Heart Palpitations (skipped beats) - AF Association

AF Association

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Heart Palpitations (skipped beats)


Hi all, in your experience does Flecainide help ease heart palpitations which I may be having rather than afib. High PR plus high BP? I take diltiazem and xarelto for a fib and also have a pacemaker. I have a call into my Cardiologist and hope he calls back soon. I have Flecainide tablets but have never used them for PIP and will wait for his instructions.

Best wishes.

35 Replies

I have been on a combination of Flecanide and Bisoprolol for quite a while, however around September last year I was told to stop the Flecanide as it was "responsible" in some way for my atrial flutter. (I had previously had PVI ablations)

Now I've had 2x flutter ablations I'm back on it, 50mg twice a day, with the bisoprolol at 10mg. However I've had two episodes of AF requiring DC cardioversion in as many months, and still waiting for EP opinion.

I can't really say it's reduced palpitations or influenced them in the negative. I had IV flecanide a few times to try and cardiovert me chemically but to no avail.

If it is skipped or extra beats(ectopics) then in my experience Flecainide has no effect whatsoever. Im on a daily dose of Flecainide and still get regular ectopics.

Flecainide is very good for controlling AF.


Flecainide has controlled my AF well but I still get ectopics which start short runs of tachycardia and I also have had short bursts of AFlutter which my EP says are caused by Flecainide.

I started taking some magnesium about six weeks ago and it seems to have eased the ectopics somewhat.

Ectopics on their own don’t usually cause a high pulse rate, so you may be having some sort of tachycardia as well. Best to discuss all of it with your cardiologist.

all replies so far are very helpful- just wanted to add that some doctors are cautious at prescribing Flecanide as PIP without either a beta blocker or a calcium blocker- others think it's fine. I asked a question about this at our last patient support group. We had a very experienced EP speaker. When I said this seems to be a grey area he replied Flecanide is a grey area!! He went on to say the large trials were done on `flecanide as a regular medication but little for use as PIP. It is definitely the case that it should only be used by those with a normal heart.

The controversy over whether beta blockers are needed with it is because it can cause the fast atrial rates to trigger fast ventricular rates which can be dangerous so you do need very good medical advice about this drug- which works very well for a lot of people.


I was on both Flecainide and Bisoprolol for many years but was taken off Bisoprolol last year as I developed Bradycardia.

I have been on just Flecainide since.


rosyG in reply to pottypete1

Yes many are but Need to be aware of possible results above

Redders in reply to rosyG

I’m just on flecainide 50mg twice daily but have been in permanent af for nearly 6 months now so I think flecainide isn’t working for me now. Waiting for a date for a cardioversion but that’s like winning the lottery.

Spoiler in reply to Redders

Wow, Redders, that is so sad to have to wait. I can go to my heart hospital in Arkansas/USA and be walking out of ER within a few hours if my INR /potassium is in range and been without food 4-5 hours. In fact, just had one yesterday. I cannot imagine having to wait... so sorry.

Nugger in reply to Spoiler

I live in Florida BUT don't have medical anymore,since my wife took early retirement & there I go into afib 16 feb this year.

$330 to see cardiologist every visit,so he says after 3rd visit & 4 weeks,think we need to cardiovert you,hospital gives me a price of $109,000 & discounts it cos no insurance to $14,200!.

I ring heart clinic to cancel & when she hears the price they quoted rings them & it gets slashed by another 10,000.

There playing with people's lives in usa & it's great if you got insurance.

So I jump on a plane & come back to uk & after seeing the doctor on 3 April am down for cardiovertion on 14th june,so yep long wait in uk.

