Disopyramide vs Flecainide

I am currently 54 years old. I had my first afib in1999. Periodic episodes treated with pill-in-pocket propafenone until 2009 when attacks became daily. Always occuring about 10 pm. Cardiologist put me on 150 mg of flecainide twice daily but still had weekly episodes. Always at night and terminated when I woke up in the morning. Now episodes are daily and lasting 12-14 hours. The doctor had long ago said it is vagally mediated. He has now decided that the flecainide is no longer effective and says disopyramide (norpace) is the better medicine to stop vagal afib.

Has anyone had succes with Norpace for vagally mediated afib and has anyone had No success with flecainide but Norpace worked? Looking for any information/advice about flecainide vs Norpace. I am also now taking 1 gm of taurine daily. Any advice or thoughts about taurine?

Just curious if you have ruled out ablation, if the taurine doesn't help (it didn't with me).

Dnrec,

I had afib for 11 years, the first five undiagnosed. Then finally it was caught and I went on meds, started with Flecainide, but went off it shortly and then tried Norpace. I don't remember why I switched to Norpace (11 years ago), but I had no problem after switching. However, I did average 30+ episodes a year for the next five years until I had a successful ablation.

I would like to have an ablation however my EP says since I have no debilitating symptoms such as fainting or pain or shortness of breath, he would not recommend it. My afib is more of an annoyance than anything. It does not affect my daily routine and after several hours it does stop. However it has been lasting longer. I am convinced it has to do with my stomach. Thanks for your help.

dnrec,

I was much like you, the afib was an annoyance and didn't keep me from living a normal life including a lot of exercise and physical activities. The one thing that tipped the scale was that my wife and I enjoyed extended hiking trips in Europe and I didn't want to get stuck on a long climb with afib, so I wasn't planning any trips. Once I had the ablation, then the trips were on.

My episodes over the years grew longer and more frequent, plus I hadn't found this forum, so I didn't try any of the supplements to help manage the afib. While I am a skeptic, I do think that adding Taurine, Magnesium and Potassium in small amounts has reduced the number of my occasional ectopic beats since the ablation, and will hopefully keep it at bay for a long time. So far, 6 years afib free.

I'd get an ablation if I were you. If you wait, your afib will become persistent and then an ablation is less likely to work. I'd get an ablation ASAP.

dnrec,

I was much like you, the afib was an annoyance and didn't keep me from living a normal life including a lot of exercise and physical activities. The one thing that tipped the scale was that my wife and I enjoyed extended hiking trips in Europe and I didn't want to get stuck on a long climb with afib, so I wasn't planning any trips. Once I had the ablation, then the trips were on.

My episodes over the years grew longer and more frequent, plus I hadn't found this forum, so I didn't try any of the supplements to help manage the afib. While I am a skeptic, I do think that adding Taurine, Magnesium and Potassium in small amounts has reduced the number of my occasional ectopic beats since the ablation, and will hopefully keep it at bay for a long time. So far, 6 years afib free.

I agree about getting an ablation before it becomes persistent. Not that it always will, but this forum helped me to decide to go for a ablation (well I already had an appointment but was wavering a bit) and I did almost a month ago. Apart from the day after the procedure when I had what I liked to call 'on demand AF' (only when lying down, stopped when I stood up) I've been blissfully in NSR (touch wood). Before the ablation I was having twice weekly episodes on average and was taking 300mg Flec + 40mg Diltiziam as a PIP. That was just too much - too much dreading at night for it to crank up.

afhound,

You may be interested in this quote from Professor Coumel's foreword to my first book: Lone Atrial Fibrillation: Towards a Cure:

For instance, the first patient who led me to describe vagally-mediated PAF was alternately in sinus rythm or AF depending on whether he was standing up or lying down.

Hans

Thank you everyone for the advice. I need to have a more serious conversation with my EP and if necessary perhaps find a new EP.

Hans, that is interesting. It only happened to me 'on demand' that one day right after ablation. Before that AF would mostly (but not always) be vagially-mediated and would certainly not stop if I stood up (or start if I lay down).

fwiw this has been linked to elsewhere and it made a lot of sense to me..

[blogs.theheart.org]

dnrec,

Disopyramide has strong anticholinergic properties, which means it is vagolytic and a good choice for vagal afib. There are some other vagolytic choices such as Propantheline Bromide that are not class 1A rhythm meds and don't have the potential for issues such as torsade de pointes that you may wish to investigate. If you send me an email I will get you more info. I'm traveling so my response time may be slow.

In general, a vagolytic med will change the character of the autonomic nervous system to be less vagal and therefore MAY prevent afib from occurring.

In a paper by Professor James A Reiffel MD entitled Have Sanctioned Algorithms Replaced Empiric Judgment in the Selection Process of Antiarrhythmic Drugs for the Therapy for Atrial Fibrillation? The following:

“There are some forms of paroxysmal AF that do not fit into the major published algorithm categories. These include autonomically mediated AF (vagal, sympathetic), usually in patients without SHD (structural heart disease) ........... for parasympathetically mediated AF I have found that vagolytic agents (eg, propantheline bromide, urecholine, tincture of belladonna) may be sufficient as a preventative therapy (or may be added to another AAD) and disopyramide may have uniquely advantageous efficacy.”

In another paper by Professor Reiffel entitled Selecting an Antiarrhythmic Agent for Atrial Fibrillation Should Be a Patient-Specific, Data-Driven Decision he wrote:

In patients who appear to have a parasympathetic (vagal) contribution to the development of AF (as with nocturnal, postprandial, or bending-associated onset), a regimen that possesses anticholinergic properties may be particularly useful (e.g., disopyramide), whereas vagomimetic drugs (e.g., digitalis) may be profibrillatory. Although the literature does not contain prospective series contrasting drugs with different autonomic profiles in such patients, my own experience suggests that nocturnal paroxysmal AF can be totally or substantially limited by the pre-bedtime administration of either propantheline bromide (without an associated AAD) or controlled-release disopyramide without a repeat dose in the morning.

Regards,

George

I thought Flecainide was also good for vagally-mediated AFib (I even read it somewhere on this site). It's been working well for me, and my AFib is definitely vagally mediated. Isn't flecainide somewhat vagolytic?

Hi George,
Thank you very much for the good advice here for medicines for vagally-mediated AFib. I am living in Sofia, Bulgaria and for some reason they do not have here neither disopyramide nor Propantheline bromide. There is one drug called Quinidine which is supposed to be close to Disopyramide, however, when I look at literature some authors say it is more risky for pro-arrythmia. The other drug is Propafenone, but this one has beta-blocking effects and is not recommended for people like me with asthma.
Could you please recommend me other alternatives that I can check if they are available here or if you know about internet site where I can order drugs like disopyramide from here?

Regards
Dobromir