Propafenone for vagal affibers

Hello,
My cardiologist wants me to change from flecainide to propafenone. But I've read that propafenone is considered unsuitable beause it may exacerbate the episodes of vagal induced AF (I'm a vagal affiber) (European Heart Journal (2008) 29, 632–639), and it may worsen symptoms.
Can anyone tell me her/his experience with this antiarrhythmic and its possible side-effects?

Thank you

Enrique - I am an ablated 'mostly' vagal afibber. I have used flecainide in the past and most recently, changed to propafenone (Rythmol SR) for a current treatment of breakthrough AF ( after10 years plus post ablaton due to treating Lyme disease)... and I do not find that Rythmol promotes more afib.

The Rythmol SR does contain some amount of a beta blocker which tends to keep my heart rate low and the side effect of that is that I feel sluggish and tired most of the time. I'm working on reducing the dosing slowly to see if I get relief from that side effect but still maintain the NSR.

With flecainide, unless a beta blocker or calcium channel blocker is also prescribed, there is a tendency for afib events to turn into a-flutter events which are difficult if not impossible to self-convert.... that happened with me on several occasions using just the flec alone.

If I were starting out with a first dosing of propafenone, I'd try to use the smallest dose available first to see if that holds rather than going for a immediate high dose. I think it would be easier to add more than try to wean down off of a higher dosing.

My EP said both antiarrhythmics work equally well. I changed to avoid the fluorine in the flecainide after I learned it does metabolize to a measurable amount of that toxin.

Jackie

Thanks, Jakie:
My cardiologist prescribed me 150 mg of propafenone three times a day. Is that dose small enough?
Enrique

Enrique... It may depend on body size and weight for dosing requirements but your dose and mine is the same... just that mine is once every 12 hours and yours is 3 x every 8 hours. Same thing.

The Rythmol SR prescribed for me is 225 mg twice a day.... which is equivalent to your dose. I've cut the morning dose in half and am doing well... It's my personal opinion that this dose is too high for me. It may not be for you.

Jackie

Thank you, Jackie. I will start with this dose and I will wait for its effects.

Enrique

I took Rythmol sr 225 2x daily.broke thru and eventually was on 425 mg 2 x daily..for me the side effects ( speedy feeling, dizziness, ) were similar to flecanide, to which I was switched...i also experienced dose creep on that , and went for ablation..anyway, I never heard that it was contraindicated for vagal a fibbers ( of which I am one)...

Jackie,. you said you halve your dose..aren't the Rythmol Sr in capsule form? how do you halve the dose? Extended release meds are supposed to be taken whole and cutting them in half can be risky...unless I have misunderstood you...

afapr14 - Yes - the Rythmol SR is a capsule. I've taken it apart and counted the contents and divided that into approximately half.

I'm not recommending that anyone else 'do this at home'... but so far, that half-dose maintains my daytime NSR. My next step is to halve the regular 150 mg Rythmol tablet for the daytime dosing and try that. If all goes well, then reduce that yet again with time.

I have always felt the standard recommended dosing of both flecainide and the newer Rythmol trial for me was a higher dose than I required.

Time will tell.

Jackie