Flecainide

Hi Folks,

Last time in A&E i was given Flec 50mg to take to see if i had any adverse reaction to it. At that time the Afib episode had converted back to nsr, and i noticed no effects from the flec.
I live an hour and a half away from A&E and am still concerned about taking the Flec when i have another episode. Does it have a different effect on a heart in Afib to when in nsr?
I decided to call the ambulance next time and take the pill after they arrive.
Do you think i am being over cautious? My BP and HR are generally low, and i am very sensitive to beta-blockers.
I had another a few days ago, not too fast so i just went to bed and it converted in about 9 hours as usual. Attached screenshot shows it going back into NSR. Yay!

Regards
John

John,

Who knows how you'll react. I've taken 300 mg flec on-demand for over 10 years without any problem. Shannon took it successfully till it led to atrial flutter in a scary episode. Others have used it daily.

George

My thought is they are finding it to be safer and safer. I have taken it for years. I have had ER docs on phone tell me to pop one at times and they really didnt know all about me. I think its relatively safe as long as you have done the first time under a doc observation.
It does cause me another problem tho. It causes LBBB. the higher the dose the lower my heart has to be to go into LBBB. This would make some since right? because Flecainide is delaying the signals from the top heart to the lower heart.

JohnBM,

Just talk to your doc about getting a companion modest dose Beta Blocker or calcium channel blocker dose to take right before or at least at the same time as the FLEC dose, and that should give a good degree of protection from a possible pro arrhythmic event.

Pro arrhythmia from FLEC is not that common in any event, it's just that when, and if, it does happen to you it can be very disconcerting, especially if it manifests as a very fast 2-1 or 1-1 flutter as I learned the first hand. Taking a rate control drug like a BB or CCB along with the FLEC can help greatly reduce the odds of such an event and will help make the AFIB or Flutter you are having less intense while you are waiting for the FLEC to kick in and convert you back to NSR.

I did take an 80mg Verapamil that morning in Holland in 2008 when I had starting cycling between 2-1 and 1-1 flutter after taking a FLEC PIP dose but I waited much too long and the pro arrhythmia had already started and 80mg was not going to do anything then in any event. You need the supporting drugjust before or at least at same time as taking the FLEC.

FLEC is the best overall of the more readily avaiable AAR drugs to most afibbers for either long standing use or PIP. Amioderone is the gold standard for arrhythmia control and Tikosyn can be very effective too for some people, but both can have some nasty side effects that can greatly limit their appeal, especially when taken long term.

Shannon

Thanks Guys,
I will stick to my original plan and go the ambulance route, and add 25mg metoprolol to the mix before the PIP. I tolerated that well one time before.
Regards,
John

It depends on how much you going to take, (50mg is minimal). If it's the first time you are taking a bolus dose like 200-300mg, you should take the drug after your admitted to the hospital, and they know what you are doing. Ambulance technicians might not understand the PIP bolus dosing concept. I took 300mg Flec right as I went to the ER room, and my initial EKG was fine, and then I started having severe issues, almost passing out in the waiting room. Nobody would help me, becase they were looking at the initial EKG, and didn't understand what I was doing, and that my situation had gone bad fast as a result of the Flec taking effect. I would have your Heart Dr. give instructions written out what you are doing, and what the Hospital/Medical staff should look/monitor for.



Edited 1 time(s). Last edit at 02/14/2015 03:34AM by The Anti-Fib.

I'd agree. Flec caused me no issues when I took it as a PIP.

What is LBBB?

Sam,

LBBB is a 'Left Bundle Branch Block' .... I have an Infrahisian LBBB that is rate dependent and even though I no longer have arrhythmia, I still must keep my dual-chambered pacemaker active and renew it with a new one whenever the battery fades, just to help protect me should my heart happen to find itself at 188bpm which is my specific trigger rate for my rate dependent infrahisian LBBB. The pacer at least comes in handy for confirming no silent breakthroughs which was instrumental too in confirming my small stroke last May was, indeed, due directly to my LARIAT leak and upon interrogating the pacer the day after the stroke when I fly straight down to see Dr Natale in Austin and seeing that I had had zero mode switches (episodes of blips of arrhythmia) for a few years since before my LAA isolation, I was then sent to Scripps for 3DTEE which finally discovered clear as a bell the leak in my LAA from the late loosening of my LARIAT suture.

It's possible if I did not have the pacer in place, and set up as it is, that should such an unlikely LBBB triggering event occur again, I could keel over and be sayonara for good. Thus why I am stuck with the pacer even though I don't need it for any of its originally intended purposes. The LBBB was discovered after I was prescribed the pacer for what turned out to be a iatrogenic drug-induced Tachy-Brady syndrome and it just so happen by serendipity that I really did need it once the I-LBBB was discovered in my very first EP study done in 2002 during the same hospital stay for my pacemaker insertion.

Shannon

Thanks again for the advice. Written instructions sound like a good idea.
I should mention that the latest episode occurred after ectopics reared their ugly heads again. From excellent advice gotten from here I started the magnesium supplementation (Doctors Best) which totally knocked them out. Recently i decided to try good state ionic magnesium liquid (sounds like it should be more easily available to the cells). After a couple of weeks the ectopics started when i lay down to sleep. Whether or not it was co-incidental i dont know, but i discontinued the ionic, and went back with docs best, and ectopics have reduced again. Maybe its the honeymoon period after an afib episode. Anyway when i regain confidence i shall try the ionic again to see does it bring them on. Has anyone else tried the ionic?

Doctors Best worked for me. If thats what worked for you, then keep using it, and maybe add to it, but don't stop what is working, especially at this early stage.

Shannon:

Do you have your pacemaker interrogated every few months---I have a device that is hooked to my telephone and sends my pacemaker data to the pacemaker lab.

Liz

By the way, what is the antidote for flec if it produces proarrythmia?

Electrocardioversion for one

Hi Liz
,
My local EP in Scottsdale is just now setting the home pacer monitor for me. I don't have it yet but will before long. Will
Save me the two hour each way drive down from our mountain town here to the big city, though Magda and I or at times on my own make that trek often enough as it is. Still it will certainly be a convenience.

How do you like it Liz?
And thanks for the reminder, we were going to get that set up his at before Magdalena's cancer diagnosis derailed such every day kind of plans and your post just reminded me I need to call my EP and get that going again.

Shannon