Flecainide and Beta-Blocker must go together?

Diane 98683 made this comment in a post: I am currently on Flecainide (plus 25 mg/day of beta blocker, which is necessary to prevent atrial flutter which I'd otherwise get with Flecainide)
Well, shoot, I am in the process of weaning myself from a beta blocker because my understanding is it can cause issues with a vagal afibber like myself. I've been taking it for about 7 years, starting with 25 mg/day and increasing to 50/mg just last year on doctor's advice because of increasing episodes of afib; doctor started me on flecianide a little over 4 years ago when it was apparent the beta-blocker wasn't stopping anything. I wasn't doing any supplementation then. Here recently the afib episodes have increased even more despite the increased dosage of flecianide and beta-blocker; presently taking 200mg/day flecianide and less than 25 mg/day of the beta blocker. My hope, after eliminating the blocker, was to decrease the flecianide, maybe to zero, since it seems to be losing effect anyway.
I didn't consult my doctor on this for I am pretty sure what he will say; hoping to go in to my annual visit with him in March and proclaim "I'm off the beta-blocker, cut down my Flecianide, taking supplements and watching my diet and afib is under control!" Perhaps I'm getting too far ahead...
So, my question to Diane 98683 and phorum followers is: Does one have to take a beta-blocker while taking flecianide to prevent atrial flutter?
May beta-blockers cause more problems than solve for a vagal LAFer in good health?
Thanks to all. I am learning so much and hope to pass on what I'm learning.
Splashing cold water on my face the last few times I felt afib coming on has stopped the episodes, well, cold! Presently increasing magneium glycinate intake to bowel tolerance, watching salt intake and have slowly increased potassium, taking 1 gram of Taurine/day and began Omega 3 supplementation again. Afib free for almost 4 days, which lately, has been an accomplishment.
Thanks, Marty

Hey there, Marty.

From personal experience, BB while on flec doesn't prevent flutter.

/L

Marty,

You are absolutely correct. Beta-blockers on a continuous basis are a very bad idea for vagal afibbers. As a matter of fact they can only worsen your condition. There is no evidence that they prevent flutter whether or not you are on flecainide. However, they do reduce the heart rate if you do go into flutter. This is important as flecainide (and propafenone) have the tendency to cause the AV node to switch to 1:1 which is highly uncomfortable and dangerous. Nevertheless, if you have never experienced a flutter episode and have not been diagnosed with atrial flutter there would seem to be no benefit in prescribing a beta-blocker with flecainide. I am sure your EP/cardiologist will agree with that if he/she gives it a bit more thought. A beta-blocker or calcium channel blocker is of course useful in reducing the heart rate when you actually have an afib episode.

Hans

Marty,

Have you tried ginger? It has been a godsend for me.

[www.afibbers.org]
<[www.afibbers.org];

George

Thanks LarryG and Hans,
I haven't been diagnosed with atrial flutter though I think I may have experienced it. Sometimes when an afib episode is beginning my heart rhythm is actually fast and regular, then changes to a less rapid and irregular pattern of afib. The pattern reverses itself when the afib episode is ending, going from irregular to fast and regular, then stopping. These fast, regular beats have never been uncomfortable; in fact, they were occuring last Monday and I had to check my pulse just to know they were happening. Last Monday, though, was the longest occurence of these fast regular beats, lasting about 10 minutes during my drive to and the beginning of a yoga class, where they changed to afib when class got underway.
I will ask my cardiologist about this during my visit with him the end of March.
Feel like I should be cutting back on the flecainide. It worked rather well at first, limiting episodes to one every 2 or 3 months for the first couple years, but lately I've been having an episode every other day. And when they do convert to NSR, rather than staying there, an hour later will begin again. And, never experienced these rapid, regular heartbeats before taking flecainide.
I worry sometimes that the last 5-7 years of taking these drugs has made things worse.
Marty

Marty - I have considerable experience with your dilemma. As is traditional, I was put on the metoprolol and flecainide... felt terrible and it wasn't completely keeping me in NSR. About that time, I joined this forum and learned about BB's being contraindicated for vagals... of course, the cardiologists I'd seen had not mentioned that at all. I decided to wean off the BB and use just the flecainide. I was warned by the cardiologist that I was likely to have flutter and, eventually, I did have one episode that had to be electrocardioverted. I took only flecainide for about 3 years. However (and eventually) in my afib challenge, I was able to successfully wean down from the 300 mg a day to 50 mg a day by optimizing the magneisum, potassium and taurine intake at the same time.... and the remarkable thing was that I went from having AF every day or every other day... often 24 hours or more and a 4 hour break of NSR and then back into afib for another 24 hours... to zero events... but still on the last 50 mg. I seemed not able to get off that small dose before my ablation date. I've always felt that had I had another month or two, I would not have needed the ablation.

