Beta blocker

If I am taking 100mg of Flecainide morning and evening is it necessary for me to take the beta blocker as well. My HR is always quite low and I can have an AF episode with an HR of 78!! I am starting to experience some dizzy spells.

Di

[Finvola]

You need to check this with your consultant who knows your medical history.

I take the same dose of Flecainide and my EP told me a beta blocker is essential in my case to control heart rate during short episodes of Flecainide-induced atrial flutter.

Before taking drugs my AF ran at 120-200bpm, so we are all very different.

[Hidden]

My consultant discharged me back to GP, GP admitted out of his depth so sent referral to hospital! Help!

[Finvola in reply to Hidden]

Can you try ringing your ex-consultant’s secretary for advice? I’m assuming your doc has referred you back to the same cardiologist? I think your GP is being honest as Flecainide is initially prescribed at consultant level and he/she does not want to interfere.

[Hidden in reply to Finvola]

Rang arrhythmia nurse, she said I had been put in to start cycle all over again! She cancelled appointment and I will see her 13/11.

[Finvola in reply to Hidden]

Not too long to wait - good that you got some action.

[wilsond]

Hmm well all I can say is same as you HR generally in AFib is not high just weird.I take Flec as pill in pocket.

However,I also get Flutter from time to time and have been told to take 5 mg of bisoprolol as PIP..and repeat if necessary.

Might be worth asking your GP...well ok...maybe not! Can you speak to an arrthymia nurse or other heart aware medic?

[Hidden]

Ello Hylda, as I know you know we are not medically trained and therefore we cannot give direct information on medication. That said, this is an issue which has been raised several times at our support group meetings and ALL the EP’s and Cardiologist’s have said that if Flecainide is taken as a regular daily maintenance dose then it must be accompanied with a regular dose of either a betablocker or calcium channel blocker. If Flecainide is taken purely as a PiP (pill in the pocket) then this is not necessary. I understand the reason is taking Flecainide regularly on its own can cause flutter.

Of course, you must check this out with your Doctor as we are all different and there may be other factors which need to be considered......

[Hidden in reply to Hidden]

Not quite ‘all cardiologists’ Flapjack, as mine put me on Flecainide 50mg x2 daily and advised me not to take beta blockers as 1.25mg Bisoprolol daily, given to me on diagnosis, dropped my BP & HR to low levels making me so dizzy I could hardly stand.

Guess we are all different - I have just booked annual blood tests & ECG to check there’s no prolongation of QT interval. I’m supposed to be followed up by hospital, but they are way behind with appointments, so have booked ECG with GP - hope their equipment has an automated diagnostic system, or the GP has a ‘good eye’🤣.

Pat x

[Hidden in reply to Hidden]

I take your point but I was clearly referring to all the EP’s/Cardiologist’s who have spoken at our support group meetings, not globally, hence my final paragraph. Just for the sake of good order, when speakers are introduced, it is always explained that they are expressing their views only and that everyone must discuss their own medical issues with their own doctor.

Good luck with the tests 👍

[Hidden]

Thanks Flapjack will keep taking the tablets!

[pottypete1]

You need to talk to your EP.

However if you have a slow heart rate and AF is around 78bpm a beta blockers may not be such a good idea.

I am on Flecainide and my EP stopped Bisoprolol 2 years ago as my resting heart rate is circa 50bpm.

Pete

[Hidden in reply to pottypete1]

Mine goes down into the 40s. It’s the dizziness that worries me! Elderly lady walking along clutching walls at 11am is not a good look! 🤣🤣

[pottypete1 in reply to Hidden]

With Bisoprolol my heart rate was circa 35-40bpm regularly.

You need talk to your EP as mine wanted me to have a pacemaker.

Pete

[Hidden in reply to Hidden]

Sorry, I replied to Flapjack in thread above. My sitting BP dropped low on 1.25 Bisoprolol and dropped lower still when tested standing & my HR dropped under 40 at times - mine’s usually in high 50’s to 60’s when resting. Cardiologist told me not to take beta blockers again.

He put me on 50mg Flecainide x2 daily and my only other med is Apixaban 5mg x2. I do take a Vit D supplement daily as my levels were found to be low & this resolved a bit of residual dizziness & tiredness I’d been having.

We all react differently to drugs and some on here have found a change of beta blocker, rather than stopping it, has reduced the side effects.

Time to book a meds review for you, I think, and I would never advocate stopping a drug without medical advice, as many drugs require a gradual reduction in dose.

Best of luck

Pat x

[Flutter-1]

I was on flec and bisoprolol and gradually weaned myself off. When I have an episode now I take 100 flec and 1.25 biso which usually put me straight in 3 hours or less.

My cardiologist advised that flec is not suitable (for me) without bisoprolol as well. There is some reason he didn’t fully explain. So I came off flec first then slowly off the biso.

Lately it seems my heart wants to go out every 2 weeks trigger or not. Like it needs a reboot or something??!!..

[MS444]

I had an ablation because Flecainide didn’t work. I was advised to use 100mg twice a day but had PAF events regardless. I reduced the dose to 25mg twice a day and that worked better. I never took metoprolol (beta blocker) unless I had a PAF event.

I’d go back to doctors and discuss it. Beta blockers can make you feel dizzy or otherwise exhausted if the dose is too high.

