Should I take flecainide if arrhythmia is just coming and going for a few minutes? Or only is there is a sustained abnormal rhythm?

[kebewl]

I was diagnosed with atrial fibrillation last week when I was in AF several several hours continuously. Since then I seem to just occasionally have AF coming and going for a few minutes. Do I need to take a flecainide if it will settle down on its own? On the two occasions I took a tablet I was absolutely exhausted the next day, is this typical (it does put me off using it) or just a coincidence? Thanks!

[Hidden]

Kebewl, I see that you have only just joined the forum so welcome. There is one very important thing for you to be aware of and that is that forum members are not medically trained, therefore we are unable to advise specifically on medication. The forum is not an alternative for seeking proper medical advice. Many of the drugs prescribed for AF are quite potent and if taken in any way other than the way they have been prescribed, there could be very serious consequences. Flecainide is one of those drugs however, it is a very effective drug and for most, a safe drug but this question is one only your doctor should answer.

What we can say is that normally Flecainide is either prescribed as a regular daily dose to help maintain normal sinus rhythm or alternatively as a Pill in the Pocket (PiP) when a single, quite hefty dose is taken once in any one 24 hour period to effectively get the heart back into rhythm. Either method MUST be under the strict guidance of your Doctor.

If you want to learn more about AF I suggest you take a look at the pinned post to the right of this page and click on “Useful links for Newbies and Oldies” because there you will be able to access lots of useful information.

[RiderontheStorm]

I only use it for emergencies also as PIP (pill in the pocket) and It wrecks me for 3 days. I take 300 mg all at once. I normally wait until I am close to having it 24 hours before taking to see if I slip in NSR naturally before ingesting. Luckily It is rare. *** I forgot to add this; The last few times I felt AF coming on I jumped up and did some exercise and started moving. THAT brought me back into NSR! The few times I did feel it coming I was actually watching TV in my recliner and very relaxed.. Hmmm.

[CDreamer in reply to RiderontheStorm]

I was similar but never waited as long as 24 hours in AF before taking as my EP always said the sooner you can revert, the better.

I agree it often took several days to feel better but then so did recovering from being in AF for 24 hours. Devil & deep blue sea.

[dmac4646 in reply to RiderontheStorm]

300mg is the max dose in 24 hours - for some people <75kg that can prove to be a very big hot - my cardio says no more than 250mg per day - yo really need to get advice on whats best for you.

[RiderontheStorm in reply to dmac4646]

300 MG is my dr. prescription to take all at once.

[dmack4646 in reply to RiderontheStorm]

Ok I am sure he/ she will gave taken into account your weight - at my weight if I take that I am wiped out for days , but , you should follow what you have been told

[Hidden in reply to RiderontheStorm]

My doctor told me to take 200 mg of Flecainide as soon as I feel that I am in A Fib. That way, the episode is done and dusted much quicker.

If I fail to convert with the 200 mg dose within 24 hours then I can add 100 mg more. If that does not convert me to sinus rhythm within 6 hours I am supposed to go to the ER. Those are my current standing orders.

Up until about 4 years ago I was to go to the ER if I did not convert to sinus rhythm within 3 hours. I was also advised to never be more than 3 hours from medical care, so long haul flights were out. It really limited my life, so I am thrilled with my new orders. But, I have to report that since 2003, one dose of Flecainide has always converted me within 3 hours. I know this sounds nuts, but 5 pees and I am fixed. Always 5.

[gelato99]

Suggest that you speak to the clinician who prescribed the Flec. for you, and heed their advice. This is never a ‘ one size fits all ‘ scenario,

Good luck and take care. : )

[CDreamer]

I used to do nothing other than valsalva manoeuvres for about an hour before taking as I would flip back into NSR quite often without the need to take Flec, which would often take an hour or so to work anyway. Remembering to take on an empty stomach would often mean needing to wait a while as AF would often be triggered by eating.

Everyone reacts differently as is their ability to tolerate AF and sometimes it is trial & error to see what works best for you, especially using PIP approach.

