EP consultation re use of flecainide (aka Tambocor) as a pill-in-the-pocket.

[jennydog]

Yesterday I had a follow-up visit to my EP's clinic. I rather expected to see his Registrar but actually saw the Senior Consultant himself. He is the nicest man who has a marvellous understanding of atrial fibrillation.

I had an ablation nearly 3 years ago when they discovered Fibrosis which was probably caused by radiotherapy to my left shoulder. I cannot have a 2nd ablation and a pacemaker may be needed eventually. I now have mild AF and take dabigatran, a statin and 2.5 bisoprolol daily. Recently I have had some episodes and use 100 strength flecainide as a pip. The AF usually stops within 2 hours. I think my trigger is stress - my stress levels are currently high due to my poor mobility caused by 2 herniated discs.

I explained that I really don't like taking drugs and only use the flecainide if I have to. If possible I will attempt to ride out an attack but is this the right strategy? Does the heart get into the habit of fibrillating? I explained that I have a new GP who is unlikely to prescribe flecainide without instructions. I indicated that I realized that flecainide is inexpensive and non-addictive but a very powerful drug. Should I be taking a low daily dose?

This is my understanding of his advice :- when I recognise an episode I should take a 100 tablet within 20 minutes. If that doesn't work then I should take a further 100 after 4 hours. Maximum daily dose is 300. If I have to take 4 pips in a week then I should consider taking 2x50 daily - for the rest of my life.

He will write to my GP outlining this plan with a copy for me so I know exactly what is happening. He will see me in a year.

I hope that all this is helpful - Oh, I forgot! His final bit of advice." Do not put on any weight."

[BobD Volunteer]

Sounds like a plan. Good result.

[Finvola]

Thank you, jennydog - interesting information and reassuring for you.

[meadfoot]

My excellent EP gave me the same advice re flecainide Pip. I had previously been prescribed 100mg twice a day by my local EP which I took for two years. However when I consulted a new EP at a top hospital I was changed to PIP seems a very sensible plan.

[Tako2009]

Hi same as Meadfoot- I was diagnosed by a cardiologist and put on daily flecainide but my EP when I saw him scaled this down to PiP with much the same advice. He didn't mention weight but did tell me to keep an eye on my blood pressure (which in my case probably amounts to the same thing!!)

[irene75359]

I had similar advice too - but from my wonderful GP. As part of a trial I was prescribed 100 flecainide alongside 1.25 bisoprolol daily by the EP. After some months I had a talk with my GP about my unhappiness at taking powerful drugs and after studying my episodes (five in two years) he advised using the flecainide as a pip, and to give up the bisoprolol when I hadn't had an episode for six months. He was very clear that bisoprolol was rate control only but felt that controlling the rate could stop the heart tripping into AF. He invited me back any time if things changed.

I used to laugh at my dear mum (96 in a couple of months) who didn't want to move because she was so happy with her GP. I understand now!