Flecainide eventually produces SVT or flutter?

[secondtry]

My cardiologist said very casually on my last annual check-up visit, when I told him I got 2/3 times a week a 3 second or so flutter like feeling rather than a more pronounced ectopic, " I told you this might develop". My question please is, is there anyone with Lone PAF, otherwise healthy and with AF well controlled on Flecainide for several years where this has occurred?

And a second Q please, has anyone successfully weaned them selves off Flecainide; as my QOL continues to improve through Lifestyle changes I feel more and more tempted to try, very slowly!

[Finvola]

Yes, I’ve taken Flecainide for six years and have had short bouts of what my medics say is flutter. Each lasts about 15 mins on average at about 110-130 bpm. Interestingly since I was changed from Bisoprolol to Nebivolol two years ago, I’ve had very few.

I did try to reduce my Flec dose twice a few years back but the PVC’s were non stop and made my life so miserable, I decided to return to 2x100mg and get peace.

My cardio wasn’t too worried about the flutter and said that if it became a problem, ablation for flutter had a high success rate. I’m happy to stay on Flec as I prefer not to go the AF ablation route and it keeps me AF free.

[secondtry in reply to Finvola]

Thanks Finvola reassuring to know!

[Paulbounce]

I don't know enough about this to comment. However as a flec user (100mg twice a day) I will follow the post with an 'invested' interest.

Paul

[KMRobbo]

No 1 - not medically trained so I do not fully understand what happened to me

No 2 - owing to that, this may not all be relevant to you but some certainly is.

I was on flec for 10 months to control my afib. Only one afib episode whilst on it, and that was when I missed an evening dose. I hate taking drugs but flec was not a problem to me. As good as drugs get, in my limited experience.

I had a PVI cryo ablation for AFib Jan29th 2018 (left atria) . So far succesful, I do not believe I have had AFIB since. ( ectopics yes but not a problem to me since I got my head round them). I recovered very quickly from the ablation in a few days no issues at all. On the 9th day I developed reentrant atrial flutter 140 bpm this was rate controlled by the 200 mg diltiazem I was taking. I was asymptomatic in high rate afib (even at 243 bpm), but I was very symptomatic with atrial flutter. Walking lounge to kitchen had me breathless. (I could run miles in AFib). The re entrant flutter was in my right atria. My EP or his regstrar advised it was very possibly promoted by the flecainide I was still taking post afib ablation. He was sure i did not have any flutter when I had the AFib ablation. (or else he would have sorted that at the same time.) Owing to some confusion at my Iocal hospital they initially thought it was just afib reoccurring and doubled my flec dose to try to cardiovert me. It made the flutter worse. No faster rate, probably owing to the diltiazem, but I was more breathless and the physical feeling felt more intense. The reentrant flutter would not stop. Any way once my EP was involved he arranged me a second ablation right atria on the 26th Feb 2018 and that stopped the flutter . Never returned, as expected by the EP as this ablation is 95% succesful as compared to what I believe is 65 to 70% sucess rate for the average of all the afib ablations.

The good news is that the flutter ablation is right atria and I understand safer and well away from phrenic nerve/Oesophagus that I understand are possible complicated areas for left atria ablations.

Please note after the flutter ablation I continued to take flecainide until the end of April 2018 with no further issues.

I stopped all drugs May 15 2018.

For me the drugs side effects were worse that the ablation. Flec had no side effects except the above. 3 of the 4 rate control drugs I tried were terrible side effects, much worse than the afib!

Best wishes.

[cuore in reply to KMRobbo]

What dose of Flecainide were you on?

[KMRobbo in reply to cuore]

was normally 2 x 50 mg on the one occasion I had missed the evening dose then I had more - i had an extra 200mg over 4 hours. (in A&E)

[secondtry]

Very useful thanks Robbo, I think I am getting closer to a position when I can reduce my daily Flecainide very slowly at 25mgs increments but will run it past my cardio first.

