Flecainide and Cardioversion?

[Snookersteve]

Hi, I started with AF in mid June which I have had continuously since then. My EP feels that the AF was brought on by an unknown viral infection (not Covid) that eventually led to me being hospitalized for the first week of July. The AF started on the same day as the infection. Whilst in hospital I had an echocardiogram which showed that except for the AF my heart was ok and normal size with a good ejection fraction of 55%. I am 68 years old (how did that happen?).

My EP tried a cardioversion on 1 October which he was fairly sure would get me back into sinus rhythm (SR) but despite 3 attempts SR was only achieved for a few seconds. I am taking Rivaroxaban and also 2.5mg Bisoprolol daily. The Bisoprolol seems to keep my BP and heart rate down to very good levels. Luckily, despite being in AFall the time, I don’t have many symptoms except that when I exercise my heart rate goes to fairly high levels (eg if I try running it goes up to 160) so I’ve stopped running but do use an exercise bike (moderately) and go for a daily 30 minute walk. I enjoy keeping fit and would love to get back to being able to exercise more strenuously (within reason). In order to do this I feel that I need to get back into SR if possible. I don’t feel that my current situation warrants an ablation procedure although this may change in future.

One way of getting back into SR is (as advised by my EP) another cardioversion attempt but this time with Flecainide beforehand (and probably afterwards). I notice that many people on this forum seem to get on with Flecainide (sometimes for decades). As my heart is otherwise normal then Flecainide should probably be ok for me as long as I continue to take the beta blocker (ie Bisoprolol) to help avoid proarrhythmias.

I was wondering if anyone had tried Flecainide and Cardioversion together and am really interested in whether this was successful or unsuccessful and any issues or concerns that may have occurred?

Thanks for reading this long winded post! If you managed to get this far I’d love to hear from your experiences. Thanks Steve.

[CDreamer]

I’ve never had a cardio version as went straight to ablation but that was 2013 & a lots changed. I think the idea is to have a loading dose of Flec - cardiovert you into NSR & then for Flec to keep you in rhythm as that is often more effective than one or other. The fact that you did go to NSR, even for a few seconds, means there is a possibility you will be able to maintain NSR.

There is a saying AF begets AF but also true of NSR so sending best wishes this works for you! Let us know how you go.

[Snookersteve in reply to CDreamer]

Thanks for your reply CDreamer. I haven't decided what to do yet as I'm coping quite well at the moment. I might try Cardioversion with Flecainide as long as I'm unlikely to end up with more symptoms afterwards if it doesn't work. Best wishes to you too!

[secondtry]

I was going to have a cardioversion whilst on Flecainide IV but as soon as the doctor said 'we are going to have to shock you' I went back into NSR. I put this down to my having vagally mediated Lone PAF.

[Snookersteve in reply to secondtry]

Pleased to hear that you went back into NSR. Presumably the Flecainide IV worked its magic. You must have been pleasantly surprised👍

[secondtry in reply to Snookersteve]

I think it was more likely the Vagus Nerve did the necessary.

[Barb1]

I have just started flecainide before my next ablation. EP thinks it will give me a greater chance of success.

[ILowe]

I do not have time to find the research right now, but I remember seeing more than one paper showing that electrical cardioversion had a higher success rate and lasted for longer on patients taking flecainide. It is also very safe, so you have nothing to lose by trying it and everything to gain. One small problem. If you have not taken flecainide before, after the cardioversion the doctor will possibly have to adjust the dose one or more times. What makes flecainide difficult to dose is that too little and it has no effect, too much and it stimulates irregularities. Your doctor should know this very well and will advise you.

[Snookersteve in reply to ILowe]

Thank you that is very useful. I was concerned about taking Flecainide. However, it seems as though providing your heart is otherwise normal it is relatively safe and quite good for controlling AF. Thanks again for your help.

[cuore]

Before my first cardioversion, I was not lucky enough to have my one -visit cardiologist place me on Flecainide before my cardioversion (lasted three days) or afterwards for that matter. He was a deficient AF cardiologist. Consider yourself lucky that your EP is willing to go that route. For me to be in sinus rhythm ( one year and seven months now) , I have had to also take Propafenone which I am targeting to stop. And, if I had not had my first ablation at the six month persistent stage, I would never have been able to return to sinus because I was one of the most complicated cases at that stage.

Keep in mind that AF begets AF. So, since June your heart, with persistent AF, has had six months to remodel. Therefore, your comment, "I don’t feel that my current situation warrants an ablation procedure although this may change in future." is not taking into consideration that your heart is constantly remodelling to the point where it will never be able to get to sinus rhythm, even with ablation. The concern is not whether Flecainide will be compatible with your heart. The concern is how quickly can I get the next cardioversion and onto an ablation if your goal is to return to sinus to have a better quality of life in exercising. In your case, time is of the essence. Use it wisely.

[Snookersteve in reply to cuore]

Thank you for your feedback which is very helpful. Pleased to hear that you have been in sinus rhythm for 1 year and 7 months. Best Wishes, Steve

[Daisy2908]

Hi Steve - I was put on flecainide for a number of weeks before my successful cardioversion in August and am still taking it although a pretty low dose (50mg twice a day). Cardiologist told me he believes I would not have got back into sinus rhythm without the flecainide. I am 55 and very active and so not being in persistent AF is much better for me.

[Snookersteve in reply to Daisy2908]

Hi Daisy thank you for your reply. It was good to hear that you had a successful cardioversion after starting flecainide. Pleased that you can be very active now you are back in sinus rhythm. This is exactly the sort of feedback that I was hoping to get. Did you have any side effects from taking flecainide?

[Daisy2908]

No side effects from the flecainide but I did have problems with the bisoprolol once I was back in sinus rhythm. Made my heart rate too slow (in the 30s) so they tried various reduced doses but after a few days cardiologist advised me to stop taking the beta blocker. No issues since then. Good luck with your treatment.

[Snookersteve in reply to Daisy2908]

Thanks for your feedback, that's very useful. Take care.

[sdweller]

Flecainide can be a miracle for some, like myself. If your doc says you are ok to take it, that is a good thing as some cannot take it at all. Especially before and after an ablation.

[Snookersteve in reply to sdweller]

Thank you for your reply. Yes the EP says I am ok to take it. Pleased to hear that flecainide is working for you. Best Wishes Steve