I’m currently on 1.25mg Bisoprolol daily and 100mg Flecainide used as a PIP. Over the Xmas period I was getting a lot more Afib break through, once every other day or so. My episodes are mostly vagal and happen early evening or wake me from my sleep and always after eating. Eating too late or over eating always triggers my episodes and there’s a definite connection between what’s happening in my guts and my heart rhythm. I spoke with my cardiologist yesterday about this and he’s referred me to see an EP but meanwhile has suggested I stop Bisoprolol altogether and take a daily dose of Flecainide at 25mg and keep the 100mg as a PIP. He said I can just stop Bisoprolol, no need to taper as it’s a low dose? I had an echocardiogram prior to being prescribed Flecainide and have had no issues with any side effects taking it as a PIP and it has always put me back into NSR within one to three hours. I was under the impression from reading on here that most people take a beta blocker with Flecainide to help prevent other more serious heart rhythm problems? Interested in hearing from others on daily Flecainide only?
Flecainide daily without beta blocker - Atrial Fibrillati...
Flecainide daily without beta blocker
I’m not medically trained Motov. All I can say is that every speaker at our AF support group who has spoken about taking Flecainide as a daily maintenance dose, says that it should be taken with either a beta blocker or calcium channel blocker for the reasons you mention…….
I originally took Metoprolol 25 mg daily with my Flecainide. I always had break out episodes. Then a new Cardiologist I saw in another state, told me to stop the Metoprolol. While stopping caused me some nasty withdrawal symptoms, I have not had a single Afib episode since. That was four years ago.
I'm not a Dr but I am surprised at the advice to STOP Bisoprolol now you are to take Flec as a daily dose.
When I was put into Flec (50mg once day)after a trip to A and E at a local hospital with AFib and following a TIA few days before,I too was taken off Bisoprolol altogether. I was taking 1.25.
A week later blue lighted to my normal hospital with a bad episode of Atrial Flutter,which I had not had previously!
So that was caused by the decision at first hospital,by a cardiologist not an EP.
I'm not trying to alarm you but I think I'd be asking questions. If you can contact your consultant I'd do so or even that rarely sighted beast a GP?
A pharmacist often knows much more than GPs too and could perhaps advise or reassure you .
I'd actually keep on taking both until I knew for sure there was no mistake,rather than risk adding to my health catalogue,but that's me a bit if a rebel I'm not either encouraging or discouraging ,just telling you what happened to me.
Please update if you can, best wishes
That was scary wilsond, so it sounds as though any dose of Flecainide has the ability to trigger AFlutter and you probably suffered the full monty without the dulling effect of the beta blocker. Nasty experience. xx
To be honest GPs are not really the people to advise on such matters unless they are also cardiologists and if it were me I think I would continue taking the bisoprolol at least untill I had spoken to the EP and had their advice on the matter. Since GPs are not allowed to prescribe rhythm control drugs like flecainide without the instruction of a cardiologist it may well be that your GP does not understand this requirement.
The switch to a daily Flecainide dose came from my cardiologist (private as the NHS are broken and have cancelled all of my cardiology appointments), I’m waiting for the copy letter from my cardiologist now so I can get the Dr to prescribe the new medication. Personally, my understanding is that 1.25mg of Bisoprolol is actually a low dose and I am inclined to agree with you and carry on with the daily dose until I get to see the EP in a few weeks time.
I'd keep taking the bisoprolol nad But as others have said 1.25mg is the lowest dose I would have expected it to be at least 2.5mg unless that would slow your heart rate too much?
I'm on 2.5mg of bisoprolol
My dad had a stroke recently and was in Afib quite sure he's had it many times before even in his younger days 30/40 years old but never caught it anyway he was put on 2.5mg of bisoprolol straight away plus blood thinners apixaban
I’m sorry to hear of your Dads stroke and I hope he’s making a good recovery. I’m on Warfarin, been on it now for nearly eight years, following an unprovoked DVT and a bilateral pulmonary embolism, I self monitor my Warfarin dose and endeavour to stay in range. With the daily 1.25mg of Bisoprolol dose my resting heart rate first thing in the morning is sub 50BPM so a higher does would drop that further. My understanding of the 25mg Flecainide daily dose is that it is also a low dose to be on? Personally, I think I’ll er on the side of caution and stick with the Bisoprolol daily dose until I get to see the EP?
