Does daily flecainide lead to increased risk of stroke and fibrosis?

McHale recently commented on another thread:

"Waiting too long only leads to stroke and fibrosis even in well controlled patients on AAR's."

I responded:

"How so? On what basis will 150mg/day of Flec lead to stroke and fibrosis when I only experience a few hours of 85bpm AF per year this last 7 years? (First diagnosed AF 1999.)

Please let me have your views."

Are you out there McHale?? I'd appreciate your views - as well, of course, as those of anyone else (-:

I suppose I take the view that for me - for the time being at least - flecainide is the lesser of the available evils. But if it does significantly increase stroke and fibrosis (over and above the AF burden that I would undoubtedly otherwise have - then I need to know about it (!) and bring my eventual inevitable ablation forward. Needless to say, at 54 My present plan is to stick the relatively small 150mg/day flecainide regimen for as long as it holds during which time ablation know-how, efficacy and safety improves.

Best regards to all,

Mike F.

Hi Mike,

I'm guessing it depends on what is meant by "well controlled." Seems to me that afib burden would be a huge variable in this equation. Also seems that well controlled could mean a lot of things and that you are on the end of the spectrum where your risk of stroke and fibrosis increase would be very small. I'm essentially in the same boat. In the last 29 months, I've had about 1 hour 15 minutes of afib, in one episode. I calculate my afib burden as 0.006%. This compares to 11 years ago, when I first had afib. My burden for the first 4 months was about 57% (including a 2 1/2 month episode). Once I figured out how to control it with K+, Mg++ & taurine, the burden was on the order of 0.02% for years. Then I went through a divorce and inadvertently increased my Ca++ intake by stress eating wheels of cheese. My worst afib burden during this time, was 4 days with a 4% burden. Other than that it was < 0.1%, though still > than the 0.02% of the preceding years. Of course the 0.006% of now is the best I've done. Hence, I don't see myself in progression.

I can say, that had I not resolved the 4% burden, I would have opted for a Natale ablation post haste. Fortunately I was able to reduce it almost immediately, though it took another 7 months to figure out the Ca++ issue.

So, for me, the question is, what level of afib burden is too much? This is obviously an something each person has to answer. I can say 4% would be too much for me and I would worry about increasing fibrosis.

Cheers,

George

Hi Mike - I'll weigh in here with my personal experience...but don't take that to mean everyone can do or should the same. It worked out very well for me and I certainly tested the limits with my saga.

My initial afib began at age 59. Once I started using flecainide for arrhythmia.. about 3 years after the onset and after first being prescribed sotalol which didn't work at all, I was mostly afib free for the next 7 years. The practice back then was also to place afib patients on warfarin. For me that didn't work well with my low platelets and once I started flecainide and the companion drug, metoprolol, I 'bargained' with my very knowledgeable cardiologist who worked closely with the EP's at the Cleveland Clinic. He agreed that as long as I felt comfortable using my natural anticoagulants, it was acceptable to him. I asked if he wanted me to sign a disclaimer and he said ... not necessary.

You probably remember my story which was I stopped the metoprolol because it was also making me feel terrible. I managed very well on just the flecainide with the directive that if I did have AF breakthroughs, I'd use the metoprolol to slow the HR and along with a bit more flecainide, and I would probably convert quickly. That worked ...until it didn't.

In years 7 and 8, I began to have more frequent AF which often was also a very long duration as well. 8 - 10 hours in afib was not uncommon and then it went to longer stretches lasting close to 20 hours. The worst was 24 - 27 hours, converting to NSR for 4 hours and then back in another bout for another 24 hours. After several months of that was when I signed up for ablation #1 with Dr. Natale in 2003.

All the while during those 8 years prior to ablation, I dosed well with the natural blood thinners including Nattokinase, 6 grams daily of Omega 3 fish oil, ginkgo biloba, other natural antiinflammatories including curcumin, and of course magnesium....all known to help reduce the clotting tendency. Maintaining alkalinity is also very important.

If anyone was prime for a stroke, I certainly was and I am grateful for all of the useful information I found on at various natural health websites on the topic of stroke prevention by natural means and my FM MD who gave me ideas as well and especially that by the late Ken Kensey, MD, who wrote about hemorehology and fluid dynamics. That information helped me feel comfortable with the approach I opted to use thanks to Ralph Holsworth, DO, who directed me to that research and Dr. Kensey's books. Now, Dr. Holsworth has collaborated with Jonathan Wright, MD and Meridian Valley and the Hemathix blood viscosity is available through that laboratory.

