Flecainide

5 weeks ago I was put on 100mg Flecainide and 2.5 mg of bisoprolol daily. I had been taking bisoprolol alone for 2 years but was having more and more bouts of AFib and spending time in hospital. I had an ablation in January 17 and I had no episodes of AFib for 6 months and I was sure I was cured but not to be. I have not had any AFib episodes since I have been taking Flecanaide but I am feeling awful. I am only sleeping about 4 hours most nights. I am waking up with slow heartbeat of about 50 or less and high blood pressure. I feel completely rung out and am hardly leaving my home. Am seeing my GP tomorrow but not sure what she will suggest as was put on meds by doctor at hospital. I wondered if anyone else has felt like this while on Flecainide and what if anything did you do.

Both flecainide and bisoprolol lower your heart rate, and bisoprolol also lowers your BP. The high BP you've observed is probably your heart compensating for the low pulse in order to maintain adequate blood flow.

Either or both the drugs could be responsible for how you're feeling, but you said you took bisoprolol alone for two years and I presume it didn't make you feel this way? If not, then it's almost certainly the flecainide.

If I were in your shoes, I would try cutting the flecainide down to 50 mg and seeing if that helps. If not, then I would ask to try another drug. Your GP isn't the right person to be consulting on this. Who did your ablation? Who prescribed the flecainide in the first place? That's who you should call.

She said that the Hospital Doc put her on the Meds.

Flecainide makes me feel kind of funny, sort of light-headed and queezy. I only take it during an Episode, and at a moderate dose. If it makes you feel bad, it's not a good Drug to take, or at least at that dose.

I suggest seeing a Cardiologist, preferably an EP Specialist. They know the most about how people react to drugs like Flecainide, or a Combination of Drugs like Bisoprolol and Flec. Until then, one suggestion would be to take the Flec 1st thing in the Morning, that way you would have a lower concentration of it your system at night. Maybe also just stop taking it for several days just to see how you feel, and then restart it at only 50mg. Many of us just take the Flec when we have an Episode, to help us get out of it, but this should be done under the care of an EP specialist.



Edited 1 time(s). Last edit at 04/04/2018 03:37AM by The Anti-Fib.

Thank you for replying. Had my ablation at Papworth and consultant there prescribed flecainide as bisoprolol wasn’t very effective at controlling AFIB. Am back to see him in 5 months and he said if flecainide wasnt helping he would look to do another ablation. Will check with my GP today about reducing flecainide but she will probably tell me to contact hospital. Also when waking with low pulse I have pins and needles in my hands is this typical?

Think the Anti Fib answered your question. You need to see an Electrophysiologist preferably, or a ‘good’ Cardiologist. From my experience over 15 years of AF, the average GP knows very little about AF and some Cardiologists have a very narrow interest or knowledge of it. Be proactive. with this condition you need to.



Edited 1 time(s). Last edit at 04/04/2018 08:52AM by JoyWin.

Why were you on the Bisoprolol? High BP?

I second JoyWin's comments. Most GPs can identify AF on a rhythm strip and that's about it. Many - albeit fewer - cardiologists don't have extensive AF knowledge and will mis-treat it. There are many stories here of cardiologists recommending digoxin for AF (wrong) or prescribing amiodarone to younger patients (unconscionable). In my opinion, here's the hierarchy for medically managing AF:

1. Electrophysiologist (he/she "runs the show")
2. Cardiologist (he/she can manage day-to-day stuff, refill RX's, adjust dosages, etc b/c the EP will have limited office hours in most cases)
3. General Practitioner (keep him or her informed, making sure the EP and Cardio's notes get sent to the office and filed)

That way everyone's doing the job they are best at, and there are at least 3 people on relatively the same page in case of emergency.

I was on bisoprolol for AFIB. Worked reasonably well for a few months but then started to have lots of episodes. Didn’t feel great when on bisoprolol alone but nothing compared to how I feel now.

Keep in mind that beta blockers don't prevent or stop afib. They control heart rate and lower BP, but aside from sotalol they are not antiarrhythmics like flecainide. I suspect flecainide just doesn't sit well with you and you need to find an alternative.

I'm not quite sure why you can't call the doctor who prescribed it and ask to try something else. Just because they were a hospital physician doesn't mean they don't have a continuing responsibility.

Thanks for your help. Will be contacting hospital about meds. I have persistent Afib but before taking flecainide I had many episodes of 150 + beats and was hospitalised. Because my heart isn’t racing I don’t know if I should accept this is how it is now. I was more or less told that.

You need to speak with the doctor who treated you and find out where you stand. If you're in persistent afib and you don't intend to try and change that, then there's no reason to be taking flecainide at all. All you need is a beta blocker to control the rate and an anticoagulant to prevent strokes. If, however, you would prefer not to be in afib then you need to either be put on another antiarrhythmic that you can tolerate or seek an ablation. Overall, you need to meet with an EP and learn what your options are. Sounds like you were not given proper information on your condition.

An understanding of what Jennywren means by "Persistent AFIB" is necessary here. Persistent AFIB is currently usually
defined as AFIB that does not terminate on its own in less than a week, or requires Chemical or Electric Cardioversion to return to NSR. Flecainide can still be use use for Persistent AFIB, to maintain NSR.

For example, I had Persistent AFIB for 8 years, but after Cardioversion, I went for a year at a time in NSR, even with no Anti-Arrythmics. I experimented with Flecainide, as a preventative measure, but ended up just using it during Episodes to help convert back to NSR on my own.

A Question for Jenny:

Have you had to be Cardioverted out or AFIB yet? Either Chemically or by Electric Shock?

" Because my heart isn’t racing I don’t know if I should accept this is how it is now. I was more or less told that. "

No don't accept this. All that is needed is probably just adjusting or alternating in different Med's. Your current side effects from the Drug Regimen of Bisoprolol and Flec is causing too many side effects.

Have never been cardioverted. When in hospital last couple of times I was ready and waiting to have it done and all went back to normal. It must have been fear that put it back in rhythm! I have been told that I can have another ablation if present meds are not working. Have seen my GP today and she will be having a word with hospital about cutting down the bisoprolol from 2.5 to 1.25. Don’t know if that will make any difference. After reading this forum it looks like I will have to get answers from the hospital.

Jennywren
Flecainide is typically effective with afib. It can and does often cause side effects. Take it from me, I am a med intolerant person. I've used flecainide thru the years. It can cause all those weird things you are experiencing. Some of that may get better with time. Carey is correct in that maybe you need to just reduce some. For me flecainide worked for a long time with all the minor symptoms. Them I guess my heart kind of said enough. Contact the doc. Reduce dose is what I'd try and if you still are feeling wiggy change meds.