Flecainide not tried in ER

They've never tried flecainide on me when I've been in the ER with afib. Why not?

Flecainide is an antiarrhythmic and it has complex prescribing requirements that requires cardiology training and a knowledge of your full history that an ER doc doesn't have in the 10 minutes they've gotten to know you. Did you know that flecainide isn't approved by the FDA for treatment of afib? It's used by cardiologists off-label, but your ER doc is unlikely to be willing to use a drug off-label without the appropriate training in that specialty. Remember, an ER's job is to stabilize you and either discharge you safely or admit you to another department for further care. Their job isn't to treat your afib. You should never expect more than a temporary stabilization from an ER.

That's odd because I've been seen by many cardiologists in the ER. I would have thought that since I was already there and in afib that would be the ideal time to try it, but I guess not.

No, they're not going to prescribe something like flecainide in an ER. In fact, they usually won't prescribe much of anything beyond the time you leave the ER. They can't follow up with you and they're just not set up for long-term care, so to hand you a prescription for something and never see or hear from you again would be irresponsible of them. If you want to give flecainide a try, talk to your EP.

My first afib in the ER, the attending (3 days post residency) put me on Flecainide. Then I had many years of my cardiologist leaving the exam room, turning back to face me, and repeatedly saying Flecainide will kill me. I think it was a random ER doctor who prescribed it. My mom and I both arrived together with our first Afib and left with flecainide. We were one room apart.

Like Carey said, it’s not a drug an ER doctor will normally suggest. Rather they would suggest you get a followup with a cardiologist. The ER doctor is only there to triage and make you stable enough to leave or get admitted.

It’s interesting that many ER doctors pushed amio. I had three. In fact, I was told at Cedars to pick another ER if I wasn’t onboard with starting amio. (2020) I have a real bad reaction to iodine and taking a catscan with contrast. I must be pre med with prednisone and Benadryl so I refused their amio suggestion. It was a few months after my first ablation and I felt there were other options at the time.

When my first ablation failed on Day Six (yikes!!), the nursing staff found that my heart rate was varying between zero to 150+ BPM. The 'zero's' lasted the equivalent of about eight beats, and they freaked out, rushing in to find me talking calmly with my wife. The internist consulted with my EP during the evening and the result was that I was to cease taking metoprolol immediately and to start on Amiodarone. I asked why not Multaq, Sotolol, Flecainide, or propafenone? Why such a big hammer. He paused, looking up at they ceiling for a second (I think he caught himself about to roll his eyes...LOL!), and then looked at me and said, 'Because it's the right hammer'. It's like the ER staff don't have the luxury of time to deal with you AND with the other ten people lined up in the hallway, to keep you for a day or three and feed you, and to do all the follow-up and monitoring required. Really, the ER is not a great place to be for all but road accidents, infarcts, and strokes. If you can get an emergency visit with a cardiologist next day sometime, you'll probably be further ahead by the end of that day with a more accurate prescription or regimen. But, that's why it's Amiodarone most/all of the time when you want the internists to help you.

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Shiny Sleeves
That's odd because I've been seen by many cardiologists in the ER. I would have thought that since I was already there and in afib that would be the ideal time to try it, but I guess not.

Yes, if a Cardiologist or preferably an EP was on call in the hospital, and could see you, then maybe they could try it. What time did you go in to the ER? If you are hoping to catch a specialist on duty in the hospital, then weekdays during normal business hours is best. I agree with what Carey is saying in general, but as you said it sometimes works depending who is on duty while you are there. It also depends on your Dr.

I used to find out when my EP was already at a specific hospital, then go into the ER, hoping they would be able to page him down to me. Another method that would work, is if you told your Cardiologist/EP that you you were headed to an ER, and when and where would he be able to meet you there. I doubt most Dr.s would be willing to do this, but my current EP will, and in the past another one was willing, time permitting. This has only worked if I went to a specific hospital, at a specific time, usually toward the end of the afternoon.

When I was prescribed Flecainide it was the worst side effects and experience I have ever had. My heart rate shot up to 180+, I turned pale and was sweating uncontrollably.
This happened on both flecainide and propafenone.

After many extensive tests in the hospital and no issues showing the hospital EP said that for some people like myself and In some cases certain anti arrhythmics can be PRO-ARRHYTHMICS. Flecainide and likely all type 1C anti arrhythmics caused some type of uncontrollable Flutter which caused my heart rate and symptoms to be far WORSE then they were without the medication.

I was in Afib for over a year 100% of the time and never once had any symptoms remotely close to being on those medications or even a heart rate nearly as high. I was immediately taken off those meds and put on sotalol and diltiazem where I had no issues at all for about a year. The sotalol did virtually nothing as I was in Afib 100% of the time with it still. However, Diltiazem was great for me keeping my heart rate somewhat controlled and allowed for virtually no symptoms at all with my Afib.

Everyone is different but I wouldn't be so excited to want Flecainide.

I loved sotalol and diltiazem, which gave me nsr for 6 months until covid and then I was hospitalized on the maximum sotalol and increased diltiazem. I always speculated if it wasn’t for covid, I would had a longer nsr streak.

Like most drugs..it works until it stops working. Enjoy your nsr time while on it. Good luck.