Could a lower dose of Flecainide be more effective than a higher dose?

Hello All,

Based on following this Forum for a number of weeks now, and paying attention to my own Fib/Flutter episodes, I have a theory about my AFib/Flutter and am looking for thoughts.

Does it sound possible that without Flecainide my heart will go into AFib, but, with 150 mg twice per day I am protected from Fib, but, the Flec puts me in Flutter? 2 years ago at the first Fib/Flutter onset I was put on 100 mg 2X per day of Flec and remained in NSR for over a year. When I then had a Flutter episode I was switched to 150 mg 2X per day. Since then my flutter episodes have been more and more frequent and for the first time in 2 years looks like it will take a cardioversion to get back to normal (scheduled for next Wednesday). I wonder if instead of going up to 150 mg's I should have gone down to 75 or 50?

I'm thinking cardiovert and drop the meds to at least 75 mg 2X per day? I read in this Forum about a number of people on only 50 mg 2X per day. My cardiologist thinks i'm crazy to try it.

While ablation is looking like it is in my future, I feel like I should try all the obvious cause/effect solutions.

I have a lot of great information and advice about Flec causing Flutter from you all in this Forum, but, wondering specifically if anyone has experienced a lower does being more effective than a higher dose.

Thanks to you all I have been taking 600 of mag/day for over a month and a half and eat tons of potassium rich foods and sleep on my right side. Interesting side note is i have been a 1 or 2 time per week migraine sufferer for 50 years and have not had one for 3 weeks; a record. The magnesium? Placebo? Who knows, but, keeping fingers crossed that after next week's cardioversion I might find the magnesium really makes a difference...

thanks all.
steve



Edited 1 time(s). Last edit at 05/26/2017 03:48PM by smb.

Steve - It's worth a try to lower your flecainide dose. I have abundant experience with long episodes of Afib and also extended flutter episodes. When I cut back on the high dose flecainide, it seemed to lessen the flutter tendency... (until it didn't)...which is typical with flutter that tends to be progressive... and nothing I tried made a difference so I was having ECV's frequently...which resulted in ablation.

One tip... if you are at bowel tolerance with 600 mg of magnesium daily, then that's one thing...but if not, then you need to keep ramping up the dose gradually until you are at the tolerance level... because then, the "ton of potassium from foods" you consume can work as work. But until the magnesium is max, a 'ton' of potassium can actually make things worse.

And, yes, migraines are frequently managed by repleting magnesium.

Keep us posted on your progress. Wish you will with the ECV.

Jackie

Thank you Jackie... i am upping the oral magnesium and i just ordered some topical (based on a prior post of yours).. cardio-version this Wednesday(first time since inception of fib/flutter 2 years ago; clearly have moved from paroxysmal to persistent) and i plan to lower the Flec dose in half to 75 mg 2x/day. We will see .. Meanwhile, mentally preparing for ablation. Tomorrow ends 14 days with a ZIO patch. While i'm confident i'm in flutter 24/7, I think it will inform the ablation decision (flutter or fib and flutter) as that time approaches.

steve

Steve - after my first ablation, my heart was mostly calm for the greater portion of 11 years. However, when afib re-surfaced again, it was first a mix ...just afib and then afib that turned to flutter... then always flutter that required ECVs.
No matter what I tried, I was unable to prevent the recurrent flutter. The EVC might last a couple weeks and then back in flutter. While I would rather have not had another ablation, I knew that the flutter was unlikely to go into remission and I've never regretted the decision to go back to Dr. Natale. So I recommend to you to keep an open mind that it may be best to go sooner, than later.

As a reminder, if you are not on a formal anticoag, then please be aware of the potential for the clot risk factor as reviewed recently in the "To thin or not to thin" post.

I wish you well with your extra magnesium, etc.

Best to you,
Jackie

Thanks again Jackie! Thanks to the education from this Forum I know an EVC is just buying time. Although i do want to see if the magnesium has made any difference. I still have my fingers crossed, but, i'm 3 weeks without a migraine.. Every day sets a new record. I'm convinced magnesium made that difference. Amazing. I'm buying time before the ablation for a few reasons, real or imaginary. 1. I'm guessing that between now and a procedure it's best to be in NSR as much as possible, 2. I need to make doctor/financial decisions. I have done enough homework to believe Dr. Natale is "THE" best in the business. My EP doctor did some of his training in Natale's clinic and follows everything Natale has to say. Even though my EP doc does about 250 per year, he says Natale has the knowledge, experience, and infrastructure to do the most complicated cases, 3. because my current issue is Flutter, i'm still considering starting with only the Flutter ablation first. I recognize that a Fib ablation is likely the next step, but, as a patient i'm still seeing the full fib ablation as being way, way, bigger and more time consuming. I understand the "while you are already in there" concept, but, getting in there seems small compared to the time and invasiveness while in there. And 4, I have very interesting insurance "that I chose". I am only covered at one medical center. I can choose a different plan to start in January. Not sure of the implications of waiting until then. All things considered, if i'm only doing a flutter, it's covered at a medical center with an experienced EP, who seems to have great outcomes, it may make sense to get the simple flutter done now and opt for the different insurance coverage for January.

and also thanks! yes, i am on twice daily Eliquis. While my hopes would be at some point after a successful ablation i could drop the blood thinner, i see the imperative right now.

steve

Steve - thanks for the elaboration... and definitely, give your plan time to play out.

I totally believe in exhausting all possibilities first. It can take several months or longer for adjustments and added magnesium to make a difference so there's no hurry if you are functional. That was not the case for me... but you are undoubtedly younger than I.

Let us know how you are.

Best to you,
Jackie

Hello
I have been taking flecainide for over ten years and have had two ablations over that period which did settle the afib down for a couple of years.
I am now having an episode every three or four days which continues up to eight days then the heart comes back to normal for three days which gives me some relief. My doctor tells me that I will go into permanent afib shortly and there is nothing to they can do.
My next appointment is next week and I will be discussing the need to keep taking flecainide as I think its causing more problems than helping the afib episodes.
Has anyone else gone into permanent fib, if so how are you managing the condition as I find it certainly effects my quality of life.

Regards
Ron

Hi Ron, Not sure if you got any answers to your question about "managing the condition", but if not, I suggest you start a new blog thread with that question. I suspect your post is too far buried in a post with a Subject about Flecainide dosing. I am personally encouraged that you have been on flecainide for 10 years seemingly without any major side effects. My current plan for staying out of Afib/flutter includes continuing flecainide for a while longer, perhaps a couple years. in the end though, i will have an ablation in order to drop the potentially toxic meds.

thanks
steve