Just go slowly and optimize your electrolytes.

Jackie

Flecainide is great for some people but for others it has some nasty side effects.
In my case, 2 weeks after I started taking it, I got what I thought was atrial flutter, my chest would vibrating at about 250 bpm. But only when I was asleep, I noticed it when I woke up and in a semi conscious state, never when fully awake.
This progressed until I was experiencing these events every night.
I stopped taking flecainide after 2 months but these vibrations or flutter continued.
I had a 7 day event monitor test done which recorded 2 of the worst night I had experienced of these chest vibration. I was woken up 3 times during the night with my chest shaking like I had a mob. phone vibrating inside my chest.
The monitor results came back and showed I was in NSR during these events.
It has been 6 weeks since I stopped taking it, I am almost back to normal, and I will NEVER take flecainide again.

Colin



Edited 2 time(s). Last edit at 02/16/2013 11:55AM by colindo.

Colin - I totally agree with you about flecainide being a nasty drug. It caused many side effects for me including visual disturbances and an overall feeling of extreme fatigue, muscle weakness and more. Overall, it was not totally effective for me during the 4 years I took it but at the time, it seemed to be the most effective according to my EP...so I used it.

I'm so glad you are off the drug and are now doing well.

Best toyou,
Jackie

Colin , did the monitor not show any Afib or flutter ? I keep a stethoscope (from ebay ) under my pillow, and listen to my heart when i have events. Usually the Ventrical is beating slow but the atrium is vibrating (you can hear a slight buzz).

Last night I actually caught my heart going into Afib (as i was woke up by a phone) during sleep as i was lying on my side (i think it though i was asleep). I started to feel flutter, then felt my ventrical skip and then slowly speed up skipping to a fast rate. It slows down and goes back to NSR when i rolled over on my back .

I am building a monitor ( im into electronics) that will detect Afib and have a buzzer to wake me up. Also it will be able to log all night as well. I see most of the monitors out there only record 30 mins at a time.

This thread made me remember what the Mass General EP told me when I was on Flecainide before the ablation. He said to always take Diltiziam with it to avoid or lessen the chances of ventricular conduction.

LarryK,

There was no sign of Afib or flutter, just NSR. That is what the nurse told me.
I wondered at the time if a 2 lead event monitor would detect flutter but was told it would.

It was a bit like shivering without feeling cold.
Very strange.
I remember once, experiencing the vibration when waking up and still in a semi conscious state and my phone rang with a short quite tone indicating I had received a text. The vibration stopped instantly. I was fully awake then.

I am still getting vibrations occasionally 2 months after I stopped flecainide.
This stuff can effect you mentally.

-Colin

Just FYI - my experience is that it seems to be difficult for some doctors, nurses and even some EPs to distinguish aflutter. That seems astounding but I have experienced it first hand. Apparently, some fail to detect the very fine distinction on the rhythm strip that identifies A-flutter from sinus tachycardia.
Hard to believe, but true.

Jackie

When I started taking Flecainide about 4 years ago, at first it seemed to work pretty well, but as a frequent afibber, not well enough. The cardiologist increased my dosage and it worked better - but still not completely. I complained about the "breakthroughs" and when she said it looked ilke I was gettin some Flutter, she suggested increasing the dosage again. I did that, and also had her send her cardio report to my EP. He said that he could understand why she thought it was Flutter, but actually, it wasn't.

I've been on a low dose of Atenolol (mornings) and a high dose of Flec for 4.5 years now, and overall, am hanging in there. I've learned when to take an extra dose of Atenolol (when I do have Afib and my heart is going fast or hard). For me, Flecainide was a game changer. I went from having Afib every single day, sometimes twice/day, to only getting it a couple of times/month, and not for long. Nontheless, I am considering an ablation more and more as I don't want to be taking medications for extended periods of time, and I don't want to get Afib at ALL anymore.

Of course, when I'm going through a "good spell", I decide I can hold off. It's a roller coaster ride.

Not sure if that answered any of your concerns, Marty, but thought I'd share. ~ Barb