Pill in Pocket Method for Controlling Afib

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atpsynthase

Protons and Pumps, Baby!
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I recently had a patient who was instructed to use the pill in pocket method for what I assume is his paroxysmal atrial fib. He explains his atrial fib events as infrequent and was given metoprolol succinate (would the higher Cmax of tartrate be more beneficial here??) 25 mg to take PRN "when in atrial fib for longer than 30 minutes"

I was under the impression that atrial fib can many times be asymptomatic and it only takes ~48 to form a thrombus... which also begs the question... should a CHADS2 score be involved somewhere here to determine proper level of anticoagulation?

Anyone have any experience with the pill in the pocket method for controlling atrial fib or have any recommendations/literature to back it up or cut it down?

Perhaps risks of daily rate control outweigh benefits?
 
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