Despite having a flu jab for the first time I have what appears to be flu! A bad bout of coughing last night set off an AF episode lasting about 15 hours so far. I've never had AF last more than a few minutes before. I took a PiP of Flecainide & Bisoprolol this morning which had no effect. Spoke to my GP this afternoon & he said to try a double dose of PiP tonight & that if that didn't work to go to A & E...which i thought sounded a bit drastic.
What is the consensus around how long to remain in AF before heading off to A & E?
Written by
Barny12
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Barney, this puts us in a very difficult position because we are not medically trained and therefore cannot interfere with dosing of medication prescribed by Doctors but what is being proposed is way in excess of what is recommended. If you can, either contact your Doctor or your nearest pharmacist for professional advice. If all else fails, google Flecainide maximum daily dose and make your own decisions......
NICE guidance below - 400gms reserved for special cases normally taken under medical supervision
Hmm, the overdose effects certainly sound pretty bad! His idea was to hit the AF hard so as to convert to NSR which sounds fair, but I think I may hit it with one double dose (5mg Bisoprolol & 300mg Flecainide) tomorrow morning 24 hours after the first PiP. And if that doesn't work head off to A & E late Thursday or early Friday.
Good idea. I’m having trouble selecting the link for NICE recommendations! If you google “NICE recommendations for Flecainide”, all will be revealed.....hope you get it sorted by tomorrow....
Hi Barny I think deciding when to go to hospital differs for each person depending on what you have been told to do by your Doctor and any other health issues you may have.
I have been told by my Consultant that as long as I don't have chest pain or feel I am going to faint I am ok to wait 24 hours before seeking help for P-AF.
I prefer to stay at home during episodes, I find hospitals stressful and my local hospital is 'failing' and not a good place to be with long waits to be seen and patients stuck outside in ambulances or on trollys for hours . Neither desirable when you have P-AF , shaky legs and need to pee every half hour,
My episodes are every few weeks and last up to 15 hours. I take an anticoagulant and a beta-blocker for rate control but have not yet been prescribed rhythm control but have told it is a possibility I may be at some stage .
I am sure for me staying at home, monitoring my heart rate , maintaining a calm atmosphere doing breathing excercises and distracting myself from my P-AF with the radio is far better for my condition than a stressful visit to hospital.
I have used Flecainide as PIP for nearly 30 years.
As Hidden has quite rightly pointed out non of us here are medically trained and therefore cannot advice on medication doses.
We would be breaking all the rules by telling you what dose of any medication you should take.
However I have no problem with telling you what NOT to do.
Do not take more than 400mg Flecainide in any 24 period. ( Preferably no more than 300mg in 24 hours.
Do not take more than 200mg Flecainide at one time.
I am on 100mg twice a day and therefore have to be extremely careful about taking PIP if I have taken my daily dose not too long before.
When I have got it wrong I have felt absolutely terrible.
You must be under the care of an EP and I therefore strongly advise you to do nothing more until you talk to him/her.
Finally have no hesitation in visiting the Emergency Department at your hospital if you really feel unwell. In my case I have done this numerous times in 30 years and when I apologised for being a nuisance was always told I wasn’t anything of the sort.
I always wait at least 24 hours if I cannot regain NSR.
My visits to the ED have nearly always resulted in a cardioversion. They have been able to do this as I am anticoagulated and can prove it.
Pete
pottypete and I are great mates, but our views differ slightly on the maximum dose of Flecainide you can take at any one time within a 24 hour period. I am fortunate in that I belong to a vibrant AF Support Group based at Epsom Hospital and over the nearly 6 years it had been running, we have been lucky to have had a very large number of EP’s and Cardiologist’s giving talks. Without exception, whenever the question of using Flecainide as a PiP is raised (and it’s been a lot) they have all recommended that the full 300 mgs should be taken in one dose because this creates the maximum permitted impact to get the heart back in rhythm. It is something I have done probably 20 times in those 6 years. However, there is a rider, if your Doctor tells you something else, by all means ask the question, but you must alway follow the advice of your Doctor because there may be specific reasons for prescribing a different dose.
Pottypete may well have a different view and for very good reasons.
When I was first told to take extra Flecainide when an episode of AF occurs,many many years ago, I was indeed told to take 300mg at a time to attempt chemical cardioversion to NSR.
Interestingly enough at that time I was under the care of a research fellow ( now top dog at the London Bridge hospital ) based at St Georges Hospital in south London not a million miles away from Epsom.
When I moved to South Hampshire I was told by my new EP in no uncertain terms that that was far too much at a time and it could have serious consequences.
For what it’s worth for me 200 mg nearly always works and 300 mg make me feel really bad for at least 24 hours afterwards.
As we have so often in the past discussed different hospitals and different EPs have significantly different views on the best approach.
The best advice we can give you is to talk to your EP tomorrow and seek their guidance.
One thing that is for sure we are all different and that makes a significant bearing on what should or should not be done.
