Hello,

I would like to see if anyone with a profile similar to mine has found one of the antiarrhythmics better suited for not causing side effects related to disturbance of the vestibular system. Specifically, either sotalol, flecainide or Multaq.

I was ablated (index) last yr for afib. Many months later, I have had 2 episodes of A. flutter. I need another ablation, but prefer not to get ablated until the coronavirus situation settles down more, exp in TX, so I will be staying on medicine (which I would like to not be on!).

I take relatively low doses & am currently on carvedilol (Coreg) 6.25 mg b.i.d., flecainide 50 mg q.12 h., Xarelto 20 mg w/dinner.

Two problems I have with regard to the meds are:
1. Had a one & only, but major vertigo 2/1/20, which apparently killed a nerve & left me with a boing/boing feeling in the head on motion. (For ~10 years, I have also had a rare type of acoustic neuroma in one ear which caused deafness in that ear & I am monitored for that, which is a possible factor in my newfound vestibular symptoms). I got a lot better after doing vestibular training for a few months to retrain my brain. But when I started on flecainide after the 2nd atrial flutter, my vestibular symptoms increased.
2. I also have a moderate benign essential tremor which had disappeared on the low dose carvedilol, but has returned slightly since starting flecainide. It is mostly only a problem when eating or with fine motor use of hands.

I am wondering if I should just hang in there with flecainide or try a switch to Multaq or sotalol. I was on sotalol before & it gave me some moderate shortness of breath & of course it is a beta blocker (dizziness), so for that reason this time I tried flecainide. I do see unpleasant side effects listed for Multaq also though & i would have to meet a $435 deductible to start it.

Should I try a switch or just stay on flecainide? Not sure if the Multaq requires starting in a hospital setting.

Thank you.

Multaq does not require a hospital stay.

If you really think flecainide is the culprit (I'm skeptical) then giving Multaq a try is easy (other than the deductible). It's generally the mildest of the antiarrhythmics and has few, if any, side effects for most people.

Thanks Carey.