Does ‘successful’ daily Flecainide usage ‘mask’ persistent AF?

Just thinking..........(pessimistically....or realistically....)

After 19 years of PAF I am still on the face of it a paroxysmal AFr.

But for the last 10 of those 19 years I have been taking Flecainide 100mg BID.

I am aware that ablation has a much better chance of success with one (or two) procedure for paroxysmal AF than persistent AF. My question is.....does this extend to/include those like me who are still paroxysmal with the aid of a AAD? Or does the increased chance of ablation for paroxysmal AF only apply to those who are still paroxysmal without the aid of a AAD? Or, put another way, could 10 years of (‘successful’) AAD use mean that I could well be a persistent AFr ‘masquerading’ as a paroxysmal AFR?? Or can I still consider myself a ‘true’ paroxysmal AFr despite having used a AAD this last 10 years?

I have been wondering this about myself. I started out paroximal (LAF) then afib free for several years following my first ablation.

After my second ablation I became more persistant and now taking Ticosyn to remain in NSR.

I'm surprised flecainide has remained effective for you for 10 years. Congratulations. It doesn't remain effective for most people for that long.

No, I don't think there's any such thing as masking persistent afib. You're either in afib or you're not, and if it's not 100% of the time then it's not persistent.

Carey said "You're either in afib or you're not, and if it's not 100% of the time then it's not persistent. "

If it's 100% of the time, that would be "Permanent AFIB".
Persistent AFIB is defined as lasting longer than 7 days, or requiring medical intervention (like Cardioversion) to return to NSR.

I m surprised youve tolerated that med so long let alone its success. I wonder what your success rate would be without taking that med? It is possible that you could be NSR without it, but of course there is only one way to find out.

Quote
The Anti-Fib
Carey said "You're either in afib or you're not, and if it's not 100% of the time then it's not persistent. "

If it's 100% of the time, that would be "Permanent AFIB".
Persistent AFIB is defined as lasting longer than 7 days, or requiring medical intervention (like Cardioversion) to return to NSR.

I didn't intend my definition to be taken so literally. While you're right that persistent only means lasting longer than a week, permanent afib means longstanding persistent afib that you don't intend to terminate (with drugs, ablation or cardioversion). "Longstanding persistent" is the distinguishing phrase.

Carey is correct. Longstanding persistent AF was what I had before my Bordeaux ablation and touch up 15½ years ago.

Gill

Mike,

My take is that the requirement to take flec chronically would be an indicator of the status of your system. That is, if you were having the same frequency of episodes, but not on a med, I would interpret that your system would be less likely to go into afib as opposed to needing to take the med all the time. What that means in terms of success %, I don't know. It would be a question for Prof. Jais.

Of course statistics are important for a group, but less meaningful for an individual.

George

Thanks for the replies all.

FWIW my mother had paroxysmal AF for over 30 years before she eventually went persistent at age 70 with no AADs.

Prof. Jais knows my history in all its detail including 10 years of daily Flecainide when he quotes me 80% chance of success with one procedure. Sabine Ernst here in the U.K. gave me 70% COS with this being with a PVI only whereas Bordeaux will also/additionally always as part of a first procedure go after non-PV triggers if they can still initiate AF after the PVI - hence (amongst other reasons) why I’m going to Bordeaux. I recall Pat Chambers having taken Dysopyramide for some years before he got sorted at Bordeaux by Prof Haisseguerre in 2005 (with later touch-up by Prof Jais in 2012). Gill here in the U.K. has now had 15 years AF-free since her ablation at Bordeaux having had been in long-standing persistent AF as per her above post.

After all my years on forums, I’ve seen a lot of folks who’ve enjoyed 20 years AF-free with daily Flecainide - particularly here in the U.K. No side effects for me, but then again maybe I’ve forgot how good it feels not to be taking it! Prior to commencing daily Flecainide I was having one episode per month always converted within an hour by 300mg Flecainide as a PiP.

In keeping me paroxysmal the last 10 years of daily Flecainide (total AF <100hrs this last 19 years) has at least prevented my heart from the remodelling that rapidly occurs with persistent AF and from everything I’ve read that’s absolutely what actually counts the most as regards COS ablation-wise.

Cheers,

Mike



Edited 3 time(s). Last edit at 06/18/2018 08:43PM by mwcf.