Could I ask why the 1.25mg x 1 Bisoprolol was recommended if your NSR rate is 50 or so? Was it to lower your BP or to accompany the Flecainide?
I ask because, when I was first diagnosed with AFib in 2018 I was prescribed 1.25mg x 1 Bisoprolol on its own, which I found difficult to tolerate even at the lowest dose.
I am 53 BPM resting HR and it was taking it sub 50. I stayed with it for three months and later tried 25mg Flecainide x 2 (half the starting dose) for several months and the episodes were still happening. I then went on 2 x 50mg Flecainide and they were even more frequent. I am glad to say that I gave up the Flecainide a week ago and have not had an episode. I tapered my dose gradually and had a few days of ectopic beats but they never continued to an episode.
I feel that Flecainide is not helpful for me and perhaps another channel blocker is needed.
I am also taking vitamin D3 (5,000 IU units) daily with vitamin K (MK7) because I was threshold low vitamin D. Have you had it checked, as it is a contributory factor to heart arrhythmia.
I hope that a medical professional will explain it better.
Saul
My HR is sub 50 now I’m on the Bisoprolol, it was 60 BPM before the beta blockers. I take Flecainide 100mgs as a PIP and have had no flutter or side effects and it usually puts me back into NSR within three hours. I also take supplements, vit C, Q10, Magnesium, Potassium and Arginine. I’m getting my bloods tested next week so will know more then on how my various levels are.
The vitamin D3 test is called 25-OH. I am also on 400mg Magnesium Taurate and Q10. Our metrics are similar so I would like to ask how often you get AFib episodes, how long they last, and at what HR?
All the best, Saul.
I'm wondering if the low HR makes a difference when considering this issue. I checked your OP - it was your cardiologist who suggested this, not a GP - the thread got a bit muddled. There are other blockers you can take in tandem with Flecainide so might be worth exploring this. Has your cardiologist suggested 50mg X 2 Flecainide? That's the lowest dose. Expect your HR to go up - which will feel odd - but I prefer it. Better circulation for one thing
Yes, my cardiologist advised the 1.25 Bisoprolol originally as a daily dose and then 100mg of Flecainide as a PIP. He’s now advocating a daily dose of Flecainide with no beta blocker and still a 100mg of Flecainide as a PIP.
So my thoughts are - your cardiologist has noted the low HR - possiy thinks that when 'rest and digest' kicks in that the HR drops lower still (worth you checking?) And that's what triggers the AF. If by taking you off the Bisoprolol and putting you on anti arrhythmia medication he hopes to fix that. Seems logical . It’s the idea of taking additional Flecainide on top that worries me. Since you're on such a low dose of Bisoprolol anyway I can't understand why he's not suggested the regular Flecainide in tandem with it. After all (if I've understood rightly) you've no history of successfully using Flecainide without the Bisoprolol I think you're wise to be asking the questions
I used to take Bisoprolol 1.25mg with my daily 200mg Flecainide and asked my EP if I could use the Bisoprolol as a PIP because of its side effects in my case. He said it would be dangerous (his word) because of Flecainide's potential to trigger Atrial Flutter and the beta blocker stopped 1:1 conduction of the flutter signals and the resulting very high heart rate.
Your regular dose of Flecainide is low which may be behind your cardiologist's thinking regarding adding on Bisoprolol - perhaps the low dose is less likely to cause problems? Certainly, I would proceed cautiously, even though there are members of the forum who were also advised to use Flecainide on its own.
BTW, I now take Nebivolol, which removed the bad side effects from Bisoprolol and the few runs of AFlutter which I have had from Flecainide are short-lived with a bearable heart rate of 110-130 bpm.
