Coming off of Flec 30 days post ablation?

I had my ablation 51 days ago by Dr. Jais in Bordeaux.

His instructions were that I can come off of Flecainide in 30 days and Eliquis in 60. My local EP said this is fine too.

However, another member of the forum here said that the norm to come off of Flec is 90 days and he had his ablation by Dr. Jais too.

Dr. Jais noted that I can restart if I experience any recurrence.

What I've noticed coming off of Flec is that I have ectopics. I maybe had 1 or 2 in the first thirty days when I was on Flec still. Now, I can have anywhere from 3 - 10 a day that I feel. I had an Afib episode that lasted for 2 hrs at day 40. It was triggered by light exercising in the gym. I was using a chest press machine going maybe 20% effort. But, the muscle contraction was triggering ectopics....then it broke through to Afib.

I stopped all gym exercise for now to avoid another episode like that.

My question is: should I be on Flec so that I can have pretty much no ectopics? Or, should I keep going without it as long as I can avoid an Afib episode?

HBK,

I’m the other forum member you refer to.

We’re you on Flec before your ablation? I was for 11 years: maybe that’s why Prof Jais told me to continue it for 3 months. Maybe the norm is 30 days for folks who weren’t on it pre-ablation.

I stayed on Eliquis for 60 days too.

Presumably this recent ablation was your first and was pretty much just a pulmonary vein isolation rather than any other areas being ablate also? Do you have your ablation report in English? That would be interesting to see if you do and you’d share it.

10 single ectopics per day is nothing much and not in my opinion any justification for returning to Flec unless your ectopics are very uncomfortable and worrying and could be kept in check with a really low dose of Flec like say 50mg/day.

2 hrs episode of episode at 40 days falls well within the usually cited ‘blanking period’ of 3 months during which time the heart is pretty irritable after the ablation and as such is in and of itself no great cause for concern. As others here have said, lay off any heavy exercise or lifting/staring for at least a couple of months post-procedure.

Cheers,

Mike F.



Edited 1 time(s). Last edit at 08/07/2019 05:33PM by mwcf.

You should be following your EP's instructions, not other forum members here. Their particulars may not be the same as yours.

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HBK
My question is: should I be on Flec so that I can have pretty much no ectopics? Or, should I keep going without it as long as I can avoid an Afib episode?

Why bother having an ablation if you're going to remain on an antiarrhythmic? I would do as your EP says and stop the flec at 30 days. You can always restart it if you have an episode. I wouldn't restart just because of ectopics. You need to find out how well the procedure worked and the only way to know that is to stop the drug.



Edited 1 time(s). Last edit at 08/08/2019 12:45AM by Carey.

MWCF, yes I have been on it going on about 2 yrs. And yes it was my first and a PVI.

I took a screenshot of my report and blurred out my personal info. Here is a link: [cl.ly]

MWCF and Carey, makes sense on stopping as long as I have ectopics only and seeing how well it worked.

I didn't really notice ectopics prior to ablation. I probably had them and they kicked me into afib every time....and I just noticed that I had afib and didn't think about ectopics.

One thing that is encouraging is that the ectopics are not pushing me into a-fib now. I've caught them on my apple watch. It will be one premature beat when taking the ECG then back to normal



Edited 1 time(s). Last edit at 08/07/2019 06:37PM by HBK.

You could titrate down & not just stop cold turkey. Not an ablatee, but I did take flec daily for a short time. I titrated down by cutting pills and did it over a month.

GeorgeN that is an interesting idea. Tapering off does seem like a smart move

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HBK
I didn't really notice ectopics prior to ablation. I probably had them and they kicked me into afib every time....and I just noticed that I had afib and didn't think about ectopics.

One thing that is encouraging is that the ectopics are not pushing me into a-fib now.

Same for me. I've short afib episodes from time to time, but they stop spontaneously, so I don't take flecainide anymore. Side effects are too bad for me.

Thanks for posting your report HBK.

Agree strongly with George about tapering off.

Presumably prior to your ablation you were getting regular AF episodes despite daily Flec - what daily dose were you on?

Pompon, what side effects to you have.

MWCF, prior to ablation I was on 50mg twice a day. But, in the last 3 months or so was when it stopped being effective. So, I started taking an extra pill as needed during the day.

I was originally on Aspirin but my EP put me on Eliquis in May after wearing a Holter monitor and showing more episodes of afib. They started becoming pretty much daily - average time about an hour

HBK, I've used flec 2*50mg/day, with 1*2.5mg bisoprolol (to prevent 1:1 flutter).
As I still had afib and the BB was killing my energy, I stopped it, keeping the flec as PIP. 100mg max. Above, I've conduction problems, with widened QRS on the ECG.
The last time I took 100mg of flecainide, my afib turned to (atypical ?) flutter for 12 hours ! I took some bisoprolol to keep my HR as quiet as possible...
Since then, I don't take meds anymore for afib. I always self convert in less than 2 hrs.

50mg BID (twice daily) of Flec is a very low dose. The usual dose is 100mg BID (usual max dose 150mg BID). PIP of 100mg is IMO too low to be effective for normal sized males. When I used it as a PIP (before I started taking daily Flec) I used 300mg which so far as I’m aware is the normal PIP dose for a normally -sized male. IIRC George Newman of this forum uses a PIP Flec dose of 300mg.

When I first started Flec in 2008 11 years ago (9 years after my first AF episode in 1999 - episodes once or twice a year always nocturnal always self-converting after 4 to 6 hours - before I started using Flec as a PIP in 2006), I took 50mg BID. It’s efficacy at that dose lasted about 8 months and then I ramped it up to 100mg BID at which level it worked well enough with me only having 1 or 2 episodes a year (for which I took a further PIP dose of 200mg that always converted me in an hour or two). Then in 2018 I had 6 episodes by June in addition to which I was despite the extra 200mg PIP of Flec taking longer (3 to 6 hours) to convert back to NSR: hence why I headed for an ablation last August.

For what it’s worth I think Flec is an excellent drug for vagal/nocturnal AFrs for whom it causes no side effects and works well. I know of folks who’ve been taking Flec for 25 years for whom it has never caused any side effects whilst providing excellent control of their AF.



Edited 1 time(s). Last edit at 08/08/2019 03:59PM by mwcf.

My own personal experience with Flecainide is not so positive. I feel very drugged and sleepy, and lately have had trouble with almost any amount of alcohol (nasty hangover), which I'm guessing may be related to long term drug use. I've been taking flec on and off for about 15 years, mostly on.

Then there is the other extreme. No antiarrhythmics after ablation, only a blood thinner for a month (warfarin). No afib breakthroughs, no arrhythmias post ablation, just a calm heart for the last 11.5 years. But the Dr. did 60 burns in the atrium. He was good at finding the problems and burning where required. I have no other details about the actual ablation.

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Ken
Then there is the other extreme. No antiarrhythmics after ablation, only a blood thinner for a month (warfarin). No afib breakthroughs, no arrhythmias post ablation, just a calm heart for the last 11.5 years. But the Dr. did 60 burns in the atrium. He was good at finding the problems and burning where required. I have no other details about the actual ablation.

If I recall correctly haven’t you had several breakthroughs of AF this last 11.5 years? Still great going even so!

Yes, three breakthroughs in 11.5 years, each lasting about 2+ hours. Two were during somewhat high anxiety/physical situations, and the other in the evening for no reason. I don't know if my success will continue, but only time will tell. I did have occasional ectopics in the first few years after the ablation, but when I started on the Mg, K and Taurine, they essentially have been eliminated.