You and I must have similar constitutions - I take 50 mg x2 and have few episodes if I had I was told to immediately take 200mg irrespective of when I took the last tablet - I found this stopped the Afib with a pretty sever jolt in circa 2 hours but I feel awful for 24 hours - I began to question this approach based on the fact that it takes about 2 hours for Flecanide to enter my system and about 6 to reach peak effect .....so I now take 100mg immediately and give it 4 hours to settle - it always settles in that time - it takes a longer than bombing it right away with the maximum dose but I feel fine afterwards. If it didn’t clear or improve appreciably in the 4 hours I would take another 2. It’s a powerful drug and combined with `Bisoporol. Was hopeless for me resulting in the only admittance to hospital with no discernible pulse !
I echo the FJ’s warnings. When I took my 1st dose of Flecainide as a PIP - 300mg it was under medical supervision for 8 hours. The reason - Flecainide is an excellent drug for AF however it also has the capacity to induce more dangerous arrythmias and should be used with caution.
My understanding is that GP’s - unless they have specialist training - do not meet the competency levels to advise on drugs such as Flecainide.
As to A&E - the criteria I was given was - if I had chest pain: if I felt very unwell and clammy; if I had trouble breathing; if HR exceeded 200; if I had syncope or near syncope: if AF lasted more than 24 hours as the sooner it is treated, the better - for no other reason. Unfortunately on the occasions I did attend absolutely nothing happened and in several cases I wasn’t even monitored so I gave up going. Other people seem to have had very different experiences and I have to say my husband and my GP have called Paramedics for me on several occasions who have been brilliant - they took 12 lead ECG - sent it straight through to Cardiology who advised so i didn’t need to go to A&E.
I think the longest episode of fast AF ie HR plus 150 I had was about 72 hours. Infections and definately this cough which seems ever lasting, triggers AF. I have been in and out of slow AF with other arrythmias for about a week with it and it’s exhausting.
The only thing that helps is lots of rest and fluids and avoid cold air.
I have a PM check on Tuesday so hoping they will advise.
I can't advise about taking a PIP as I'm not able to use them.
However you wanted advice as to when to go to A&E. I've had PAF for over 20 years and the hospital suggest if your resting pulse is consistently over 100 OR if you are presenting heart attack symptoms (sweating, aches and pain, light headed, breathless etc.), that's when to go and don't delay.
Now though, because I get it so regular (every 7-10 days) and don't have any heart attack symptoms, they don't mind my resting pulse being in the order of 150.
I also note from my travel insurance that their standard is you need to be able to walk 400m on a reasonably level path but without getting breathless.
The above are my general guides but we all experience AF in different ways and have different effects. So, always play it safe.
Can I ask how long your attacks last for? I too get them approximately every 7 days despite taking Sotalol twice a day and can take an extra one when I got into AF. My attacks usually last for about 36 hours. Do you take regular medication?
This one lasted for 20 hours, but they're normally few and far between - say lasting 2 or 3 minutes every couple of months. Not on any meds at the moment but was given the PiP option to take as & when.
Last year I had PAF starting on average every 8 days and it lasted on average 2 days. Yes, that's a quarter of my life in AF. Fortunately it's quite mild and no heart attack symptoms so didn't go to A&E at all.
I take 2*47.5 mg Metoprolol and warfarin. When in PAF I take an extra 47.5 mg of Metoprolol.
I took Sotalol for many years, gradually increasing the dose until I was up to the maximum recommended. I didn't take an extra tablet when in PAF.
Thank you Alan. I sometimes wonder if it would be better just to take a pill when you go into AF as taking them regularly does not prevent the attacks which have become more frequent. I was on the maximum dose of Sotalol and then changed to Flecainide which didn't suit me so put back on Sotalol. Now just take 80mg twice a day and an extra when AF kicks in.
Take care
I have been told repeatedly by GPs and EPs that if the heart is going at above 100 bpm (one said 90 bpm) for more than 20 minutes and is unresponsive to taking previously agreed additional medication (in my case an extra half tablet of Sotalol) you must call for an ambulance. You should also call for one if your symptoms are unusual *for you* or are more prolonged than usual. If the heart is beating below the rate given above, it’s less dangerous, but the stroke risk is still raised. You should make a G P appointment if the episodes are becoming more frequent.
Thanks to everyone for all the replies, they were much appreciated. Fortunately the AF gradually reverted back to NSR around 10pm last night after a concerted attempt at various vagal manoeuvres. Phew!
Now paranoid about avoiding another coughing fit. Flipping flu!
I have no confidence in GP’s, they’re so overworked and under pressure they can’t operate properly and the majority have no more of a clue than the average cloud in the sky. So you’re best off making your own decisions because you know yourself a million times more intimate than any so called GP.
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‘When or if’ to go to A&E with AF episode and other general moans! 
Controversy over when to go to A&E when in AF, could this be a good question for Patients' Day?
When should I go to A&E
A&E