I had Atrial Flutter and was put on 50 mgx 2 Flecainide.
My heartbeat was too low at 50 odd to take beta blockers. Sub 45 tends to precipitate arrhythmias.
The Flecainide was increased to 100mg x 2 when the flutters persisted and I've had none for over a year. I had episodes once a week for years. So the Flecainide definitely stopped my AFlutter with no beta blockers.
That’s interesting, I’m not 100% sure what the difference is between flutter and Afib but it’s related I believe? I think the reason many have both Flecainide and a beta blocker is to stop more serious ventricular fibrillation that Flecainide has been associated with? I also read that’s why you usually have an echocardiogram to check the structural integrity of your heart before starting on Flecainide. My pulse is sub 50 bpm most mornings on Bisoprolol and that’s on the lowest dose and I think French find my pulse drops very low just before I get an Afib episode? I’ve also read that if you have Afib that’s vagal and brought on by food etc. that being on a beta blocker can make things worse. You’re taking a much higher dose of Flecainide than I’ve been told to take and no beta blocker, is that correct? If that’s the case, then 25mg dose as a daily dose along with 100mg as a pill in pocket approach, without Bisoprolol should be ok I guess?
I've never heard of a dose as low as 25mg once a day. That is exceptionally low but if it works for you then good luck.
I take 50mg am and 25 pm. Works for me.
Do you take any beta blocker or calcium channel blocker with that - and can I ask which ahrrythmia you take the Flecanide for? Thanks
Diltiazem slow release 120mg
I'm like Palpman 2x100mgs Flecainide and no BB; taken it for 8 yrs no problems so far. I am an active 68yo with Lone PAF, HR 55, BP 115/70 and importantly implemented many lifestyle changes to help dodge AF & Flutter.
Hi Motov, when my cardio put me on Flecainide she reiterated several times to always take a beta blocker with it. Don’t ever take it without. However, even at that I got another arrhythmia by taking it even with a beta blocker and when I asked the doc about it she said to give it time. Uh no !!!!!!I went off it immediately, got an EP and
Take it now as a PIP.
I’ve been on flecainide 50mg twice a day with no beta blocker since August 2020 with no ill effects and no AF. This was on the advice of my cardiologist. I’m now at the point where he is advising me to gradually stop the flecainide and keep it as a PIP. Only on day 3 but so far so good. I’m just hoping that this is as successful as his other advice. Good luck with your treatment, the daily flecainide has been great for me.
That sounds reassuring. There’s so much contradictory information here and whilst the natural assumption is to “trust the doctor “, this clearly doesn’t seem to be the case!
Bravo, Daisy. I was also on 2 x 50mg Flecainide and since I stopped it been better. No telling, is there ?
Really good to hear that saulger - gives me hope I’ll be the same! A lot of people seem to say AF always comes back - I’m hoping that it won’t for me.
Curious to read this. Have you had ablation? Or just found that the Flecainide kept things under control. I've been on 50mg X 2 for almost 2 years but it never stopped the AF completely. I chose to use PiP rather than upping my dose. Then ablation- only partially successful unfortunately Now I take 25mg in the eveand 50mg in the morning. I'd ime to reduce if I can but they told me PiP Flecainide on its own isn't safe. Am also on Diltiazem for that reason
Hi Singwell, no I’ve not had an ablation, just a cardio version in August 2020. Before that I’d been in persistent AF since April 2020. Only coming off flecainide because cardiologist thinks it might be better not to stay on it long term, I’m just hoping the AF won’t return. Good luck with your treatment - interesting that different people receive different advice!
I hope this has worked for you! I currently take 100mg twice daily, with no beta blocker. I was taken off Metoprol four years ago, and have not had an episode of afib since. It has also pretty much stopped my occasional PVC's that I have had since I was in my twenties. FYI I am 74. Have been taking Flec since 2010. My current Cardiologist here in Germany has told me to cut my Flec from 100 twice daily, to 50 mg mornings and 100 mg in the evening. I will start this tomorrow, and have my fingers crossed. The reason for the reduction is my HR hovers around 6O and the Doctor said that is too low.