In the end the ablations (I had one and then a touch up 3 years later) seem to have worked. Taking Flecainide in regular high doses combined with continuous beta blockers may not be the ideal solution

[Kikimalikimalou in reply to MS444]

What is PAF?

[Hidden in reply to Kikimalikimalou]

It’s when you have an episode and it stops if it’s own accord as I see it. You might go ages before the next one or just a few days

[Kikimalikimalou in reply to Hidden]

Thank You .

As I am relatively new to AFib (4 months), how do you know if your having an episode? I just don’t know!

I’ve had bouts of being breathless and extremely tired and was wondering if this is what’s classed as an episode?

[Hidden in reply to Kikimalikimalou]

I can usually feel my heart jumping about all over the place during an episode. Am breathless too. Could you check your pulse and see what is happening?

[Kikimalikimalou in reply to Hidden]

Yes will do. Cheers

[MS444 in reply to Kikimalikimalou]

If you type “what is PAF” in Google it is the eighth item from the top.

[Hidden]

I take 150 flecainde a day and 1.25 nebevolol which is fine keeps me about 60 beats a minute, most prescribe a beta blocker with flecainde routine I think but best check with cardiologist.

Andy

[willec49]

Hylda, I was put on 50 mg. flecainide day and 100 mg. flecainide night along with a full 25 mg. tablet of metopolol (beta blocker) with both doses. I felt awful, sluggish, with no energy. I cut both doses of the beta blocker in half and it made a huge difference. I feel much better. My heart rate is low, sometimes under 50 bpm and I am light headed at times getting out of a chair after sitting a while but overall but cutting the beta blocker dose in half made all the difference. I have been on this regimen for about a year so far.

[Hidden]

Tried Flecainide as a pip, but episodes just carried on regardless. As I am asymptomatic most of the time once each episode has settled in my EP has discharged me. Hoping to gain more control taking the medication daily.

[Bagrat]

Early on in my disease trajectory I was swapped from bisoprolol to flecainide 100mg twice a day and never given a beta blocker. I know the usual advice is that both are needed but an attempt to reintroduce a low dose beta blocker a few years ago still dropped my heart rate so was abandoned.

I do feel your consultant/arrhythmia nurse is the one who can assess your individual situation.

[Hidden]

Seeing my arrhythmia nurse 13/11 for bloods etc.

[Treffynnon]

Hi Hylda, I’ve been taking 150mg of flecainide twice a day for 7 years. Initially I also took beta blockers but for me life on beta blockers was far worse experience than AF. As my heart rate rarely goes above 125 when in AF and my resting heart rate is 55-60 he agreed to stop them. As has been said many times there is no right solution to this; experimentation and on-going dialogue with your EP is the way to go.

Steve

[Hidden in reply to Treffynnon]

Thanks Steve

[jwsonoma]

Mine also insisted I needed to take an HRate drug with 75mg Flec 2x a day. My resting HR is 50-60 with out so he said 1.25 MG Bisprolol would do the trick. I cut a 5mg in 4.

[Hidden in reply to jwsonoma]

I’m doing that at the moment down from 5mg as my hr isn’t as high as yours.

[Shcldavies]

I know first hand that Flecainide can cause serious Flutter, the Beta Blocker helps keep this risk lower. Don't change anything without Doc agreement.

[secondtry]

I don't take any BBs with my 200mg Flecainide as my pulse & BP are quite low and despite checking twice my cardiologist maintains BBs would make me feel unwell. I have Lone PAF and am 66yo. This policy plus a lot of lifestyle changes has been fine for 5+ years. Check with your medics.

[dani777]

I'm not a doctor and I'd guess that most of us on here aren't, either. So I'd suggest you ask your GP. All I can say is that if your heart rate is already very low, that beta blockers tend to lower it even more. So be careful. Also perhaps worth considering are you on the right medication if it hasn't stopped your palpitations? I'm of the belief that everyone is different, so what might work wonders for one person might not work well for another. I have, more than once, disagreed with my GP over the years on various issues or medications he wanted to prescribe or prescribed where I hated the side effects or the meds just didn't work. So also remember you have say in this as well, I wouldn't always allow your GP to dictate particularly if something isn't working for you. But always at least ask them their opinion before you increase your dosage, or consider to take an additional heart medication. x

[Hidden in reply to dani777]

My EP referred me back to my GP because a) my episodes are asymptomatic and b) I didn’t want an ablation. Asked my GP what now and he admitted he didn’t know and referred me back to hospital again. 😱😱

[Hidden]

Please see my reply to TommoHFC on this subject

Pat x

[Hidden]

How do I find that? Di

[Tapanac]

When I was on flecainide (50mgs twice a day) I was told to take bisoprolol as it would keep the heart rate down as flecainide was basically an arrhythmia pill. One went with the other. However, I found I was too lethargic on 5mgs so I was weened down to 1.25mgs of bisoprolol and that seems OK as since my ablation my heart rate is only between 39-45 which apparently is too low. As I've had two operations recently one thing at a time as to what comes next with Afib tablets. By the way mine was tachycardia Afib so everyone is different, but only in my opinion and from what I was told regarding me, I think the two are usually put together. Good luck and hope you feel well.

[Hidden]

Many thanks Tapanac. I am down to 1.25mgs of Nebivolol.