AF Association

Flecainide failed after 8 months

Well, I was doing quite well with Flecainide but a few days ago my heart woke me up at 3 AM thumping and skipping beats. I took extra pill but it didn't help.

AF continued the whole day and never stopped after that - 4 full days now, although it is not with devastating symptoms like a year ago that landed me in ER, just tiredness, weakness. I guess Flecainide still works a little bit. Called my EP yesterday who told me to increase Fleca to 150mg twice a day and come tomorrow (Tuesday) for cardioversion and discuss (schedule) cryoablation. He put me on Eliquis too.

I wonder if I am in permanent AF now and is cryo better path than RF?

11 Replies

Sorry to hear that!

Good ole Flec failed me as well.... I was on max dose of 300mg with no effect at all.

I've had all the Ablations and cardioversion and now after an AV Node ablation I'm Pacemaker dependent and off all antiarythmic drugs!

Steady pulse now pumping blood around the body which has given me a new lease of life!

It's all a journey my friend!




It looks very much as though I am heading along the same route. Could you tell me what type of pacemaker you have had put in, and how long ago? I am hesitant, any reassurance would be greatly appreciated.


I had a St Jude Pacemaker inserted approximately four years ago!

A fabulous invention and a real lifesaver.

Simple procedure requiring an overnight stay. The incision site will be a little sore however it's all good!


I have a St. Jude mitral valve put in 20 years ago! However finally the AF has caught up with me and my EP is gently moving me towards AV ablation and pacemaker. Did they ablate the AV node as well? Are you in the States?


I think you are in Australia!


Hi Annaelizabeth

Yes my AV Node was ablated.

I am in Australia 🇦🇺 😊

I'm sorry you're heading in the same direction 😕

AF certainly is a journey!


Hope the cardioversion works, if it works you will feel a great sense of relief.

Only problem with being on 150 x 2 Flecainide you will be unable to take any additional Flecainide as PIP as you are now on the maximum daily dose already.

I cannot comment on the Cryo v RF question although I understand Cryo is good for first time ablation.

Ask the EP lots of questions.



Flecainide was ceasing to work for me although my AF was still just about paroxysmal. I was offered cryoablation which worked for me and I now off drugs and AF free. Cryoablation is quicker and more effective if your AF is emanating from the pulmonary veins and they are of normal structure. Once your AF becomes persistent I understand that the atria gradually change and AF can originate from other foci. This means that other areas have to be a later so RF is necessary.



Thank you Peter. This gives me some hope.


Lets just separate the two questions here. Flecainide doesn't just fail. AF progresses. It often use to be thought that the drug lost efficacy but since there are no receptors in the body for flecainide as there are for narcotics, the body doesn't get used to it and need more to work. If AF starts to breakthrough again this is because the AF has progressed. Now this is important!

Now for ablation. Cryo ablation is very effective with simple AF where only the four pulmonary veins are providing the rogue impulses which cause the AF. It is much easier for both patient and EP that RF ablation and takes far less time to perform. The shortcoming , however, is that if the AF has progressed to the point when other areas of the atrium may be firing off then Cryo ablation may not stop it. Since the cryo balloon only fits into the entrances for the four veins then these are the only areas which can be ablated. As I said, in simple AF for many people this is enough and years of freedom ensue but do be prepared that a second or even third RF ablation may later be needed to "mop up" any extra pathways.

By the way, you are not yet permanent until cardioversion fails to return you to NSR.



Thank you all for your comments. What an eye opener/education.


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