Problems with Flecainide?

I started taking 300 mg of Flecainide with 30 mg of diltiazem at the onset of afib in late May. My episodes had increased to monthly before that, and I am scheduled for an ablation on 8/12. Initially, the Flecainide worked great, shortening my usual 18-24 hour episode to 2-3 hours, but the episodes became more frequent, now weekly and the Flecainide is not working at all, since I am 23 hours into an episode. Also took another 150 mg tab 6 hours and 12 hours into the episode. I also started Coumadin 2 weeks ago in preparation for the ablation.

I now have a pulse rate of around 120 when moving, ( but regular) , then when I stop moving it slows down and becomes irregular. (Both are not normal).

I'm wondering if anyone has had Flecainide cause an increase in episodes, and stop working. Also wondering how long I should wait to go to the ER to try to get converted. I was thinking of waiting and calling DR. Schweikert's office Monday morning for advice. I've always converted on my own in the past, but this feels different with the fast regular HR when moving around. The resting afib feels the same.

It seems the AFib is taking it's last shots before the ablation, which is frustrating, but at least it makes me feel I made the right decision in scheduling it. I wish I could have it done today!

Thanks,

John

Things have become more interesting 28 hours into this episode. If I'm very still, my pulse will appear to return to normal, only slightly faster than average, around 66 bpm. As soon as I stand up, it shoots to 120 , not irregular. Then when I sit back down, it spends about 5 minutes in what feels like normal afib before becoming mostly regular again.


I called DR Schweikert's office and a very pleasant Dr Coursin returned my call. I'm going to drive to Akron early Monday for a Tee and cardioversion if it doesn't return to normal by then.

John ( Ablation 8/12) It can't come quick enough!

Atrial flutter?

Could be flutter, I've never had that before. Thankfully, I'm pretty sure I'm back in NSR this morning, and won't be driving to Akron for a cardio version. Just gotta make it until next Tuesday for the ablation.

John

john:

The only way you would know what is/was going on would be to go immediately to ER and have a AKG run.

Liz

John,

Sorry to hear that you're having problems. Too many twists and turns with this afib. I don't blame you for wanting to have this ablation over and done. Hope you have no more incidents and everything goes smoothly on August 12.

Doreen

Hi John - glad to hear that you are apparently back in NSR. That sounds quite unsettling! I was on Flecainide for 5 years, and for me, it was a God send. I was at the point after 5 years of wrestling with Afib on my own, to getting Afib twice/day, every day. I started Flecainide and after they ramped it up to 300 mg/day, I finally got relief. I only had 1-3 minor/short episodes most months, and that lasted for 5 years. I did decide to have an ablation last September, as my husband was ill, Dr. Natale was in NY (where I live), and I decided that Flecainide had too many drug interactions. (what if I got another disease or needed to take an important medication but couldn't, because it didn't mix well with Flec.).

I think alot of people find it stops working after awhile, but for me, I had a pretty good 5 year run with it. At least your ablation is almost here.

Best of luck to you! ~ Barb

Thanks everyone, Yes Barb, I think Flec seems to work great for some, or most people. For me, I think it increased my frequency of events, then stopped working at all, followed by making me worse with a new "atrial flutter " twist. Dr Schweikerts Partner, Dr Coursin called me back in five minutes on Saturday after I contacted their on call line. He was great, not making me feel like I was bothering him on a Saturday evening. He set me up for a possible cardioversion today, but thankfully, I didn't need to go. His nurse called back this morning to check my status. I'm not used to such nice service from my medical care.

Heart held on yesterday when I had to run back to the car during an "easy" hike ( about 4 miles out and back) because my wife was having a low blood sugar episode. ( We forgot to take the glucose). Not something I wanted to do after having a 37 hour afib episode end that morning.

Anyway, one week to go.

John - My experiences there at Dr. Schweikert's Heart Rhythm Associates has been nothing but positive.
You're in great hands. Dr. Coursin did one of my ECV's. The whole team is not only extremely helpful and competent,
but very caring.

Best to you with your ablation procedure.

Jackie

Thanks Jackie, I'm glad to have found them

John21, with your ablation only a week away, should you go into flutter again just try to control the rate down as close to 100-bpm with either beta blocker or calcium channel blocker ( or a specific combo of the two with a higher dose calcium channel blocker like verapamil or diltiazem with a very low 12.5mg dose of immediate acting Metoprolol twice a day is just the straight BB or CC-blocker doesn't bring the HR down and stabilize it some).

Of course, discuss all this with your EP before doing it, but I would not try to do an ECV this close to your ablation, should you trigger again into either AFIB or Flutter if you can get the rate down to a reasonably comfortable and safe level and just ride it out for the next days until you go into the procedure while in the flutter where Dr Schweikert will have no problem at all in discovering right away where that trigger is and zap it along with the rest of the standard ablation protocol.

Best wishes,
Shannon

Thanks Shannon,

Hanging in there for now, had another "regular" afib episode last night, no flutter to speak of , resolved in 9 hours. Found of from Dr Schweikert's nurse that I am his first case next week after getting back from vacation. I asked her if that meant he would be "fresh" or "rusty" She said he is always "Fresh".
I've had more episodes of afib in two weeks than I usually have in a year. Getting ablated just in time, I Hope!

John

BTW,

I never had flutter before. Could I have had a bad reaction to the Flecainide? I took 600 mg in 3 doses (300,150,150) in 24 hours during the episode over the weekend. The episode still lasted 37 hours. Didn't take it last night and I converted in 9 hours, and I didn't have any of what I perceive as flutter. ( high regular HR around 120). It was just my normal afib in the 80-100 range.

John

John I find flec and flutter are close friends.
Mark

Flec is known to have pro-arrythmic effect in some people, A-Flutter in particular.
Flec is "use-dependent" meaning the effect is more pronounced the faster the Heart beats.

Flec helps some people get out of AFIB, but makes things worse when they try to use it preventively.

The max daily recommended dose for Flec is 400mg. Did you have side effects at 600mg?
Were you ever monitored in Hospital to test Flec safety for you?
To much Flec can literally slow down the heart so much is just stops, killing patient.

Your Doc should know this stuff, especially if you have an EP Doc, that all basic stuff that's in the Medical literature, and studies.