Spoiler in reply to Nugger

Bless you, I do not know how people survive so symtomatic with it, I do not think I could. What an ordeal!!!!The only thing that so far has taken my rate down is cardezim IV, I feel like daylight and dark. Most of the time they start this before cardioversion to give me relief while they wait for my lab results, it never converts me, altho it does some people. The first time I went into ER 4 years ago, my rate was 230. My insurance is $3,000.00 deductible then it pays 100 % of anything, including meds. So that figures $250.00 a month deductible really. The coverage is through the company I work for. Those prices that you were expected to pay is inbelievable and it is a curse for you heart to have more damage from continuing in afib. So Sorry and do understand your suffering😮

Nugger in reply to Spoiler

I'm same,in states they had me on carveida lol but it didn't slow my rate down & couldn't walk up a small hill or stairs but over here they use bisoprolol & I'm on the max dose but can't belive the difference,in fact I walked up this steep hill that's half a mile long no problem & I used my kardia when I got to the top,thought I'd gone back into rhythm but hadn't.

They've put me on the dreaded amioderone before I have the cardioversion & that's slowed it down some & now I never feel it bouncing around like before but the loading dose of 200mg 3 times a day for the first week is terrible,kept feeling sick & spitting salt water ect but a lot better now I'm on 200mg twice a day.its only till I have the cardioversion I hop,don't intend taking it any longer,many thanks

Spoiler in reply to Nugger

I had refused amio twice, finally took it last Nov 3 weeks after IV loading dose, stopped it because I could not even get my breath while in NSR, ears ringing and glands in my neck felt like the mumps. Maybe bisoprolol is the answer, that one has not been used on me. Cardiac arrest on second dose of Tikosyn and the first pill converted me. Wow i was impressed with that only to be devastated with the second deadly dose.

Nugger in reply to Spoiler

Why the second dose if the first one worked ? Or was it on a separate occasion

Spoiler in reply to Nugger

If I go into afib it is persistent unless cardioverted, I have gone 20 months fine on propafenone med. then a break through. I never just go in and out of it like some people. I cannot really say it worked, I was not on amio long enough, it did not convert me on the IV loading, I was DC cardioverted then given the IV doses.

Spoiler in reply to Nugger

It was different times, yes.

I’m on Flecainide and regularly get ectopic beats and missed beats. According to a 24hr ECG, I was even getting noctutnal pauses of 3-4 seconds.

I’ve been on Flecainide for 2 months. Occasional ectopics, but not nearly as often as before I was on it. Before I was taking flecainide I would get ectopics every time I laid down.

With professional advice first from an experienced Naturopath you may want to try 200mgs per day of CoQ10, I believe this helps my skipped beats. My Naturopath prescribed it with Mg as well. Mg relaxes and CoQ10 strengthens. Good luck.

I was on flecainide and diltiazem to control my AF. I had a pv isolation Ablation and kept on the flec and diltiazem for 2 months. After 9 days I developed arrhyhmia. At hospital they decided it was the return of AF and doubled the flecainide to try to cardiovert me. At this point everything got a whole lot worse. More investigation revealed I actually had atrial flutter ( right atria!) My EP advised me that flecainide promotes atrial flutter. So we reduced the flec it I had to have another ablation to get rid of the flutter. .

As you can see from the other comments, Flec impacts everyone differently. I recently had an AFIB attack after 20 months following my second ablation which required a cardioversion. Up until that time I had severe ectopics which made me feel that I was possibly close to another AFIB event which unfortunately happened. Since that time 5 weeks ago, I have gone back on Flec 100 mg 2x per day with a concurrent tiny dose of Metropolol for the reasons stated in these replies. Since I went back on Flec, I have had almost zero noticeable ectopics and a very even and steady heart rate. I’m sure they are some ectopics creeping in from time time but they are not noticeable. So, for me, Flec works great, but of course time will tell longer term. Some folks have been on Flec for 10, even 20 years or longer while others cannot tolerate it. Talk to your EP about a higher dose if you can tolerate. It may help your ectopics if you are lucky like me. I don’t believe that Flec as a PIP is a great solution since you have to have an event to use it. The more you can prevent AFIB events, the better off you are.

Good luck

My EP prescribed Flecainide when I was having PACs. His concern was that PACs could lead to afib. He also prescribed a calcium channel blocker because of the concern that Flecainide can promote flutter. My experience was great: stopped PACs and no side effects. YMMV...

