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.