[Lovetheoutdoors in reply to CDreamer]

Hi there. I came out of hospital yesterday after being admitted with AT Monday. Now on diltizam. Had small meal at 530 and AT started. Still getting used to this! What did you mean by valsava manoeuvres please. Need to try whatever there is for this not so nice condition. Don't know how I'd manage without all you lovely people and your support. Take care

[Elsieclarke in reply to Lovetheoutdoors]

Hi

I keep a wee list of things I try.

Here it is pasted below

Hold nose and close moth and exhale like u do to pop your ears

Lie backward quickly from seated to lying position

Head down deep breathing

Drink cold fizzy drink quickly to induce burping

lie on right side curled up head down

hold your nose, close your mouth and exhale hard while straining as if you were on the toilet

wrists in cold water

headstand

blowing into a straw or into your finger

coughing whilst bending over

put finger down your throat to gag

Fill a sink with cold water and plunge your face in it. Sometimes this little jolt can help. Others have said a cold shower has a similar effect.

Try belly breathing.

Lie down or sit comfortably, and relax. Breath through your nose to a count of four, slowly filling your belly. Exhale through the nose or mouth for the same four count. Breathe deep into your belly, not your chest. Make the inhalations as long as the exhalations and breathe in a circle, i.e., don’t hold your breath on the inhale or exhale. You can also try breathing into the belly and holding the breath for a count of ten (stopping if you feel uncomfortable), then resume breathing rhythmically to a count of four.

Blowing into a closed fist like a trumpet

Hold your breath for a few

Blow into a syringe whilst lying down (face up) for 15 seconds

Modified VM - blow into straw sitting on floor for 15 seconds then immediately lie back feet in the air.

Lying on your back and raising your legs and pushing down as if you are straining for a poo can also work

Cheers Elsie

[CDreamer in reply to Elsieclarke]

Lying on your back and having someone else raise my legs very quickly worked best for me but blowing into an empty syringe could also work.

Find a recording of a heart in NSR - a few on YouTube - and listen to it whilst taking LSD - Long, slow, deep breaths (not the other kind!).

HeartMath meditation slows HR and keeps me calm. heartmath.org/

My thoughts after 13 years of coping with this condition - still alive and kicking - is that adapting to a new reality of sudden onset AF is a jolt and a reminder that we need to take care of ourselves and each other. You will do better if you can stay calm and not make your first reach for medications to make it go away. All meds come with affects, not always positive.

After anticoagulation, prophylactic treatment against stroke, everything else is about QOL.

[CDreamer in reply to Lovetheoutdoors]

Regarding meals - learned the hard way!

Our autonomic nervous system controls our digestive system so it is really important that we take our time around meal times. Make an occasion of slow preparation, slow eating - slow everything down and anticipate food, use all your senses - savour the way it looks, smells and tastes.

If you feel particularly stressed then don’t eat, postpone, delay and go for a walk, take some deep breaths, put on some music - anything that helps you to start to relax as you need to be in Rest & Digest mode, not Fight or Flight mode.

Don’t listen to news, read news, letters or your phone at meal times or an hour either side.

The vagus nerve (the main nerve highway between stomach and heart) is very easily triggered when we are eating.

Some people are triggered by certain types of foods so keeping a food/symptom diary can sometimes be informative of which foods to avoid.

[Lovetheoutdoors]

Wow.Thank you. I definitely will try these.

[15sunbe]

I would take Flapjacks advice. However, if it's just coming and going - just occasionally and for a few mins - personally I'd not take any meds. I'm a long term sufferer from AF. It's scary, initially, but not life threatening.

[TheProf]

It is , as they all say personal. I have had palpitations for nearly 20 years ( ever since I went on a extensive weight reducing diet - not claimimg any connection), They passed in a short time usually a few seconds on minutes. Then in 2012 I was in hospital following an unexplained motorcycle accident and I had one while being monitored. The investigation showed an AV node tachycardia which didn't bother so I didn't have any treatment at the time. Then in 2019 after some massive weight gain I had an episode of AF which went on for a few days but was at a low rate 80-100 bpm as my normal heart rate was near to 50. I was sent to a cardio who gave me an emergency injection and various medications which stopped the AF. Since then I have been on fecainide which controls it, but I still get minor palpitations when I lie sometimes - so I sit up and they go in a few seconds. I have read in a medical journal that former endurance athletes are more prone to AF - I wouldn't claim to have been an "athlete" but I did once do extensive training for triathlons and did about 100 of them including one at Ironman distance. Again it's all personal.

