PACs / flecainide

I'm 62 and generally healthy..except for this afib thing.

Been on very low dose metoprolol 5 years after a couple of afib/flutter events.
PACs have increased from a couple a day to several every minute. My cardio doc ignores them.
PACS might be induced in part due to bradycardia: my resting HR is high 40s (ex runner).
I am concerned that PACS accelerate the progression of afib and, separately, atrial damage.
For that reason I want to try flecainide, but without a betablocker to avoid bradycardia (which will probably be worse).
Any experience out there with flecainide without a rate control drug?
Flecainide affect on PACs?
Any experience/knowledge of progression of PACs at this level (20,000 a day)?

thanks. sven

If you have not seen an EP Doctor, that would be my next stop. Plenty of articles out there on PAC/PVC progression and the effects on the heart when too many of these for long periods of time. Not so benign as once thought. I recently read an article that anything over 100 ectopics a day should be addressed. There are many recent articles on this topic - suggest you do some research. Many of these articles are on this forum.

I have been on Flecainide for many years for this. It does help control these extra beats, but over time can lose effectiveness, so dose adjustments are common and sometimes combined with BB (so many to choose from) or Calcium Channel blocker . Everyone is different. This drug has been around for many years, and for a lot of Docs first go to. Unfortunately, as my EP told me, when comes to meds, trial and error to see what hopefully works. More EP's are doing ablations for these because of recent research.

Here is one research article to get you started. [pubmed.ncbi.nlm.nih.gov]
There are more recent ones than this.

Hope this helps.

Quote
swhanson
Any experience out there with flecainide without a rate control drug?

There is a risk there that most EPs don't want to take. It is possible for Flecainide to allow a one to one beat conduction between the atria and the ventricles. This could be very dangerous. I'm sure Carey could explain this better.

Before you try Flec. try Magnesium in 3 forms Glycinate....Malate....Taurate taken all together. I....like you...were having that many (20K) or more Pac's a day earlier this year + this combo of Mag. dropped them down to a few hundred in a few days + now 6 months later to just a few dozen or so a day give or take.
I have had many posts about this in the last few weeks on other threads so you can find them easily with much more detail.

I know being Pac Hell/Jail is horrible....i personally would rather be back in lone Afib with around 10 episodes a month then have 20K Pac's a day or more as you can KO the Afib quickly with a PIP + then you have relief for 2 or 3 days anyway but it is much harder to treat/deal with Pac's of that many a day.

GL

I agree, experiencing these ectopic beats at high levels is worse for me than having AFIB episodes. More EP's are treating high burdens with ablation - technology has improved in tracking and fixing. When the meds stop working, I am heading in that direction.

There are reasons to do flec w/o a rate control but you would want an EP to make that call. Not a GP or a regular card.

according to my cardiologist I have recently been having PACs vs AF altho when I went to their office last week for EKG of course my PACs had stopped and I was in NSR so they couldn't tell other than my description. All I know is I feel worse with these PACs, I could not feel the beats but I felt strange and felt horribly tired which is why I felt my pulse and realized I was having problems altho it was only 97. So is this normal to feel this way with PACs?

With myself, there is great variation in how PACs feel. Sometimes they are not noticeable. Otherwise, they wake me. Never are powerful....as other folks have reported. Some folks are greatly bothered and feel substantial impact. This is not the case with me. Sorry, I can't give anything useful.