I am in flutter - again - just less than two weeks ago had an ECV for the same. The flutter has been traced to the scar tissue of previous ablation (13 yrs ago). I am now on a list for touchup but don't know when. I have a phone consult with an EP from the Afib Clinic (at VGH) next Tuesday. I am considering just enduring this until I speak with him.
About nine months ago my episodes started coming tidily on the last week of every month (until now). Most of the time they were stopped with PIP of flec (when predominantly fib not flutter). Now flutter has taken over and it does not respond to the PIP dose of Flec. Two months ago I went back on 2 x daily 50 mg. flec.
For the last 24 hrs. my heartrate has been 101-115. At times it is so "mild" that I don't even feel anything until I take my pulse. How long can I sustain this heartrate without problems??? I have no other underlying health issues. My afib is genetic - no triggers. My blood pressure is normal.
How many ECV is too many??? I think I have asked this question before. In 2020 my heart has been "shocked" five times so far (once did not work and I had to go to another hospital to get the job done).
I hesitate to go to the nearest ER as the last time I was there I was placed in a bed next to a woman who had been travelling for months, was being swabbed for the virus, was now living in a house with one confirmed case of Covid 19. At least I was in-out in 2.5 hrs. I even walked to and from the hospital (30 min when healthy) to avoid having to use public transit. Don't want to call an ambulance for this "nuisance".

Any suggestion? RE:
How long to stay 100+ (in the past it has gone to 130+}? Is 5-6 days too long?
How many ECVs is too many?

Sorry you're in this situation. There is no number of ECVs that is too many. I've been cardioverted some 15-20 times and I'm by no means the record holder. ECVs do no harm and have no long-term effects. The tachycardia can't be left untreated indefinitely because it will eventually cause harm, but we're talking months or years, not weeks. Waiting until you meet with the EP next week is no problem whatsoever.

I saw no mention of rate control drugs. Do you have a beta blocker or diltiazem?

I would definitely not go to an ER or call an ambulance. You're in no danger and waiting a week won't do you any harm.

Thanks so much. This eases my anxiety. I am taking also bisoprolol and Xarelto.

I have always heard on this board that Flec is an antiarrhythmic drug and that we would likely also need a beta or calcium channel blocker to reduce the heart rate. But when I look at the description of Flec from the the Mayo Clinic they also mention that it treats fast heartbeats like Flutter and Tachycardia. So if Ritva only has a fast and regular heartbeat (flutter) is Flec alone appropriate?

https://www.mayoclinic.org/drugs-supplements/flecainide-oral-route/description/drg-20063854

Flecainide is used to prevent or treat irregular heartbeats (arrhythmias) such as paroxysmal supraventricular tachycardia (PSVT) and paroxysmal atrial fibrillation/flutter (PAF). Flecainide is also used to prevent life-threatening sustained ventricular tachycardia (sustained VT).

Flecainide belongs to the group of medicines known as antiarrhythmics. It works directly on the heart tissue and will slow the nerve impulses in the heart. This helps keep the heart rhythm normal.

There is a chance that flecainide may cause new or make worse existing heart rhythm problems when it is used. Since it has been shown to cause severe problems in some patients, it is only used to treat serious heart rhythm problems. Discuss this possible effect with your doctor.

Quote
JakeL
I have always heard on this board that Flec is an antiarrhythmic drug and that we would likely also need a beta or calcium channel blocker to reduce the heart rate. But when I look at the description of Flec from the the Mayo Clinic they also mention that it treats fast heartbeats like Flutter and Tachycardia. So if Ritva only has a fast and regular heartbeat (flutter) is Flec alone appropriate?

Flecainide has a very rare side effect of allowing the heart to conduct atrial beats to the ventricles at a 1:1 ratio. During flutter or AF, your atria can be beating at rates of 300 bpm or more. As you can imagine, if that kind of rate were to be conducted to the ventricles, it could be fatal. EPs will usually prescribe a beta blocker along with it to guard against this possibility. I've seen a few people prescribed flecainide only, but they're taking a risk. It's a rare side effect, but considering the potential consequences, I wouldn't recommend it.

Thanks Carey. I found a study from 2016 that also shows that using Flecainide and Metoprolol together is more effective (at least for rhythm control) than using these two drugs separately.

https://pubmed.ncbi.nlm.nih.gov/26893497/

This study is a monocentric, prospective, randomized, open-blinded trial on 173 patients with a recent episode of paroxysmal or persistent AF.

Patients were randomized into:
- group A (flecainide + metoprolol; n = 80),
- group B (flecainide only; n = 72), or
- group C (metoprolol only; n = 21).

Conclusion: Flecainide-metoprolol combination therapy improves effectiveness of rhythm control in persistent symptomatic AF and increases tolerability, with a concomitant reduction of side effects and a better compliance.

Maybe just up the beta blocker dose for the next week or so while you wait for the consult. Knock that rate down below 100 and there’s nothing to worry about.

I agree with Wolfpack.

Thanks for all the excellent responses. Yes, I will increase bisoprolol dose for now. My heartrate has been consistently between 100-115. This I can tolerate reasonably well. If it goes over 120 I start feeling lousy - from past experience.
Can't wait for the touch-up ablation.