Flecainide and mri perfusion scan

[Kittyca]

Hello everyone, I am new here, I have a question regarding my PAF. Do I need any investigations before taking flecainide? 24 hours ECG , blood test were done. My usual PR is between 47-55 . I have heard that MRI heart perfusion is required. Has anybody heard (or done) about it?

[BobD Volunteer]

Here in UK it was alwasy the case that flecainide could only be pfrescribed in the first instacne by a consultant and usually under hospital observation for the first time as it can cause serious other arrhythmias. It is also important to check that there are no cardiac artery problems which is why you have heard abut MRI. There are other checks and whilst over the many years of my arrhythmias I have had two angiograms, a CAT scan and at least four echocardiograms I have never had an MRI.

[Kittyca in reply to BobD]

Thanks a lot,I ve been with PAF for 17 years. It comes and goes but now it happens more often. My uk cardiologist advised me to take 2,5 mg bisoprolol and flecainide after 15 minutes PAF starts. But other uk cardiologist cancelled flecainide and told that before using it as ‘tablet in a pocket’ one needs more investigations. GP cannot decide who is right.

[Frances123 in reply to Kittyca]

The latter cardiologist is right. Like BobD says, first dose should be under hospital conditions. My first dose 16/17 years ago was in hospital, by IV and bed wheeled next to nurses station so I could be watched. I was fine and have been on tablet form since. Maybe you could tell GP you would be happier with latter cardiologist and would be prefer to have more tests as AFib is happening more often and want to be thoroughly checked over. X

[Kittyca in reply to Frances123]

Thank you very much for your advice. It seems that my gp referred me to mri but I have not heard from cardiology department yet. I phoned them and they told that dr would look at it and decide.😁

[Londonlass]

I was told I would need either a CT coronary angiogram scan or an MRI heart perfusion scan before being prescribed flecainide. These were to exclude functional and structural heart problems. I had the MRI and as no problems were found, I was prescribed flecainide as “pill in the pocket” which I took at home. Even though I had been told all was well with my heart, I was very nervous about taking flecainide for the first time at home. I would certainly push for more investigations if it were me. Hope all works out OK for you.

[BillThielen]

Ah, yes I remember well the moment I decided to cast my fate to the wind, to put it rather melodramatically. The ER doctor on duty that night said she had only one thing left to offer me — electro cardio version. Mind you this was my 6th ER visit inside 10 months and PIP Flecainide wasn’t working anymore. Grudgingly The following day I agreed to a permanent regimen of Flecainide (100m twice daily). It changed my life. It has been two years and not one episode of PAF. I am faintly haunted by the possibility that the drug may turn against me. But that is more than compensated by the relative peace of mind from which I have benefitted, and so too my wife.

[Bahrain22 in reply to BillThielen]

I take 50mg twice a day and run 3-4 times a week and get no PVCs now - it is life changing as I now feel fine, as long as I do these 2 things. I've been on it for 18 months.

[Kittyca]

Thank everybody for the answers! being with PAF for 17 years I am only now starting understand the nature of it. First 12 years when I had episodes I was immediately transferred to ED and had amiodorone cardio version with prescriptions to continue it for a month after the episode stops. once when I was in the country and had an episode the doctor did intravenous injection of novocaidamid. (Only after injection I was informed that it was extremely unsafe). Each doctor I met were private doctors. In 2015 next private doctor prescribed flecainide as a ‘tablet in the pocket’. Nothing was said about risks. At last I met the cardiologist who said that to start it one needs more investigations and that cardio version with amiodorone was rather dangerous either. Now waiting the decision. Again , thanks a lot for all answers😁

[doodle68]

Hello Kitty I am in the UK and was recently prescribed Flecainide daily (having seen an EP privately because my hospital appointment was cancelled) but I have yet to take it because of the C19 lockdown and the need to have someone with me when taking the first dose in case I have to go to hospital .

Another Consultant suggested I go to A&E when in P-AF for the first dose but I refused to do that, firstly the difficulty of getting there in lockdown also the possibility of having to spending hours on a trolley and risk catching Covid in our notoriously poor local hospital.

Before it was prescribed I had to have a new Echocardiogram to check the soundness of the heart, that was ok also when I take the first dose I was told I must arrange an ECG with my GP for a week after starting Flecainide to check for Long QT syndrome.

[Bahrain22]

Hi, I had a halter monitor and an ultrasound scan but nothing else before the EP prescribed me Flecainide. I've been on it for 18 months and had no complications or side effects.

[Kittyca]

Thank you very much,! Still waiting the decision from cardiology. The forum is absolutely excellent. Thank you very much for all help . !!!