Time limits for flecainide's effectiveness

I would be very interested to know how long those of you who have taken (or are taking) flecainide (Tambocor) have found that it effectively controlled your afib. Three months? six months? a year? longer?

Has anyone ever read anything about the average length of effectiveness of flecainide (Tambocor)?

The reason I ask is that since starting on 100 mg of Tambocor twice a day over five months ago (last May) I haven't had any breakthroughs at all of afib. I have had dramatic results with the drug. But I am wondering how long I can reasonably expect it to hold me in normal sinus rhythm. I know no one knows for sure, and it varies from patient to patient, but there must be some consensus opinion about the average length of effectiveness of the drug that one could expect. If there is no clinical data, then your own personal experience would be most helpful to to me.

I am concrned about my drug's length of effectiveness because I have a tentative date for an ablation with Dr. Wharton scheduled for Dec. 31. If I am still in normal rhythm then, the big question is whether I should go through with it on that date or postpone the procedure. My thinking for postponing it would be that maybe I could wait long enough to take advantage of better technology. But I have read that better technology won't be generally available for at least two more years, and by then my flecainide might have quit being effective. If flecainide has an effectiveness time frame of about one year, that means I could reasonably expect to go out of normal rhythm by next May, and I don't think by May the technology will be much better (if any) than it is now. If this is the case, I might as well go through with the procedure as scheduled on Dec. 31 of this year, since I have met my insurance's out-of-pocket maximum for this year, and while my symptoms are still mild and very well controlled. Also supporting this position is my thought that generally speaking if an affiber has an ablation when there are no symptoms or they are very mild, there is a better chance of a cure on the first try than if the symptoms have been around for a while. Does anyone have any opinion about this?

I just don't know whether it would be wiser to go through with my ablation this Dec. even though I am having no problems or wait for better technology, but by waiting I run the risk that by then my flecainide might no longer be effectively controlling my condition. It is a touch decison, and I agonize over it. I would be interested in any and and all feedback.

Appreciatively,
Stan

Greetings
Very good question. I have just started using Flecainide on demand, 100mg at onset after which I convert within 3hrs. However my frequency of Afib has increased but I have not been avoiding all triggers trying to find a balance. Thus I am now going to eliminate triggers and then see what the frequency is. If it reverts back to twice a month then OK, if not the Afib could itself have become more frequent (it is three times a week at the moment) then I will try the daily approach to see if it reduces the frequency. From Hans surveys there shouldn’t be much of a difference but again everyone differs and for most using the on demand approach has not increased frequency. I think by using the on demand approach then you will logically increase the time interval the drug is effective for. However we are talking Afib here and logic doesn’t always hold true.
Ablation I agree is gaining momentum and I like you would rather wait until it becomes more refined especially as I live in the UK.
Take care
Chris H

I take flec on demand with good results. If you are doing well on flec., it would seem wise to delay ablation until the discomfort of your symptoms outweigh the risks of the ablation. As you said, ablation techniques will only improve with time so why not use it to your advantage. As to length of effectiveness, I have found no clinical data that says flec becomes less effective with time. I suspect in some cases that people doing well on it stop taking it or start skipping doses thus the loss of effectiveness or it was never very effective for them to begin with so they give up after a while, I don't know. Glad your in NSR.

I think it is one of those everyone-is-different situations. That said, I have taken flecainide (125 mg.) for two years, but have had, in the last few months, to add in 25 mg. of attenolol everyday for rate control because I was having occasional AF (3 to 4 a year). Consequently, I haven't had an episode since starting the attenolol. I seem to recall that there have been posters on this board who have taken flecainide for as long as 5 years, but I wouldn't depend on my memory. The combination of drugs I'm taking now seems to be working well for me, at the moment, and my heart feels quite steady. So, you might consider adding another drug if the flec. wears off, and thus postpone your ablation yet again. Sam H.

Hi Stan:

I have been taking 100 mg twice a day since June 2001. I haven't had any AFIB during that time period so the drug has been effective for me up to now. I also wonder how long the drug can be effective. My cardiologist said he has one patient that has taken flecainide for ten years and is still benefitting from it. However he also said that usually the drug does not stay effective indefinitely. I believe the drug does make me more tired but I have a number of other problems that also might contribute to lack of energy so it is hard to tell how much effect the flecainide has. I am also interested in learning whether the risks of ablation are better than the side effects of drugs.

thanks, Jerry

I take flecainide (300mg/day) and have been on it since approximately May 2001. I got into some trouble when I tried to reduce to 200mg per day and it took me some time to stabilize. I seem to be stable now and have not had afib for close to 2 months.

I know there are people that have been on it for 6 years plus.

Personally I do not like taking it and who knows if there is long term damage. I have heard of some liver problems associated with flecainide.

My choice is to try a PVI RF ablation sometime around May 2004. I had an unsuccessful afib ablation in Feb 2001 and have been waiting until the procedure becomes more of the norm. I have noticed a lot of members have opted for the ablation lately but again it is a personal choice. It is just like buying a PC. After you buy one it is obsolete in a couple of months so when do you jump in. If you are relatively young (mid forties or lower) and are doing well, maybe you shoud wait. I believe 10 years from now there will be a procedure that will be safer with a 95% or higher cure rate.

The cryo ablation has a new release but probably will not be ready for prime time for another year or so. Even then, the last release cryo proved to be ineffective after a few months/weeks.

take care
keith

Stan, you know me, significant with Ellen. I talked with my EP about you and he siad you should wait. Indicated some new things on the horizon, and if no breakthroughs it would be better to wait.

Of course, for me, I am so glad i did it.

Tough Choice.

I have been on Flec. for 2 years and hate the stuff. It was effective for a while and then the Doc. added tropol. I am now off the toprol and I am coming off Flec. I take 100 Mg. twice a day and am now on 150 an feel better already. The Doc. said to drop 50Mg. every 2 weeks this is bad stuff. I get head aches, get a bit dizzy right after the dose and sometimes feel my heart is pounding.

I am taking 600 Mg. of Mag. and it seems to be making a big difference. Has anyone else done a stepdown off Flec?