Flecainide PiP dose?: Dear all, Whilst I... - AF Association

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Flecainide PiP dose?


Dear all,

Whilst I understand that we are not medically trained and can not give medical advice, I’m interested in others experiences.

I was wondering for those that use flecainide under a pill in pocket “on demand” regime, what dose do you use, and following the dose how long before AF subsides?

Secondly I was wondering for those ablated but with continuing AF episodes what is the frequency of your post-ablation AF?

Thanks in advance for your replies.


10 Replies

Whatever dose you end up taking, it must not exceed 300 mgs in any 24 hour period. Most, but not all cardiologists prescribe the maximum dose as this produces the best chance of getting the patient back into rhythm. Most suggest waiting between 20 to 30 minutes to see if there is a natural return but how long it takes is anyone’s guess. After my first and only CV it could take anything up to 8 hours. After my first ablation around 2/3 hours and now, after my second ablation, less than an hour, so it is clearly very variable. As you say, you must follow the advice of your Doctor because Flecainide is a potent drug and there may be reasons why might be prescribed a different dose.....

I take 150mg and the longest my a fib has gone was 12 hr.

Since my ablation my AF is milder. I have radiotherapy damage to my left atrium so am unlikely to become AF- free.

I take 2.5 bisoprolol daily which is important when using flecainide as a p-I-p.

My EP says that it is important to take the flecainide within 20 mins of becoming aware of an episode. ( Does the heart get into the habit of fibrillating? He wants it stopped asap). So take 100 flecainide and if it doesn't stop within 2 hrs then take another 100. Max is 300/day.

Currently this works well for me. I have flecainide on hand at all times as it gives me confidence and control. Incidentally, it is an 'old' drug and relatively inexpensive.

Hi Kfib

I too take PIP flecainide 150mg. I normally take within 15 minutes if I am awake when PAF occurs but I am never sure how long I have been in AF when I wake during the night so take it straight away. AF usually resolves within about 2 hours. I don’t go anywhere without my flecainide.

I have had 3 ablations now and tend to be AF free for about 9 -12 months post ablation and then the frequency begins to increase so much so that I have had 5 episodes in November this year.

Have decided that I won’t put myself through anymore ablations as I don’t tolerate GA very well.

I hope you stay well

I take flecainide as a PIP and always take it immediately the episode starts. I originally started with 100mg but that didn't always kick in and I usually had to take another 100mg some hours later. So now I always take the full 200mg and within one to two hours I am back in SR. Even before then, my heart has slowed down considerably which makes the episode much more bearable.

I take 100 mg flec with 1.25 of bisoprolol as a PIP,as I have paroxysmal AFib and flutter

Usually stops it within an hour or so,if not ,repeat. Can do 3 times.

After that I don't know what I ought to do as never got that far!

I was told to take flecainide, with bisoprolol if I was not currently taking bisoprolol. This was partly to make sure the flecainide behaved itself:) and partly because of the benefits of bisoprolol. These are not just rate control, they also include the way bisoprolol restrains adrenaline.

Looking back, at the three times in my life when I hit 'the big one' that lead to cardioversion, I wish I had also tried a good dose of bisoprolol since in two of the cases, the AF started after successful completion of something stressful.

A surgeon -- used to tackling AF etc by intravenous injections -- once explained to me the principle of the 'bolus'. You need to send a wave of concentrated chemical through the heart. This can be done orally, hence PIP. Hit it, twice if needed, respecting the daily dose limit.

I take 200mg of flecainide between 20 and 30 mind after an episode starts. It usually last for anything between 45mins and 2 1/2 after that. I haven't had an ablation yet, although I am on the waiting list.


You can reduce your Afib episodes or at the very least make them less severe - all without med. Here's how:


After 9 years of trying different foods and logging EVERYTHING I ate, I found sugar (and to a lesser degree, salt – i.e. dehydration) was triggering my Afib. Doctors don't want to hear this - there is no money in telling patients to eat less sugar. Each person has a different sugar threshold - and it changes as you get older, so you need to count every gram of sugar you eat every day (including natural sugars in fruits, etc.). My tolerance level was 190 grams of sugar per day 8 years ago, 85 grams a year and a half ago, and 60 grams today, so AFIB episodes are more frequent and last longer (this is why all doctors agree that afib gets worse as you get older). If you keep your intake of sugar below your threshold level your AFIB will not happen again (easier said than done of course). It's not the food - it's the sugar (or salt - see below) IN the food that's causing your problems. Try it and you will see - should only take you 1 or 2 months of trial-and-error to find your threshold level. And for the record - ALL sugars are treated the same (honey, refined, agave, natural sugars in fruits, etc.). I successfully triggered AFIB by eating a bunch of plums and peaches one day just to test it out. In addition, I have noticed that moderate (afternoon) exercise (7-mile bike ride or 5-mile hike in the park) often puts my Afib heart back in to normal rhythm a couple hours later. Don’t know why – perhaps you burn off the excess sugars in your blood/muscles or sweat out excess salt?? I also found that strenuous exercise does no good – perhaps you make yourself dehydrated??

I'm pretty sure that Afib is caused by a gland(s) - like the Pancreas or Thyroid - or an organ that, in our old age, is not working well anymore and excess sugar or dehydration is causing them to send mixed signals to the heart - for example telling the heart to beat fast and slow at the same time - which causes it to skip beats, etc. I can't prove that (and neither can my doctors), but I have a very strong suspicion that that is the root cause of our Afib problems. I am working on this with a Nutritionist and hope to get some definitive proof in a few months.

Also, in addition to sugar, if you are dehydrated - this will trigger AFIB as well. It seems (but I have no proof of this) that a little uptick of salt in your blood is being treated the same as an uptick of sugar - both cause AFIB episodes. (I’m not a doctor – it may be the sugar in your muscles/organs and not in your blood, don’t know). In any case you have to keep hydrated, and not eat too much salt. The root problem is that our bodies are not processing sugar/salt properly and no doctor knows why, but the AFIB seems to be a symptom of this and not the primary problem, but medicine is not advanced enough to know the core reason that causes AFIB at this time. You can have a healthy heart and still have Afib – something inside us is triggering it when we eat too much sugar or get (even a little) dehydrated. Find out the core reason for this and you will be a millionaire and make the cover of Time Magazine! Good luck! - Rick Hyer

PS – there is a study backing up this data you can view at:


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Marvellous thanks Rick for a helpful answer to my questions! Not sure where this forum would be without you.

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