options

I'm 88 --going in for my 6th conversion next week . Having trouble staying converted! Meds I'm on daily:
metformin
aspirin
propafanone
mettroporolol 50/2times day
coumadin
protonix
prevestatin

Should I switch from Propafanone --to Flec --any thoughts anyone> thanks.

Do you think you are vagal? The propafanone has beta blocking properties and you have mettroporolol on top of that. If vagal, these could contribute to afib triggering.

Propafanone is a class Ic antiarrhythmic, the same as flecainide, so an AV nodal blocking agent should be given with it to protect against 1:1 conduction. I've experienced 1:1 conduction. Trust me, you don't want to go there.

Being of the same class, I wouldn't expect it to perform any better than flecainide. You can try it, but don't be disappointed if it works about the same.

Carey:

I am Vagal, only get AF at night when resting---I have taken Propafenone (150mg.) every night before bed for about 14 years, my EP has never had me take a AV nodal blocking agent. I have never had any problems such as you have had, perhaps it is because I take a small amount.

Liz

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Elizabeth
I am Vagal, only get AF at night when resting---I have taken Propafenone (150mg.) every night before bed for about 14 years, my EP has never had me take a AV nodal blocking agent. I have never had any problems such as you have had, perhaps it is because I take a small amount.

Yesh, some EPs forego the precaution while others absolutely insist on it. The risk is low, but the consequences can be grave so it just depends on how your EP weighs the risks. Both of mine believed that risk was unacceptable and wouldn't even consider prescribing flecainide without a beta blocker.

Anyway, I just mentioned this to explain why Vincent is likely taking both metoprolol and flecainide. Propafenone and flecainide do not have beta blocking qualities. If they did, this would be a non-issue.

A case history illustrating this: [www.ncbi.nlm.nih.gov]

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Prevention of vagal type LAF
Flecainide and disopyramide can be quite effective in preventing vagal LAF episodes. They are both powerful drugs and can have very serious adverse effects so they should only be used by afibbers with structurally sound hearts. Beta-blockers and sotalol have strong beta-blocking properties and are contra-indicated for vagal afibbers as they are likely to worsen their condition by further increasing vagal dominance of the autonomic nervous system. Propafenone also has beta-blocking properties, but is likely to be OK for most vagal afibbers unless they have a genetic predisposition to metabolizing the drug slowly. Some afibbers have found the time-release version of propafenone (Rythmol SR) to be significantly more effective than the standard version taken two or three times a day.

<[www.afibbers.org]

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GeorgeN
Propafenone also has beta-blocking properties

Okay, that's news to me so I did some more digging and the answer is as clear as mud. It seems that its beta blocking qualities are easily demonstrated in vitro but not so much in vivo, and in vivo is all that counts. The effect ranges from undetectable to significant and is genetically determined. For example, this is a typical statement on that issue in the literature:

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However, although the beta-adrenoceptor blocking effects are readily demonstrable in vitro, clinical data are more inconsistent, because the beta-adrenoceptor blocking action has been reported as being undetectable to significant.

[www.ncbi.nlm.nih.gov]

So it may have some blocking qualities for some people, but propafenone is known to cause 1:1 conduction so a cautious EP would add a beta blocker or CCB to it just as with flecainide.

I am (was) a vagal AF'er and propafenone was middling at best. Plenty of breakthroughs. I had to drink beer to counter the beta blocker effect of it. No lie.

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wolfpack
I had to drink beer to counter the beta blocker effect of it. No lie.

Well now, that was a novel solution. ;-)

Vincent, I hate to hijack your question with this side track about propafenone's beta blocking qualities. I think the only safe thing we can tell you is to go ahead and give it a try. Who knows, maybe it will be more effective for you, but it could go the other way too. I think the most likely result is it won't be significantly better or worse than what you're on now.

And if it's not an improvement, there are three more drugs you can discuss with your EP, namely sotalol, Tikosyn and amiodarone. They're kind of heavy hitters so should be tried last, especially amiodarone, but you're not out of options yet.



Edited 1 time(s). Last edit at 09/24/2017 01:26AM by Carey.

If the Propafenone isn't really working, then I think that trying another Anti-Arrythmic is the way to go. I took both Flec and Propafenone, and reacted differently to them, Propafenone speed up my HR, while Flec, calmed it down. In addition Flec can be used short-term just to help you convert out of a AFIB episode, so getting used to it, to see how you react to it, may be worthwhile. Be on the lookout for development of Atrial Flutter. On the down-side, Flec can cause Flutter, I got it, and many of our posters have also reported this. This is why if I take the FLec, I only take it short-term to help convert out of an episode.

Many options as far as Anti-Arrythmics, hopefully you can find one that helps.



Edited 1 time(s). Last edit at 09/23/2017 03:15AM by The Anti-Fib.

Just a comment on flecanide Not everyone on flecanide will experience flutter as a side effect of flecanide