was started.

[Ken44]

A related discussion, Stopping atrial fib. short cuts. was started.