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Joseph

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Was packing for a flight leaving tomorrow morning but guess my heart had other plans. After a year of zero issues I went into a-tachy and my heart rate bounced between 70 and 170. We were very much looking forward to a month in Thailand, not a night in the ER. My local hospital is conservative so are trying Diltiazem and mitropolal first as they don't like to do cardioversion (no cat lab). I'd say there's a 1% chance we'll catch our flight and just wanted to share my misfortune (but not looking for sympathy). Hopefully just a delay and not a problem that's going to derail my fun.
 
My local hospital is conservative so are trying Diltiazem and mitropolal first
I concour, I've got reservations about cardio version. Something less damaging first IMO.

https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/electrical-cardioversion

Ask if you're getting metoprolol tartrate or succinate .

The difference is worth understanding

1708601638668.png


Best wishes
 
I concour, I've got reservations about cardio version. Something less damaging first IMO.

https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/electrical-cardioversion

Ask if you're getting metoprolol tartrate or succinate .

The difference is worth understanding

View attachment 889923

Best wishes
But if I get another punch of my cardioversion card the next one is free 😁

They put me on 25mg succinate and my regular EP said to take it twice daily. The last time I was on some form of metropolol I had brain fog all day. Seems like this one is working better but will see how I am in 35C weather.

Think we'll cancel the Tiger Mountain hike but otherwise will pretend I'm in perfect health.
 
I was cardioverted (is that a word?) in my electrocardiologist's office on Monday. I wasn't really given any choice of medical approaches. The doctor recommended an ablation that can't be done - I'm sure that he realized it's probably not possible (without putting me on heart lung machine, or replacing my aortic valve, or something similarly drastic). I don't know if I could have waited to see if new medications would have reversed my aortic fibrillation.

I didn't think about alternatives - I wanted the symptoms to stop.
 
Ask if you're getting metoprolol tartrate or succinate .

The difference is worth understanding
Wow! Thank you for including that chart! Just 2 days ago I switched from Metoprolol tartrate 12.5 mg twice a day to Metoprolol Succinate 25mg once a day. I was told the Succinate was a "time release" version of metoprolol, but I didn't realize there was that much of a spike in the release of the Tartrate version.
 
but I didn't realize there was that much of a spike in the release of the Tartrate version.
as it happens tartrate works really well for me, you'll notice that the graph only shows one administration of the 50mg of tartrate.

1708667210167.png

so taking two administrations would simply add the first bit directly after that.

Also since you can see the effect is so much more pronounced (make sure to be reading the lower half of the graph which is "Reduction in exercise heart rate" as a negative scale.

As you can see the action and disposal of the succinate (indicated by the blood plasma levels) is not dissimilar to the single 100mg of succinate.

For me I get up, do my walk / cycle and or gym, which raises my HR and the relative absence of tartrate allows me to have good training time (I have a tachycardia). Then about half an hour later I'll take my metoprolol and my HR settles post exersize like it should.
I then take in the evening (its common a do the other one of walk / cycle but no gym) and can go to bed with a nice even HR

So for me and my condition I prefer that "steadying of my arrhythmia of (which I find for me persists longer than the reduction effect) and does not get in the way of (say) cycling in the day or doing work in the day. I found Succinate always left me like something was holding me back when I was on it just after surgery.

HTH

PS: one tends to need to read the pharmacokinetics carefully: for instance
from https://www.ncbi.nlm.nih.gov/books/NBK532923/

There is significant hepatic first-pass elimination, which results in around 50% of the oral dose reaching the systemic circulation. It is 11% bound to serum albumin. The half-life of metoprolol is about 3 to 4 hours in most patients for non-extended release tabs.[NB the tartrate]. Metoprolol excretion principally occurs via the kidneys[NB, so not hepatic].[10] Metoprolol succinate produces more level drug concentrations as compared to metoprolol tartrate, which has more peak-to-trough variation. However, despite these differences in pharmacokinetics, studies have concluded that both agents produce similar clinical effects, both acute and chronic.​

Wikipedia makes this note:

The different salt versions of metoprolol – metoprolol tartrate and metoprolol succinate – are approved for different conditions and are not interchangeable.[19][20]

bottom line is that one may work for you while the other doesn't.
 
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I wonder if I was on tartrate previously, the initial reaction was much more pronounced than the succinate that I'm now taking twice daily. Sitting in Incheon after a 14 hour flight and my RHR never dropped below 75 (when normally I'd be in the 50s or 60s). EP already said we'll discuss another ablation when I return. Going to try to enjoy the vacation (responsibly). Best!
 
Seems we're in a similar boat at the moment. After a year of no Afib, I had a few weeks of high HR, low HR, skipped beat... No change in treatment... just went back to 'normal' after a few weeks. Have some travel to Euro zone and India/Thailand coming up. Fingers crossed for us both.
 
Seems we're in a similar boat at the moment. After a year of no Afib, I had a few weeks of high HR, low HR, skipped beat... No change in treatment... just went back to 'normal' after a few weeks. Have some travel to Euro zone and India/Thailand coming up. Fingers crossed for us both.
Best of luck, we're 20 hours in flight time (thanks to a last minute airport delay) and waiting at Changi, Singapore for the last leg to Bangkok. So far I've been able to run from terminal to terminal without collapsing so that's a good start to the vacay.
Cheers!
 
Just to put a bow on this (in case anyone is interested), I survived and had a fantastic trip and am back home after a 20 hour flight. Two days after arrival in Bangkok my heart self-corrected and for the duration of the trip my rhythm and rate were perfectly normal. The heat and humidity are no joke, and I expected that, but the metoprolol didn't seem to affect me in any perceptible way even with high activity in 43C heat (although obviously my BP was probably lower than normal). I'm seeing my cardiologist and EP next week since when I was in the ER the topic of another ablation came up. I'm not fond of being on a beta blocker (I don't even take OTCs, just warfarin) but I'm also not thrilled with another round of burning the inside of my heart. Guess I'll see what the experts recommend based on pacemaker telemetry and overall health.

railay-4-islands.jpg
 
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