Premature atrial contractions - flecainide?

[Browncoat]

Hi folks.

I could do with some advice/recommendation/thoughts please

I was diagnosed with paroxysmal AF several years ago and given flecainide (Pill In Pocket). Although I was never advised to attend hospital on the first use, and have only used rarely - always preferring to see if the episodes 'rectify themselves'. My own research leads me to consider my AF as vagal since it only occurs at rest, usually at night, sometimes triggered by cold drink, or a large meal.

Over the years I have had bouts of fast AF that have either self-terminated after 30 minutes to 2 hours, or I have taken the flecainide to end them. Overall I have been very lucky (possibly helped by supplements including magnesium, ubiquinol and L-carnitine). I am not on any anti-coagulants as I am considered low risk, but I do take FruitFlow (an anti platelet aggregation supplement).

However, over the past year I have been increasingly plagued by sustained periods of premature atrial contractions, often lasting for a few hours. The heart rate is not raised, but my Kardia sometimes records these as AF. On just two occasions, these periods have developed into full-blown fast AF that have reverted to normal sinus rhythm after an hour or so.

So, when is a period of PACs considered AF?

Last night I didn't get alot of sleep as the PACs were waking me, so I took some flec... should I take flecainide to settle these sustained periods of PACs?

I'd be grateful for any thoughts?

[rosyG]

question for your doctor I thiink1 Flecanide is powerful and needs to be supervised. Pleased you are managing well. My vagal AF is similar to your- episodes lasting 4-6 hours now rather than 6 6 years ago but not such a fast heart rate. I take Bisoprolol 1.25 just as PIP to keep heart rate down a bit during episodes

[Browncoat in reply to rosyG]

Thanks for the reply.

When I saw my GP at the end of last year, his advice was to consider taking Flecainide 100mg twice a day. This seems like a large change from the once every couple of months currently.

My GP was also reluctant to refer me to a cardiologist when I asked (I hadn't seen one for 8 years), but later he did agree to refer me privately when I realised that was the only way I was going to get to see a cardiologist.

The cardiologist said carry on with PIP, but the PACs have worsened since then. He arranged an echocardiogram (due March, but cancelled) also offered to put me on the ablation waiting list whenever I want. I am waiting for the echo and will be interested to see if my heart is still structurally OK (it was when I had my first AF).

[secondtry in reply to Browncoat]

I go with your GP try 100mgs Flecainide twice a day, has worked for 6 yrs for me. As I also don't take anti-coags yet, can I ask who put you onto FruitFlow a new one on me?

[BobD Volunteer]

Ectopics (PACs or PVCs ) never become AF. Two quiet different things. Have you tried to slow deep breathing exercise? Try the search box top right.

[Browncoat in reply to BobD]

Thanks for getting back to me.

That's interesting as I have several ECG readings where I have captured a period of PACs 'morphing' into AF. The PACs appear as double or triple beats (full P,Q,R,S,T waveform), with 'gaps' between the next beat(s). The gaps slowly get filled in until I am in full-blown 140+bpm Afib. Maybe what I think are PACs, is slow Afib?

Thankfully, I am a fairly calm person when my heart is misbehaving and I don't think I get too anxious, but I do get a bit fed-up when it's waking me up during the night! I do tend to do the breathing exercises or meditate whenever I get a 'full-blown' fast episode, though these are rare.

[Finvola in reply to Browncoat]

If you can see a P wave then it is probably an ectopic beat as AF doesn’t have P waves. Ectopics can sometimes trigger other arrhythmias - mine occasionally start runs of tachycardia.

[Browncoat in reply to Finvola]

Hi Finvola.

That's what I find interesting; the P wave is clearly there on the ectopic/PACs, but on the occasions that it has 'become' AF, it becomes harder to differentiate a distinct P wave from the 'mess' of the previous T since they have become bunched-up - sometimes it's still there, and sometimes it's missing. It's fascinating... but would be more fascinating if it weren't mine

[BobD Volunteer in reply to Browncoat]

Best throw away your gismos and enjoy life is my view. Its going to happen one way or another. As Finvola says p wave =not AF. Developing one arrhythmia from another is not unknown. The ones I have now are nothing like the AF I started with fifteen years ago. lol 😁 Sadly it seems to me that if your heart is prone to arrhythmias all you do is chase one into another till you finally depart this mortal coil. I had about ten years free of all after my third AF ablation so not complaining.

[Padayn01 in reply to BobD]

Been almost a year since your last ablation BobD how's the recovery now?

[BobD Volunteer in reply to Padayn01]

Not talking about it. Too depressing. Get rid of one thing and another takes its place.

[Padayn01 in reply to BobD]

So sorry to hear that bob you got your abalation the same time as me just can’t get it right can we lol

[Alessa69 in reply to BobD]

So sorry , are you OK Bob?