Hi there,

Don't know if my experience is relevant, but when I was diagnosed with Paroxysmal ad in 2009 and nothing helped my going up hills, I was given an appointment to see a cardiologist who was not helpful when I gave him my symptoms. I carried on having breathing problems and finally paid to see one privately, and what a difference! I had tests done and referred to a consultant for ablation, which I had in Dec 2009, and was successful! However 2 years on I had a recurrence of symptoms and was put on Flecanide and Bisoprolol, then my GP said I could drop.the Bisoprolol as I felt so tired. Since then just being on Flecainide and Riveroxoban I am able to cope, alas I still struggle on hills, but the consultant I saw said that I was not bad enough for another ablation, and in any case he would not recommend it because of my age ( now 78). Since then another attack happened after my dental implants, which readers will remember my post about excessive bleeding following that. I still haven't been told what happened but my cardiologist said that the electrics had gone mad, and he said I may have to have a pacemaker. If nothing else happens I am still going on a walking holiday, and hope for the best! At least I have made it to 78 and still quite active, but no pushing myself too much. Thought the bit about going privately may help if you are in distress at having to wait a long time for help. Best of luck, Sunny-fi

A few times I had quite severe ectopics, constant bigeminy that went on for ages. A couple of times I got so fed up with it that I tried my PiP of 100mg Flecainide and 1.25mg bisoprolol and it went away within 30 minutes or so. I never got a chance to ask my EP if taking them was the right thing to do, but it worked for me.

This is in no way advice. Just something I tried.

CVSKL in reply to UScore

Hai..your pacs bigeminy still haunted u? I'm daily pacs bigeminy before and after ablation, post ablation 3 weeks ago..What medication reduce your ectopics bigeminy? Many thanks

UScore in reply to CVSKL

Oh that sounds bad. Mine were never daily, just occasionally. And I've not had any runs of ectopics since my ablation 4 months ago.

Although they are supposedly not harmful if they kept happening to me I would be hassling my cardiologist / EP for advice. The constant bigeminy was almost as unpleasant as having AF.

Flecainide and Bisoprolol did seem to sort it for me though. I did wonder if just bisoprolol would do the trick but never experimented with it.

Good luck, hope it calms down. 3 weeks is still very early after an ablation and things can still change significantly.

CVSKL in reply to UScore

Many thanks for your reply, appreciated..I will try wait and see 1st..still in healing period and hopefully will reduce..God bless u and family..

I would like to thank everyone who posted answers to my post. I really appreciate them all and am glad for this forum. Have an appointment with my new EP tomorrow. The Flecainide did help but heart still feels aggitated.

NCMH1970 in reply to Sunny-fl

Flecainide used to help me brilliantly- but since my second ablation it’s not working as well ( bigeminy returned) I have upped my flecainide to 100mg at night and 50mg in the morning but still have symptoms- I am loathe to up the morning dose as well as I feel more tired , it’s a real drag and I feel your pain ! I am wondering whether or not to go for ablation no.3 ????!!!!

Sunny-fl in reply to NCMH1970

NCMH, I feel your pain as well and it really is a drag. I sometimes use different words to describe this condition but I will refrain! I started back on the flecainide again but had to stop after a few days because of feeling so sleepy and dizzy but heart did calm down. Best to you and wishing you success if you go for the third ablation.

Hi Sunny,

I am in south Fl too! We should compare notes. Still haven’t found a good ep. I travel to another state for an excellent one.

Sunny-fl in reply to CCW66

Yes I noticed you were nearby and was wondering if you had a good EP in the area. I would like to compare notes.

Have been to three. I live in Palm Beach. One was pretty good but staff horrible. Dr Renkovik in Delray.

Sunny-fl in reply to CCW66

I have been to two. I am having trouble with pacemaker leads that the first EP put in. I am seeing Dr. Platt now in the Gardens.


The best electrophysiologist I have been to is Dr John Marcus Wharton at the Medical University of South Carolina. Google him. Outstanding credentials plus caring, considerate and absolute expert. I travel to him—he is that good. Have been to a lot from Cleveland Clinic to NYC —he is the best.

Thank you. I will check that out.

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