Question re: Fleccanide, Afib, and previous heart issues

Has anyone with previous heart issues been successfully or unsuccessfully prescribed Fleccanide as an anti-arrhythmia med?

I had a mild MI in 2011 with a stent placed to fix. No damage to heart and was back on full weight lifting and endurance training within 10 days as per Cardiologist approval. No loss of ejection fraction or structural damage at all.

Fast forward 10 years and developed paroxysmal Afib in June 2021. Echo is still very good. As per my new Cardiologist and new EP I have what is considered to be predominantly Vagally mediated paraoxysmal Afib due to many years of intense excercise. Main triggers for me are that they happen only at night when laying in bed especially (but not always) after eating large meals earlier in the evening.

EP started me on Sotalol as a first line med as per instructions from my Cardiologist. However, Afib seems worse now. Maybe slightly fewer episodes but when they hit they last 24 to 36 hours now instead of my typical 8 hours or less previously while taking Carvedilol. From some of the research papers and cardiology articles I've read, Sotalol may not be the best option for Vagal Afib, plus the med itself scares me a little. Cardiologist will not try low dose Fleccanide due to issue I had in 2011 when I was seeing my old Cardiologist in another city.

Just curious if anyone else has been down this particular branch of the road and actually tried Fleccanide as a PIP or maintenance med with Cardiologist approval? Thx.



Edited 1 time(s). Last edit at 02/12/2022 04:50PM by MarkL.

A lot of cardiologists will be reluctant to prescribe flecainide due to your MI. Flecainide comes with a stern black box warning about using it in patients with a recent MI, but "recent" is defined as less than 2 years. You're well beyond that so you should be okay, but many cardios will still be reluctant. For one, if they were going to consider it at all they would probably insist on a full cardiac workup to ensure you really are free of structural damage. (Stress test, echo, etc)

But I'm curious why you're seeing a general cardiologist and an EP. Since you suffered no structural damage from the MI and you have afib now, why are you seeing anyone other than the EP?

Carey, thanks for the response and explanation. I'm not actually pursuing taking Fleccanide just curious why she is so opposed to it. All my tests, stress, echo, etc. are perfect and my Afib, while present, is asymptomatic. But I guess I do understand her logic now.

After the MI in 2011 I had a follow-up annual check up with the Cardiologist who did the stent for 2 years afterwards. I was released and told to only come back if I experienced any issues. In 2018 I moved to a new city 6 hours away so I established with a new local Cardiologist who got my records from the old one. Did this in case I had issues down the road, which I have obviously had. Saw her again when the Afib issues started in June 2021. She ordered the ZioPatch which confimed 4% Afib burden along with flutter. She tried to control with Carvedilol but that didn't work. She then referred me to the EP who is in the same Medical university group (large med school here) in which both she and my Internal med doctor practice.

Have no intention of pushing the issue because I am strongly leaning toward proceeding with an ablation after I consult with a highly recommended second EP at Duke University. Rather take my chances with an ablation than to try a plethora of meds, fight side effects, and the whole time be delaying what could possibly be a major fix/improvement. I am extremely athletic (for someone my age) and I'm tired of being scared to do anything.



Edited 1 time(s). Last edit at 02/12/2022 07:33PM by MarkL.