Flecainide dose

I am a 61 year old male. This year I have had three intense fast AF episodes. The first didn’t respond to drugs so I had a Cardio Version which put my heart back in rhythm but at 30bpm which was too slow so I had a pacemaker implant... sorted. A few months later I had another fast AF episode and another CV. A few weeks ago I had the third fast AF episode and was prescribed Flecainide 50mg twice a day which put my heart back into rhythm, I have now been advised to up the dose to 100mg twice a day. I am also taking Bisporolol and Rivaoxaban. Since increasing the dose of Flecainide I can hear my heart thumping away (in rhythm) at night and it is very difficult to get to sleep. Has anyone else experienced the same with this medication? Also I am not sure why the dose was increased when I was fine on 50mg twice a day.

[jedimasterlincoln]

I've been on 50mg twice a day of Flecanide most of this year. Before that it was a couple of periods in 2013 and 2015. This is also the drug they have given me half a dozen times IV as a chemical cardioversion (it's worked once which could have been coincidence) as every other time I've needed DC cardioversion (20 times).

I am also on Bisoprolol 10mg once a day. I have been told that when I am "in fast AF" I can take an extra 2.5mg of Bisoprolol and increase my flecanide to 100mg twice a day. My EP did say the flecanide would only rein in a fast beat and stop it racing away (something to do with reducing the number of beats passing through the "junction box" in the heart) and that the dose wasn't needed as much if everything was OK.

As a side note, when I'd had ablations in July and December '14, I was OK for a bit and then I developed an Atrial Flutter. When I was admitted to hospital locally they said it was flutter not AF and likely the Flecanide was making it worse/had contributed to it.

I've not had any intense "hard beating" of the heart over night that I can directly blame the Flecanide for though.

[CDreamer]

Pulsatile tinnitus is quite common in people with AF whether or not you are taking drugs, if you glance back through posts you will see several in the last week or so talking about the cessation of the noise after ablation.

It never bothered me much as I couldn’t remember a time when I couldn’t hear my heartbeat and when I awoke from sedation after ablation and couldn’t hear it I got a shock and didn’t know if I was dead or alive!

When in AF at night it did get tiresome as I would often lie awake listening to it and waiting for the rhythm to change until I put in earplugs and listened to Audiobooks which distracted me and helped me fall asleep.

I guess the only way to know if the Flec is to blame is to stop using it and see if it goes away.

You may find this article helpful.

healthline.com/health/pulsa...

[wilsond]

Not that I've noticed.I went down from 100 mg twice a day to 50 mg as I was having visual disturbances .It did send me into flutter,which I didn't have before,so it can be a difficult drug for some effects. Maybe some on here can help more. Perhaps a call to whoever prescribed it explaining problem?

Best wishes x

[Hidden]

I had a lot of palpitations when first on Flecainide and they could last hours. After about 5- 6 weeks my heart adjusted and now I have hardly any and of short duration. Hope things settle for you. Can you contact Cardio secretaries or GP to see if there’s a letter explaining increase in dose?

[ILowe]

I have a new Cardiologist. She wanted to double the dose to 100/100 (with 1.25/1.25 bisoprolol) instead of 50/50. When I protested that this much, in the past, had resulted in increased palpitations/irregularities, she said that is easy to test for. I had the 24 Holter done. New equipment-- I wish I could afford it and do my own tests. The next day in front of me the results were read on the computer, and a standard template report printed on the spot. The report counted the kinds of palpitation. She then showed me on the screen that I had loads of them during the day, and none at night, so my hypothesis was wrong. If my hypothesis was right that flecainide increased palpitations there would be palpitations at night when I was not nervous.

I love to be out-argued like that!!

The point is, that there are ways of making these dosing decisions based on evidence.

So, while I was at it, I asked her if she could see from the data, if flecainide for me was dangerous. She said she could, she knew what to look for. She promptly enlarged some of the trace and showed me that things were safe and why. She did not feel threatened by questions like this.