Ref: Burgan and Burri, Rev Med Suisse. 2013 Mar 6;9(376):514, 516-9

[Tchingwa]

Hi,

I use to have Arrhythmia problems, have they checked your magnesium levels, potassium levels, and vitamin D it’s very important they are regulated. In addition I have stopped all caffeine and chocolate. I try not to eat a lot of sugar at one time, I try not to let myself stress out too much or overwork myself and I am able to control my arrhythmias. My doctor gave me Metoprolol emergencies For when I can’t convert my self out Of SVT . Not sure if Afib and SVT are the same but when I go the hospital And get an EKG during my episodes I’m normally I’m Afib. Again Not sure if it’s the same. But I don’t have attacks anymore.

[Lilypocket in reply to Tchingwa]

It's funny you should say that and I agree 100% . I am on Flec and Bisoprolol for PAfib. I still get episodes . I started taking magnesium 3 x a day. I got a bit D test ( my own initiative) and I was under normal. So I got some from my GP. I also drink camomile, orange flower infusion maybe 3 times a day. This month I have had 1h1/2 Afib and I think the vit D maybe helping. Who knows 😊

Take care

[Tchingwa in reply to Lilypocket]

Thanks for sharing.

[Guitar335]

Definitely one for your doctor first and foremost ...

Personally Ive tried lots of things and in the end what works for me is 3 x 50mg Flecanide per day.

Flec as PiP did not work for me and the idea of Afib for 24 hours then a big whack of 300Mg of Flec would not make me feel good. I think I would struggle to know whether 24 hours of AF was the cause of me feeling bad or the Flec.

I stopped drinking alcohol, caffeine and took magnesium. If Im honest I don't think any of them made a difference...and I have to reluctantly conclude its the Flec that keeps me safe. I sooooooo wish it was not the case but Im learning to accept it is.

Having said that I went to an all night rave in Ibiza, drunk too much alcohol and caffeine and my heart tripped out...but thats me just being a total idiot! I do believe there is a correlation of alcohol and AF for sure. Theres plenty of evidence and studies to show that and my Cardio confirmed. Binge drinking is sadly a no-go LOL

[kebewl]

Hello everyone thanks very much! It's the first time I've posted on a forum and great to get all the responses. I have paroxysmal AF and PiP flecainide 100mg to a max of 300 per day. I can't take beta blockers as I'm asthmatic. I was told to go in if AF persists for longer than 24hr. Hopefully it won't, in which case I'll never see doctor again to ask when to take it- but after seeing the above I think I'll wait for a few minutes and not take medication if it is very transient but wait until it is still going on after hours. It's really helpful to hear about triggers. I have always noticed palpitations after coffee so I'm cutting that down but seen conflicting findings in literature. I had a couple of hours AF yesterday after a glass of wine (and large meal) so I guess I should give up alcohol too :(.

I have bought a portable ECG that is useful that I use to check when I feel palpitations (I did some exercise testing briefly in a previous job so remember what an ECG should look like). I can use this to check I only take medication when needed. Also a phone app that measures regularity of heartbeat using the camera (although it only works when my hands are warm- rarely). I already used a Garmin to measure heartrate and have another app (cardiograph) that analyses garmin data and flags up high heart rate that doesn't coincide with steps- but not sure that is any more useful than taking pulse to check heart rate.

Does anyone exercise and do you do anything differently because of AF? I was just told to slow down if I have an episode but otherwise carry on as normal, but have been feeling more apprehensive about working out.

[Lilypocket in reply to kebewl]

Hi

Just wondering if the large meal and not the red wine was the trigger. I sometimes get Afib after an evening meal with no alcohol.

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