[BobD Volunteer in reply to Alessa69]

Having survived cancer and cardiac arrest I am quite sanguine and know things could be far worse! Still bulding race engines, heavy duty gardening and DIY but at my own pace these days.

[Finvola in reply to BobD]

👏🏻👏🏻👏🏻

[Lilypocket in reply to BobD]

Are you still Afib free,Bob?

[BobD Volunteer in reply to Lilypocket]

No AF just everything else. lol 😁

[Lilypocket in reply to BobD]

Well I have to say while suffering from " everything else" you still come across as pragmatic and upbeat! 😊

[BobD Volunteer in reply to Lilypocket]

No point in being miserable. Too much to do! One sparkles when one can and takes a low profile when not .

[lockerbie in reply to BobD]

Love your attitude Bob!

You always have great information. After four Ablations myself and reading everyone’s comment and helpful hints I’ve come to realize that this condition of ours is one that you just adjust and go on. Listen to some advice and then figure out what is best for you as an individual .

Love to all from across the pond.

Sue

[Lilypocket in reply to BobD]

Love the word "Sparkles" - so apt! When I'm Afib free and feel the other niggles less for a time I really feel good and "Sparkly".

[Buffafly in reply to Browncoat]

I have usually found that I get an ‘early warning’ of AF in the form of ectopics - not sure what kind. Around the time I was diagnosed with AF I used to get them in showers and thought they were AF! So even if they don’t ‘morph’ they do go hand in hand I think. It has been suggested that it is a sign your heart is trying to go into AF and failing especially after an ablation.

[Lilypocket in reply to BobD]

Hi Bob

My AF bouts are often preceded by PVCs/PACs so I wonder if there is a link? Obviously they are not Afib but can they occasionally provoke it or warn of an episode?

Take care

[BobD Volunteer in reply to Lilypocket]

Sabine Ernest once told me ectopics were a good sign as it showed the heart was trying to go into AF and failing.

[Murchi37 in reply to BobD]

When you say trying to go into AF, I somewhat can understand and agree with that sentiment. Now why would a heart want or try to go into A-Fib? I suppose theres hundreds of reasons

[Shcldavies]

Speak to your EP, Flecainide can cause serious problems and it can be a life saver, only the experts have the knowledge to say which. I have learned that the GP, Cardiologist and EP all have limits to their knowledge and in this case the EP is probably the best one to advise (it does depend on the individual). One cardiologist (not my normal one) who treated me when I was blue lighted to hospital identified the cause of my condition as Flecainide (although I had been taking it for 5 months without any problems - thought it was a miracle drug) and he suggested the drug should never be used without monitoring. My EP confirmed Flecainide was the likely cause of my condition during my subsequent ablation. The good news is that my Flecainide induced condition put me at the top of the ablation list and following a shaky few months I am now back to better than normal as I am on just 1.25 Bisoprolol to keep the MAT (which could not be ablated) at bay.

[Browncoat in reply to Shcldavies]

I wish I could see an EP - I had to resort to private to even see a cardiologist!

[secondtry]

Next time you get an episode try some of the vagal 'tricks' mentioned on this Forum e.g. a cold drink sent me into AF once and the last time I had a short episode a cold drink from the fridge gulped down stopped it. There are several other activities that can both start and stop an episode.

[Browncoat in reply to secondtry]

I have to admit, I haven't tried to 'cold-shock' myself back into NSR... I will try it next time. Thanks for the suggestion.

[dh1120]

I have had severe PACs that I am very sensitive to for over a year now. So far I have not been diagnosed with AFIB. My EP prescribed me Flecainide 50mg x2 daily. It worked great for 8 months, not one episode! I didn't feel any until 4 months ago and they slowly came back hard and heavy. He has raised my dosage to 100mg 2x daily and I am not so sure that I am tolerating it well but am hoping what I believe the side effects of raising my dosage goes away. But what it boils down to is Flecainide has helped with my severe PACs.

[Browncoat]

dh1120 ; Thanks for the input. Do you mind telling me how you would describe your PAC symptoms? Also, what flecainide side effects are you experiencing?

[dh1120 in reply to Browncoat]

My episodes consist of pounding, flutters that I feel in my neck, skipping beats, short of breath, chest feeling uncomfortable, heart rate sometimes goes up then down, cough, to mention a few. The side effects I am having are extremely tired, feel like I can’t get enough air, overall not myself. Doctors office just called and told me to go back to my lower dose until I see my EP and send them any Kardia readings.

[Browncoat in reply to dh1120]

Thanks... sounds like mine are getting, but without the breathing issues (thankfully). Although I put my symptoms down to the arrhythmia itself rather than the flecainide. I'm finding I'm popping flecainide (1 x 100mg) most days at the moment. My instinct with most medicine is to try to get by without it, but I think with PACs that lead into AFIB, and with that phrase, "AFib begets AFib" in mind, I think I'll just have to get used to taking it!