[Shcldavies]

Yes, I thought Flec was a wonder drug for 4 months then it gave me a serious flutter. I took it from there mutterings of the Cardiologist when I was in ICU that not every Dr thinks its good. That said many on this site take to with no problems at all. If you want to know about my journey on this please read my posts from Dec 2018

[secondtry in reply to Shcldavies]

Thank you, as with most AF issues we are all affected differently

[Reena09 in reply to Shcldavies]

Did the flutter come out of the blue? Or did you feel different?

[secondtry in reply to Reena09]

Arrives just like an ectopic only a bit different if that makes sense.

[Reena09 in reply to secondtry]

And how does an ectopic normally feel?

[secondtry in reply to Reena09]

Ectopic = One big missed beat. Flutter (if that is what it is, not just mild ectopics) feels much less of a shock and lighter for a few seconds longer

[Shcldavies in reply to Reena09]

I had been experiencing flutter before, my original arrhythmia sometimes morphed into flutter but this was not too bad and I always came out of it. It did seem to get worst the higher dose of bisaprolol I took but that may be because my condition deteriorated. When I started on Flecainaide I thought it was a wonder drug for 3 months then I had this bad flutter (see my earlier posts). The good news is that I then went top of the list for an ablation and after a slow recovery I am now better than ever.

[secondtry in reply to Shcldavies]

👍👍👍

[Hidden]

Well, not me and I've been on 100mg twice a day for 35 years.

[secondtry in reply to Hidden]

Wow thanks a lot Ed that is re-assuring

[Hidden]

Also, I would ask to see the evidence for his claim in the medical literature.

[Buffafly in reply to Hidden]

Flecainide can convert atrial fibrillation into atrial flutter, potentially resulting in a rapid tachycardia with more than 200 bpm in case of 1:1 atrioventricular conduction[28]. The reported rate of this proarrhythmic effect is 3.5% to 5.0% and has been associated with high adrenergic conditions[29].26 Feb 2015

ncbi.nlm.nih.gov › articles › P...

[secondtry in reply to Buffafly]

👍

[Oscal in reply to Buffafly]

I ha,d the following experience on Thurs last.Awoke at 4 am with AF. Took 1 Flec 100mg as a PIP. At 9am took my usual daily meds ,Dabigatran ,Bisoprolol,5mg amlodapine,lisanopril,doxazosin. Later on at 11am took mt BP 113/79 pulse128bpm.Still showing I was in AF.An hour later,my pulse was normal at 80bpm.However AF lasted all day.Took 2nd flec at 4pm ,AF subsides at 7pm,showing clear on BP monitor. As has been said many times on this wonderful forum,we are all different,how we react to the drugs,the success,or otherwise of the Ablations ,Etc.Bob and the others who advise no more than 300mg of Flec in 24 hours are correct for most people,When I took 200 in one dose,I felt faint,but then I am on a lot of other meds.Thank goodness for this site and the great support and Info.

[Shcldavies]

This was an opinion of a cardiologist, no claim, no evidence, but it is reasonable to believe that there is some experience behind it. We all know Flec is a wonder drug for many and many on this site have taken its for years. What many may not know is that it does effect some detrimentally (I am a living example). A good thing about this site is that we can all learn from the experiences of others and the knowledge we gain from this can help us through this terrible condition.

[dwright12]

Yes, that is what my cardiologist said also. I was diagnosed with flutters and was on Flecainide for over a year and continued to complain about flutters. I had an ablation and stopped Flecainide. Best day of my life.

[secondtry in reply to dwright12]

Thanks good to know.

[Buffafly in reply to dwright12]

I was taking Propafenone which is in the same class as Flecainide and one day things went suddenly pear shaped with a mix of fast arrhythmias, possibly because I wasn’t taking diltiazem or bisoprolol with it. I did continue taking it with the addition of diltiazem until my ablation when I was told to stop immediately and no one has suggested taking either medication since.

[secondtry in reply to Buffafly]

Thanks Buffafly, I have made a note in case I have to suggest it to my cardiologist!

[Reena09 in reply to dwright12]

What does a flutter feel like?