Flecanide safety

Went to my Cardio Monday to get a prescription for Flec (also have a call into Natale's office). I sometimes get A-flutter. He told me about how Flec can make a 1-1 atrial-ventricle conversion possible during a flutter when the flutter rate drops to around 250 or below, which would lead to a black-out heart rate - and worse, that that can infrequently lead to ventricular arhythmia which can of course be fatal. (for those who don't have a-flutter, it is a constant rather than erratic beat - the atria is usually contracting around 300 - 360 times per minute, and exactly every other beat is transmitted to the ventricals 2-1).
This scenario is a primary reason I didn't go on flec 2 years ago when things were as bad as they have been this week (I'm in afib 8 hours now and counting). He said that diltiazem inhibits the 1-1 conversion and wants me to take it along with the Flec. Both reduce heart rate which is a trigger for my afib.
Feeling stuck on this one and looking for feedback and knowledge about Flec, particularly as it relates to this a-flutter concern. Thanks, Ralph

Ralph,

Shannon had an incident like you describe. He posted about it in the last few months. From his description, the incident was very ugly. He is probably your best bet for advice here.

George

Ralph - The info you quote is accurate. Using flec w/o a rate controlling drug can cause aflutter. I don't want you to take this as advice to either use or not, but I'll tell you my experiences during my AF years. Since I didn't get along with most drugs especially beta blockers, I decided not to use them, but did continue to use the antiarrhythmic (flecainide) at dosing of 150 mg twice a day....and that worked fairly well. I was not AF free but the events always self-converted eventually. However, I did have one event that didn't and that's because the AF turned into the scenario you describe... A-flutter... and required a hospitalization and a wait to use warfarin, a TEE to see if I had formed a clot and then cardioversion. When I arrived at the ER, even the people there were alarmed at my high HR and other stats.

For me, with an already relatively low heart rate, metoprolol or diltiazem really render me incapacitated... but the thought of the ER experiences I've had with flutter give me pause when considering refusing a rate control along with the antiarrhythmic.

Last summer when I had the horrific AF breakthrough as a result of treating Lyme, when I was put back on heart meds... I was prescribed Cardizem
(diltiazem) and flecanide... Again, I was incapacitated both physically and mentally but I negotiated my way into an Rx of 30 mg. tablets Cardizem that I could cut in half and dose myself rather than the standard dose of 120 mg a day of the Sustained Release... (I believe that was the dose) .

I learned by experimenting that I could stay in rhythm and not have flutter with only 15 mg Cardizem dose in the morning and another 15 mg twelve hours later... along with the flecainide....

So I'm telling you this as a consideration that if you are able to get the 30 mg tablets and tinker with your own dosing, you may be able to actually feel relatively decent while taking the drugs. I'm very drug sensitive so not a good example but it did work very successfully... no AF after electrocardiovesion in early October '12...and still 'holding. Eventually I weaned off all but used only 50 mg of Flecainide (once again) and that held in NSR and now I'm off all drugs again.

Oh... I did learn that the new PIP protocol is the BB first and then 300 of the flecainide all at once. That's a nasty bolus for me!

I wish you good luck. I've had at least 4 flutter events... sometimes it can feel relatively benign and a couple have been the heart chaos from hell. I don't wish that on anyone so do be aware that flutter can be nasty.

Jackie

For me flecanide had bad side effects and I wouldn't give it to a dog, ask your doctor if he would take it.
Some people can take it ok. But I wouldn't recommend it.
And I should add it didn't stop my Afib.

Colin



Edited 1 time(s). Last edit at 06/12/2013 01:46PM by colindo.

Ralph,

See all of Shannon's posts in this thread: <[www.afibbers.org];

George

Ralph, I never had any aflutter bit Flec 350mg plus 40mg Diltiziam as a PIP always worked for me - fwiw

Thanks George. I'm not picking up the Flec prescription :0

Ralph - Flec was a God send for me. I've been on it for over 5 years now and while it's starting not to work as well, it gave me my life back. I wouldn't write it off so easily. I don't have any obvious side effects from it and it helped me a LOT.

Everyone is different ~ Barb

Barb, I think the problem for me is that I often get a-flutter. If it weren't for that, I'd be trying it.

Ralph Wrote:
-------------------------------------------------------
> Barb, I think the problem for me is that I often
> get a-flutter. If it weren't for that, I'd be
> trying it.

Could it be that the atrial flutter is really high rate atrial fib? This is what was happening to me last year and earlier this year. After recording my episodes, my cardio said it was aflutter but when I showed it to my EP, Dr Barrett, he said it was atrial fib. Since starting 50 mg flecanide BID and reducing my atenolol to 25 mg BID my AF has been very well controlled. Went 3 months without any problems. A recent bout of bronchitis set my afib in motion again (2 brief episodes lasting about 1 hour) but easily terminated by an additional 50 mg flec and 50 mg atenolol.

If your heart is structurally sound and you pass an echo and stress test, you are a good candidate for flecanide. I have had no noticeable side effects so far.

Cheers,
RalphL.

No Ralph, unfortunately, it is a-flutter. Not only recorded a full episode of it in the ER, but I can tell you that the feeling of A-flutter is very different than the feeling of afib. Aflutter is entirely in rhythm. It is very clear when I'm in it.