According to EP JOHN MANDROLA, MD "AF-rhythm drugs (propafenone, flecainide for example) often make atrial flutter worse."

drjohnm.org/2013/08/atrial-...

"11. Rhythm control drugs rarely work to control atrial flutter. Rhythm control therapy of atrial flutter differs greatly from AFib. In fact, most rhythm drugs (not beta-blockers, Ca-E blockers or dig) can create a favorable milieu for atrial flutter. That’s right; some AF-rhythm drugs (propafenone, flecainide for example) often make atrial flutter worse. This is especially relevant to athletes on AF-drugs. Athletes who take AF-rhythm drugs (without beta-blockers or Ca-E blockers) can sustain dangerously high heart rates during exercise. I tell athletes who take these drugs to either not exercise, or stop exercising, if they feel like their heart is out of rhythm."

I wonder why rhythm control drugs are used in Europe but not by EP JOHN MANDROLA, MD in the USA.

I was put on Flecainide and it didn't work for me and there were side affects.

[Finvola]

Yes - I take 200mg Flecainide daily and have occasional short runs of AFlutter. My EP says this is caused by Flecainide organising the rogue signals and that all anti arrhythmic drugs have this capability.

A medical article which I found explained the mechanism which makes this possible - it was over my head but I understood from it that AAD's slow down part of the electrical response which can make ideal conditions for a AFlutter circuit to start up.

In my case, the answer to your second last paragraph is that the awful symptoms which I had from PAF were much, much worse than the occasional run of AFlutter - which I have been told can be ablated if I wish.

[Hidden in reply to Finvola]

I had an ablation for A Flutter and then later another one 4 months later for AFib.

[Goldfish_]

But you had fibrillation not flutter didn't you?

[PeterWh]

Certainly I am not on rhythm control drugs and EP assessed rate control was important. EP initially prescribed Flecainide and when I had DCCV about 5 to 6 weeks later and then I went back into AF just over 24 hours later. When I saw him 10 days after that he took me off Flecainide.

[Hidden]

Hello PeterWH,

I understand that you already have persistent AF. Hence, taking rate control is important. The article was about P AFl.

[pip_pip]

I have been on both these drugs some years apart, and within the day of takingthe flec my AF intensified quite dramatically and hospital was the answer. Within two days of prop the AF became flutter (which can happen with prop) and intensified terribly. Hospital again beckoned.

Amioderone always helped me. Wonderful drug.

Phil

[Paddinton]

I was put on flecainade a few months back, and it certainly changed my atrial flutter. Previously I would have an attack that lasted between 5 and 15 minutes, every three days. This would leave me totally exhausted for hours, sometime up to 12 hours. Since the flecainide, I have attacks several times a day, maybe as many as 20, but the only last 30 seconds to a minute, and, generally, do not leave me tired unless I have them for several hours (a rarity). As such, they do not impact on my life as much.

I'm due at the Freemans Hospital in Newcastle on Wednesday to discuss my ablation, so, touchwood (he says touching his head) the problem will be sorted fairly soon.

[Hidden in reply to Paddinton]

My Atrial Flutter increased in duration. Anywhere from 4 to 42. Usually 10 - 18 hours nearly on a daily bases. I am very fit otherwise hence I was amazed how well I coped and did not feel overly tired.

[CDreamer]

So what happens when you have both - which I usually do when heart goes out of rhythm? Not that I will ever take a beta blocker or rhythm control drug ever again!

[achillesfib]

Im new at this but I dont understand the need for anti arrhythmias if your rate is controlled? It seems as though that is the least intrusive and safer method. Ive heard of many that are persistent taking that and NOACs. With all the dangers of Flec and Amod, Im considering just that route.