Flecainide or Verapamil?

Saw an EP yesterday. He wants me to send a recording from my Kardia to him if I have A fib. Until then I am not sure of best course of action. He suggested Flecainide rather than the Verapamil I am currently taking. Possibly pill in pocket. Due to my sensitive reaction to the medications I have take so far (beta blockers not tolerated, then verapamil) I am nervous about trying flecainide as pill in pocket without seeing if I tolerate it first as a lower dose. He said I could take it regularly, but if I only have infrequent episodes of PAF perhaps pill in pocket is better. He said if you do that you take a 'loading dose' which is higher than if you take it regularly. I am taking half dose of verapamil but my BP is sometimes low and I don't really like the lower heart rate if most of the time I am not in Afib. Would welcome hearing about other people's experience.

4 Replies

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  • It is important to know that you have a structurally normal heart before taking flecainide. Have you had a coronary angio and echo?

    If you have paf then pill in the pocket flecainide may be very good. I can usually settle an episode with just 50mg

  • I have had an echo which found no heart abnormalities, but not an angiogram. I have a bicuspid aortic valve but he knows about that. Is 50 mg a low dose?

  • Yes 50 mg is low dose. Ischaemic heart disease should be excluded before starting flecainide. Ideally this means doing a coronary angio, but not all cardiologist adhere to this recommendation

  • I was put on flecainide alone, after reacting to the combination of Bisoprolol and flecainide. I was on it for almost a year and it worked well for the first few months then I started having episodes of PAF which gradually got worse but didn't have any side effects from the medication. My resting heart rate whilst taking it was in the mid forties rising to mid fifties so it did slow me down a lot. Hope this helps.

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