I've often referenced my post on "Sticky, thick blood" and appropriate testing to be sure that those markers are low in the range helping to insure that blood is not sticky, but rather, 'thin and slippery.' Drivers of inflammation are prime in contributing to sticky blood that clots easily. So many factors influence inflammatory responses that produce 'sludgy' blood and unfortunately, those predictive markers are not typically considered standard blood tests so one has to push to have those assessments regularly. Fortunately, for me, it was automatic with my functional physician.

This is critical information regardless of the Afib factor and especially as one begins to mature. A lot of 'stuff' begins to happen as a result of diet, environmental exposures, EMFs, oxidative stress and just "living" these days so my experiences 20 years ago are even more relevant today.

Most of us have easy access to nature's great aid the "Earthing" or "Grounding" factor that Cardiologist, Stephen Sinatra has so widely talked about and how it helped his son very seriously ill from EMFs. Walking barefoot on the ground or wet sand near water helps reduce platelet clumping in a very short time. The photos are graphic. I would not want to part with my Earthing pad that's at my feet at the bottom of the bed for a nightly treatment. Consider reading the book, "Earthing - The most important health discovery - ever"... by Clint Ober, Stephen Sinatra, MD and Martin Zucker. (c) 2010 - Read some at the "Look Inside"[www.amazon.com] feature on Amazon.com
And refresh your memory with some of the posts here on Grounding or Earthing. If you can't locate, let me know.

Be well, Mike.
Jackie



Blood viscosity - The unifying parameter in CV disease risk: [www.holisticprimarycare.net]

Commentary: [www.bloodflowonline.com]

Is Your Heart Pumping Sludge: [imcwc.com]

Sticky, thick blood - risk of stroke or MI
September 06, 2012
[www.afibbers.org]

The Blood Thinner Cure : A Revolutionary Seven-Step Lifestyle Plan for Stopping Heart Disease and Stroke
Kenneth R. Kensey MD and Carol A Turkington (c) 2001

The Origin of Atherosclerosis - Volume 1 An Introduction to Hemodynamics
Kenneth R. Kensey, MD and Young I. Cho, PhD (c) 2001



Adding a PS on 10/9/15 - regarding the question about increased risk of Fibrosis...

All drugs deplete magnesium and magnesium deficiency is known to allow for fibrosis formation. Lots of previous posts about William Rowe, MD's research with endurance athletes, MgD and fibrosis.


J



Edited 1 time(s). Last edit at 10/09/2015 09:43AM by Jackie.

Jackie and George,
Many thanks for your responses.
George, my AF burden was 0.03% last year and thus far for this year is 0.01%.
Jackie that material on earthing/grounding is on my reading list!
With hindsight I suppose McHale's assertion could be interpreted in two ways. Either that even with good control with AARs the remaining AF is still enough to cause significant risk of stroke and/or fibrosis OR that the AARs themselves independent of any AF burden can cause significant risk of stroke and/or fibrosis. I chose - rightly or wrongly - to interpret as per the latter whereas George appears to have gone for the former! My main concern with Flec is that it will lower my EF, but since I still have plenty of stamina in general and that my resting HR as I write this in the early evening after a light meal an hour ago is circa 50bpm, I can't imagine I have too much of a problem in that regard.
Thanks again guys and wishing you well also,
Mike F

MWCF, does that mean you only had 3 hours of afib last year?

Enrich,

Indeed it does. 3 x 1hr episodes all nocturnal all converted to NSR with 200mg Flecainide.

And long may it continue (touching wood and everything crossed.....)

Incredible! Congrats!

I am at 25 hours this year. 7 months between episodes. Hoping I'm done for 2015!

-Eric

McHale recently commented on another thread:

"Waiting too long only leads to stroke and fibrosis even in well controlled patients on AAR's."

Mike,
I guess what I'm saying here is that I waited too long and although Flec was controlling my afib, it took just one weekend of uncontrolled and choatic bursts of afib that led to my stroke 3 days later. Also another poster here was on Flec for 10 years and was well controlled, only to find out that she had buildup way too much Fibrosis and needed a second procedure; a LAA isolation to finally put the beast down hopefully for good which may require long long anti-coagulation. Remember afib is cumulative and the disease eventually spreads outside the PVI's.

Not saying using Flec or another AAR leads to progressive fibrosis or eventual stroke but......if you get a chance to get abalted by a top EP why not.............

McHale

Thanks for the response McHale.

With my present AF burden of one to four hours per year, I'm not unduly concerned about either fibrosis or stroke (I take a junior aspirin per day for its wider benefits anyway) and, as such, am reasonably relaxed about leaving an ablation for another year or two. When the time comes, I'll know it and will be on it!

Best regards,

Mike F