Regular double beats - flecainide doing more harm than good?

Greetings from the UK,

Brief history is I had 2 ablations in 2019, I'm 54 and Afib sadly came back in 2021 so been on drugs since then which mostly seem to have kept things in check apart from brief spells. When I have spells they seem to be after exercise, sometimes a high HR (atrial tachycardia is it) that then drops back into Afib. 3 ECGs attached, one showing the weird double beats I'm getting, and the other 2 showing the HR and the Afib.

I've been on 50mg flecainide and 2.5mg bisoprolol twice daily, however due to cold extremities and in consultation with the cardiology depart we tried Adizem in February but after a few weeks that seemed to make things worse, and then switched to 3.25mg Carvedilol on 14th April.

But like I saw with Adizem I am getting more and more Afib epsidoes that are lasting longer and longer, sometimes up to 12 hours.

The cardilogy department upped both the Carvedilol to 6.25mg and the flec to 100mg twice daily, but that doesn't appear to have helped.

I've been keeping notes of episodes for the past 4 years, on looking back I noticed when I tried 100mg flec previously it didn't help and I noted that I was getting a regular double beat, which disappeared overnight when I reduced the flec back to 50mg.

So question is, could the extra 50mg of flec be actually making things worse? I'm getting the regular double beats now (ECG attached).

Second question is if I go back to bisoprolol is there any long term risk/complications with cold extremities? I am hoping I can elevate symptoms by wearing more layers/fingerless gloves on very cold days etc

thanks!

Greg



Edited 1 time(s). Last edit at 04/29/2023 04:07PM by kitenski.

That first ECG shows pre-atrial contractions in a bigeminal pattern. I spent months putting up with that. It's annoying but harmless and if it continues long enough your brain will get used to it and you won't notice unless you think about it. The second one is probably either flutter or atrial tachycardia (can't distinguish with a single-lead device). The third is just plain old afib.

I seriously doubt the flecainide is making it worse and increasing the dosage might help. Easy enough to find out: just stop the flecainide for a few days. Just be aware you might find out how much it's actually helping. But if it's not, there are other antiarrhythmics they can try, but I'm unsure what the choices are in the UK.

Switching the beta blockers isn't going to make your arrhythmias go away. All beta blockers and the Adizem (diltiazem) do is slow your heart rate and lower your BP. They are not antiarrhythmics.



Edited 1 time(s). Last edit at 04/29/2023 05:48PM by Carey.

Quote
Carey
That first ECG shows pre-atrial contractions in a bigeminal pattern. I spent months putting up with that. It's annoying but harmless and if it continues long enough your brain will get used to it and you won't notice unless you think about it. The second one is probably either flutter or atrial tachycardia (can't distinguish with a single-lead device). The third is just plain old afib.

I seriously doubt the flecainide is making it worse and increasing the dosage might help. Easy enough to find out: just stop the flecainide for a few days. Just be aware you might find out how much it's actually helping. But if it's not, there are other antiarrhythmics they can try, but I'm unsure what the choices are in the UK.

Switching the beta blockers isn't going to make your arrhythmias go away. All beta blockers and the Adizem (diltiazem) do is slow your heart rate and lower your BP. They are not antiarrhythmics.

Thanks for this, in my case I seriously think taking 100mg flec seems to bring on more episodes of Afib, a higher resting HR and also the pre-atrial contractions, whereas dropping it to 50mg this morning and this evening appears to have dropped my resting HR to "usual" and the pre-atrial contractions have stopped.

Yes, switching beta blockers was purely to try and address the cold hands/feet on bisoprolol. However of the two I've tried alongside flecainide they don't seem to work as well as bisoprolol, so I am wondering if there are any long term risks/complications of sticking with bisoprolol and putting up with the cold extremeties.

Quote
kitenski
Thanks for this, in my case I seriously think taking 100mg flec seems to bring on more episodes of Afib, a higher resting HR and also the pre-atrial contractions, whereas dropping it to 50mg this morning and this evening appears to have dropped my resting HR to "usual" and the pre-atrial contractions have stopped.

Yes, switching beta blockers was purely to try and address the cold hands/feet on bisoprolol. However of the two I've tried alongside flecainide they don't seem to work as well as bisoprolol, so I am wondering if there are any long term risks/complications of sticking with bisoprolol and putting up with the cold extremeties.

Okay, that's an unusual reaction to flecainide, but I can't argue with success so if 50mg works better for you then stick with it.

I don't think the cold hands thing does any lasting harm. Many people experience that with beta blockers. Interesting that bisoprolol does that to you but carvedilol doesn't.

Attributing secondary effects to drugs asks for some experimentation (unless dangerous). There are so many things able to disturb our well being it's hard to be sure this or that is a sure culprit.

An update since my first post...

Since May this year I started feeling more & more dizzy, out of breath and with lots of ectopics/PVCs/PACS/SVTs etc. I even got dizzy bending down to put on shoes/tie shoe laces.

My resting HR had increased considerably, was 51 bpm on a 21-week avg, and went up to 64 avg during May and June a 25% increase

My walking heart rate avg increased from 82bpm 18 week average to 103 8 week average - a26% increase

Respiratory rate increased from 11.1 breaths/min to 14.1

My heart goes to say 120/130 when running/cycling even jogging super slowly to the end of the road and just stayed there, it didn't go up when out of breath or down when coasting down hill or stopping etc

I was getting more and more regular arrhythmias 24x7 - A combination of a Wellue ECG with it's AI analysis showed me having sinus with supra ventricular ectopy; atrial bigeminy, Atrial fibrillation, atrial tachycardia, sinus with single pacs

I stopped the Flecainide on the 4th July completely and I am now back to feeling normal, no more ectopics, no more out of breath, no more dizzy spells, no atrial tachy when doing easy exercise!

My stats have dropped back to where I'd expect. I've just come off a telephone review with my cardiologist who agreed I made the right decision and wants to follow up in 6-8 weeks to keep an eye on things.

He's suggested staying on the Bisoprolol and using 100mg Flecainide as a PIP if I go into AFib and it doesn't stop quickly.

Sounds good!