I'm fairly new to the idea of using one of my two daily Flecainide doses as a PIP, and until this week my daytimes have been smooth sailing so I have not had to use a PIP. However, I'm now having an occasional daytime A-F episode and some questions are now coming to mind:
1. Those of you who state that you have Persistent A-Fib -- does that mean that the A-Fib is happening 24 hours a day, but you don't take any anti-arrhythia med, either as a preventative or as a PIP? Or that your A-Fib medication does not always stop an episode?
2. Those of you who have Paroxysmal A-Fib but have frequent several-hour episodes . . . do you just live with it, waiting to see if it stops on its own, or do you pop a PIP right away, hoping to stop it in its tracks?
3. So long as a person is taking an anti-coagulant, how long is it safe to wait-and-see before taking the assigned anti-arrhythmic PIP?
Thanks to all!
Frances
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Nanfranz
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At my last visit to my EP we discussed using flecainide as a pip. I explained that my episodes of AF were milder since my ablation and that I tended to wait for them to stop, often by going to sleep. He shook his head and looked very disapproving. He told me that I should take a 100 tablet if the AF didn't stop within 20 mins. If that didn't work within 3 hrs to take another 100. Max is 300 in 24hrs.
All this begs the question DOES A FIBRILLATING HEART GET INTO THE HABIT OF FIBRILLATING? I rather suspect that it does.
PS I understand that flecainide is best taken along with bisoprolol and I do take 2.5 bisoprolol daily. If I start having more than 3 episodes of AF weekly then I am to start taking 2x50 flecainide daily.
2) I've always taken my PiP(s) as soon as I get AF. When I get AF I get AF, it doesn't come for 10 or 20 minutes and then go by itself. Before I started using PiP, episodes would last 10-12 hours.
Hi Nanfranz,
I'm not medically trained but the following is based on what I have been personally told by my EP and what I have gleaned from qualified EP's and Cardiologists who have spoken at support group meetings. It will be interesting to see if others agree or disagree!
1. Generally, at our level it's a bit difficult to make a distinction between persistent and permanent AF, but with permanent AF, it is probable that AF will not be stopped by any form of treatment. Persistent AF however, is likely to respond to forms of treatment but when this is no longer the case, it has become permanent therefore rhythm control drugs are no longer effective.
2. When I was prescribed Flecainide as a PiP, I was advised by my EP to wait no longer than 30 minutes and then take the full maximum daily dose of 300 mgs in one go. I was told that it would dilute the effectiveness of the drug if I took it in stages. At one point I was taking a daily maintenance dose of 2 x 50mgs of Flecainide and this had to be taken in conjunction with either a daily beta blocker or calcium channel blocker. I was told that if Flecainide was taken as a PiP only, it could be taken on it's own without betablockers or calcium channel blockers. I was encouraged to use Flecainide as a PiP and a maintenance dose to maintain sinus for as long as possible between my cardioversion and subsequent ablation.
3. As with everything to do with medication and dosing, you must follow the recommendations and advice given by your Doctor because he should have a clear understanding if your condition.
As I mentioned earlier, this is what I have been told in connection with my condition and this should not be seen as suitable for everyone.....we are all different!!!
Exactly what I was told and my understanding and experience of using Flec as a PIP.
I didn’t take beta blocker whilst taking Flec as a PIP or when as a daily dose as it made me very ill and I don’t get why there is a difference between advice?
The only thing I can add is that I was prescribed 100 mg x2 daily after a prolonged AF episode,and taken off my betablocker immediately at the same time.One week later, I had gone into AFlutter...
It is interesting because the 2 EPs I've seen said you needed to take a betablocker with the Flecainide. I only take 1.25mg of bisoprolol, although I take that with each 100mg of Flec that is required. No-one's ever told me to take the full flec dose in one go either.
When I was in hospital being given Flecainide by IV, they give it very slowly over 24 hours and then stop as soon as you return to SR. Also, when I was in hospital and taking Flec by tablets they made me wait aaaages between each 50mg tablet.
That’s interesting, when I saw the instructions for Flecainide as a PiP, it said the first dose should be taken under medical supervision but my Doctor said that it would be OK for me. This is why I am very cautious when discussing medication, there are so many conflicting views out there!!
My first time with Flec was in hospital, on the IV. I didn't have any medication to take at that time as I was still waiting for my appointment with an EP.
So when I was given it as PiP I guess they thought the IV counted as the first time as I wasn't told I needed medical supervision for it.
I take 50mg flecainide twice a day and have not been given an anticoagulant or a beta blocker. I was also told to use up to 300mg of flecainide in 24 hours to stop an af episode.
I always saw this as a last resort and will usually wait until the second day in a row of being in af (usually 120 - 160bpm) before taking it. If I am over 200 bpm I will give in sooner as physically it is harder to cope with all the other things I need to do. I have episodes roughly 3/4 days per week and they can last 30 minutes to a coupe days.
I am genuinely not sure how long to wait before taking a PIP as I thought it was for when I can’t cope with an episode any more - so I am reading all the comments with interest!
To take not, and the problem goes away vs never stops.
To take, and a positive result, that may have happened anyway.
What is the harm in taking? Depends on how you react. For me this was the definitive question. I resolved henceforth to always take, and take promptly. My risks in taking are small, with enormous gains.
Exactly. The main risk is that if you take too much you can make it worse. This is well documented and well known. That is a major reason for taking a little bisoprolol with the flecainide if you are not already taking it.
The other choice for you/your doctors is do you take a little, then some more later if you need to, or do you hit it, with one high dose. The absolute limit is 300mg per 24 hours. My prophylaxis dose is 50/50 daily. When not taking flecainide, hitting the system with 100 makes sense, with another hit of 100 four hours later. The idea is that a bolus dose creates a peak that passes which is a mini shock. Not every doctor understands this method.
I get myself into trouble sometimes by my strong tendency to avoid medicines. Sometimes we need to take them to avoid a bigger problem.
I was given a diagnosis of 'persistent' last year when having episodes about twice a week, lasting for days at a time. After various beta blocker meds, having no effect, I'm now on Flecainide 50mg twice a day with extra for a PIP if needed.
I didn't want to take daily Flec but the local pharmacist recommended it. I now only have episodes about once a fortnight, and take 100mg straight away when it starts. The episodes now only last up to 12 hours.
It's difficult to tell if it's just the Flec which has helped, as I've made other lifestyle changes at the same time, such as eating more healthily and losing weight. So it will be interesting to see what happens as I intend to wean myself off the Flecainide in a couple of months when I've reached an optimum weight :o)
Flecainide made me so sick (especially nauseous) and anorexic, and, and..., that I became suicidal. I had every side effect, along with the toxic amiodarone, that life was spent on a couch for 8 months. It is simply not to be taken cheerfully. Oh yes, intestinal blockages more painful than childbirth. My a-fib was persistent, but what is the difference between that and permanent?
As an aside: cardiologists always look disapproving, but I may be saying that because they took my mental state dismissively and didn't believe the drugs had any part in it. I was a "difficult" patient as I didn't conform to their notion of outcomes.
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