Flecainide - usage and dosage

I saw my EP yesterday and had an excellent Q & A session. I am currently reducing my Flecainide dose in 25 mg steps from 200mg daily to 150mg daily, with the aim of 100 mg daily. Some points which may be of interest are

Runs of PVC's - even bi- and trigeminy are not significant and are thought of as benign. He said he had successfully ablated PVC foci in patients whose lives were plagued by thousands of them.

Flecainide is organising my signals into runs of tachycardia and he advises not exceeding 200mg daily, so progression will mean ablation.

Flecainide without a beta blocker is not a good idea because of its tendency to organise signals into tach and flutter when there is a need to keep the rate down.

In the absence of AF symptoms, there should be no adverse physical effects, such as fatigue or difficulty breathing. Even though drugs can cause such side effects, he warned me not to make that assumption but to refer to a GP for confirmation that 'nothing else is at work'. Good advice that.

He gave no opinion on the rate of Flec reduction - it seems to be a matter of try it and see.

All of the comments above are one EP's advice to one patient with specific reactions to drugs and AF and without any other health issues. I hope some of the points are helpful - there is much more on ablation as the way forward but that has been well aired by others.

Flecainide reduction is now my main aim and I know there are a few others in that position - onward.

12 Replies

  • Thank you, Finvola, that's very informative.

    Good luck with the reduction. Take it very, very slowly.

  • Thank you jennydog - I'm planning on months at each step of 25 mg, being 6 weeks into the first step down.

  • Been to loads of places by boat, plane, up to high 30's C temp-wise, no problems to report. Except take care having that extra cold beer or two if you drink, that did affect me one holiday.


  • Thanks Finvola. Hope to join you on the reduction trail soon; when I do I think I will step up the lifestyle changes perhaps temporarily to compensate for the lower drug e.g. Mindfulness & breathing exercises.

  • Hope it goes well for you orchardworker. Have you seen the thread referring to Dr Gupta's breathing exercise for ectopics - I found it worked and I like the calming effect it has.

  • Yes I did thanks Finvola. I will probably email him tomorrow as I have found what helps when doing those exercises (which I have been doing for 6+ months) is to use either of two pressure points 1) applying pressure just above the bridge of the nose or exactly mid chest at nipple height. Doing this I found can slow down taking a new breath in considerably longer.

  • PVCs?

  • Premature ventricular contractions (PVC's) are extra or early heartbeats originating in one of the heart's ventricles (lower chambers). They feel like a missed beat, followed by a thump and cause many of us misery - others can have them and barely be aware of them.

  • Thanks. Another symptom I seem to share with other AF suffers!

  • Regarding your point that flecenaide has a "tendency to organise signals into tach and flutter when there is a need to keep the rate down" - I have also had this experience.

    I use rate control (atenolol) with flecenaide when engaged in tennis or squash. This keeps my heart rate down, but the beta blocker also makes me feel spaced out during exercise. My cardiologist suggested I try exercising without rate control - just the flecenaide. I tried this Friday and went into an extreme dizzy state and had to sit down. During this state my AliveCor reading was wild, all over the place and "unreadable".

    I tried AliveCor again a minute later, and it was back to normal but my heart rate felt fast and ineffective - like flutter. Not sure what to make of this -

  • Scary Thomps - I felt that Bisoprolol was holding me back during exertion and asked if I could use it as a PIP during tachycardia. The word my EP used to describe that scenario was 'dangerous' - in my case of course.

  • I would agree with the point that 200mg of Flec is as much as you would want to take.

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