Flecainide advice

[hartbeast]

Happy almost New year. Guess my heart wanted to get one more kick in, before we say goodby to 2019.

My still recurring AFib episodes have been 3-6 weeks apart, albeit milder and shorter, since my ablation in June 2018. Tonight’s episode is a bit more intractable, as I usually take 1/2 a 25mg metoprolol, wait 30 minutes, then take 100mgs Flecainide and it’s usually done within 2 hours of taking the Flecainide. But tonight I’ve taken double that, it’s been two hours, and although the rate is averaging 83, I’m still in AFib.

I still have another BMI point or two to lose, but I’m following all other anti-inflammatory and heart-healthy guidelines, including magnesium, no sugar/alcohol/caffeine/gluten, low dairy, plant-based diet etc. my only daily Med is apixaban, plus I take magnesium bisglycinate and a couple of other supplements, on advice of my primary care doc (GP).

I’m writing to ask if you lovely folks who do PIP take a full dose right away, or start with less and add more, if necessary? The Flecainide and metoprolol drag me out, and I’ve been having good luck with low doses until today. Also trying to decide if I should go for a second ablation, but not keen on the idea. 61 year old female.

Any advice and kind words appreciated, as I’m feeling a bit gutted, in these wee hours of the morning...

[hartbeast]

Thankfully, I finally just converted back to SNR after 3 hours 🙏 but still interested in how you use PIP, dosage, if you take it right away or wait a bit to see if it will stop on its own, how long it takes to convert after you take PIP, etc.

[wilsond]

Hi good to see you back in nsr. I take 100 mg flec 1.25 biso at onset of af or flutter. Also drink lots of cold water . After an hour if still going..repeat. never had to take the third dose.

It took a while for the lifestyle changes to really kick in but def made huge difference.

Best wishes x

[hartbeast in reply to wilsond]

Thanks so much for the info and encouragement, wilsond!

[secondtry]

You may wish to check out taking magnesium in a compound with taurine i.e. magnesium taurate. I am fairly sure it has helped me.

[hartbeast in reply to secondtry]

Thank you, second try. I take magnesium bisglycinate, I will research and ask my doctor about magnesium taurate.

[Rubymurray25]

Hi, It is such a wonderful feeling when you can convert yourself, isn't it? When I was on Sotalol and had an PAF episode i was told to take 100mg of Flecianide after 30 mins and if no joy another 100mg after a further 60 mins, my success rate was better after two dosages and probably worked 5 out of 7 times. After my recent ablation and a change of meds to Bisoprolol I have now been told to take 3 x 100mg of Flecainide immediately. It might be that I know instantly when I go into AF whereas I believe that is not always the case? I do find it interesting all the different usage of a PIP but I guess not only are we all so very different all Cardiologists have alternative views!

[hartbeast in reply to Rubymurray25]

Thank you Ruby, it’s interesting to hear how your doctors approached the “stepping up” process. Has your EP suggested a second ablation, as mine has?

[Rubymurray25 in reply to hartbeast]

The recent ablation was in fact my second. It transpires I had AF and Flutter, the first ablation in May this year only dealt with the AF and when the Flutter came back after almost 6 months ( Nov 19 ) , the last 3 months of which I was on no medication ( other than Ribaroxiban ) and had no PIP so on both Flutter episodes 19/11/19 and 28/11/19 I was given a Cardioversion and put down for an emergency ablation which was done on 11/12/19 and at that point I was given Biosoprolol 2.5 daily and the 3 x 100mg Flacainide as the PIP. During the second ablation by a different Registrar Cardiologist is was noted that something was missed off during the first ablation on the baseline ( ? ) so hopefully now I am sorted??? Hope that helps.

[irene75359]

I used to start with 100mg of flecainide and take another a couple of hours later if the first one didn't seem to be working. Now I take 200mg immediately an episode starts and so far it has always worked within two hours.

[hartbeast in reply to irene75359]

Thank you, Irene, good to know.

[ILowe]

Good question to ask. Unfortunately I cannot see an easy answer. For several years I relied on PIP similar to what you describe. Then, I hit the "big one". Whatever I did had no effect. The first time I did not know what was happening and it led to a DCCV (electrical cardioversion). The second time I knew in my bones that the AF was not the usual one, and was the big one. I tried 2-3 times, at intervals, to use PIP. No joy. Fortunately I had a doctor I could see quickly and he put me in hospital overnight while doing cardioversion using amiodarone. This method is not known or used in Britain. Third time I tried for several days on my own so the amiodarone trick did not work and I needed a DCCV.

After that the doctors said, no more PIP. I should take bisoprolol/flecainide coctail for life.

The evidence I have seen suggests that action within 48 hours has more success. I have no idea how to get that in UK.

So, for you, if and when you get back to NSR, you might want to consider the life option with your doctors.

[hartbeast in reply to ILowe]

Thank you, ILowe, it’s useful to hear your experience. They used amiodarone IV on me in the hospital, before I had my ablation, then kept me on the amiodarone after I left the hospital, and my body really did not like that. But since the ablation the episodes have been milder and shorter, at least so far. Although it’s disheartening to hear how most people’s experience is that the episodes continue to get worse over the years. My EP says that if things get worse for me, I need to either go to the permanent cocktail option or at least try another ablation. I guess I’m just trying to put that eventuality off…

[Barty11]

I've had afib for 10 years. They were always short episodes (-2hours) and I always knew when one would hit me. It happened about once a month. My cardio put me on 100mg Flecainide slow release per day and it stopped the episodes for about 5 years. After that I started to get short break throughs and I increased the dosage to 150mg per day. Total success since then. I'm well aware that you cannot eliminate afib with meds but you can certainly suppress it. I do not take anticoagulants because my afib is under control. I absolutely know if I have an attack. And since they never (not even in the past) took longer than a couple of hours, my cardio does not think It warrants taking anticoagulants. These create their own problems. It is important to take the slow release Flecainide since it provides the body with an even amount of the drug for 24 hours. It is not available everywhere and I get mine from France. I believe in the UK only the 200mg dosage is available as sliw release.

[hartbeast in reply to Barty11]

Thank you, Barty. I had a stroke before I even realized it was caused by a fib, so going off anticoagulants isn’t an option for me. But I’m glad to hear that the slow release flecainide works for you. I will ask about that.