Yes thanks this has worked for me, no flecainide for almost 12 months now and no return of AF so far. Hope your reduced dose works for you.
Thanks, and I wish you good luck as well. So much conflicting information here. Although my first Cardiologist prescribed Metoprolol, I had many events. He then reduced it to half a tab, instead of one. My second CArdiologist, said you should never take it with Flec, and took me off of it. Like I said, I have not had an event in four years. While taking Met, I had one at least once a month! There is nothing in the Flec literature, that says it should be taken with a Beta Blocker. Not one of my Cardiologists has ever even suggested an ablation. My first Dr actually said to me, " Why the heck would you want someone to burn holes in your heart. You know, that is what they do, don't you?" He also said half of all ablations fail. He said it is a way for some doctors to make money, and to never trust those who suggest it, over medication.
I have been taking Flecainide daily for circa 17 years without a beta blocker. It was never suggested or offered and in those days I knew diddly squat about Afib. It was prescribed by a cardiologist in hospital on the MAU. First dose was given intravenously and my bed was wheeled next to nurses station so I could be observed. Had no problems with it and was discharged next day with script for the tablet form which I have been on ever since. It has only ever been the lowest dose. x
17 years is a good stint! Can I ask how has it controlled your Afib, do you get many episodes still?
It did for many many years but my PAF gradually got worse, which is the nature of the beast. September 2019 I had an ablation. Like many others I had to have a second (mopping up) ablation October 2020. Had a few wobbles in the blanking period, which is normal, but except some ectopics now and then I have been ok since. Have follow up July this year and hopefully if all goes well I’ll be able to stop Flecainide then. x
Thanks for replying, I guess that’s the road I’m on right now! My cardiologist said try the daily Flecainide route until I see the EP to discuss the ablation option. Meanwhile I’m looking into borrowing the money to pay for the procedure which isn’t cheap but is currently the only option as the NHS is only available for covid these days!
Motov, I in the same boat. PAF for four years getting more frequent at around 100 BPM and lasting 3-5 hours and converting spontaneously. I was getting it almost weekly on the Flecainide and believe that, since I gave the Flec up completely, I will have a clear month in January (fingers crossed).
Do check your vit D3 level !
Sounds good. I’d love to go a week, never mind a month without Afib! Since Christmas it’s become a very unwelcome visitor almost every other day! Hence why I’m being put on daily Flecainide…. Fingers crossed! I’ll definitely check my vit D3 levels 👍
Good luck Motov. I also had one month recently with 7 episodes, a few occurring every other day. I am now one month into upping my vit D level from 31.1 ng/mL to 50-60, which will take time and I'm told is the level to be on, to stave off episodes.
I am not a new-age romantic but was impressed by a chap Steve Carr in Australia who manages to live AFib free without medications (and others who have followed his recommendations).
Also, please check out this thread on Afibbers.org (free to join the forum):
"First successful test of Steve Carr's protocol? (Outside of family members)"
Of course, the only issue is the anti-coagulation, otherwise AFib is not life-threatening, and worth contesting.
Saul
Having a high vit D level has not prevented my afib attacks from increasing to around 7 a year. I'm blaming the pandemic as before the beginning of 2020 they were few and far between!
This could well be true as there are a variety of triggers. Can I ask what your vit D3 level is (25-OH) ?
72 ng/mL.
Wow. You are right ! Be well !
Hi Motov
I don't tolerate beta blockers so I was on 2 x 50mg flecainide rhythm control and 200mg diltiazem mod release as rate control for my afib. I had a cryoablation for the Afib. Successful. I carried on with the meds and this was planned to be for 3 months until at least the post ablation review.
After 9 days arrhythmia kicked it but worse symptoms than previously, at 140 bpm but a bit variable, I was quite incapacitated. (In contrastv was asymptomatic in Afib except for a high heart rate) .
A phone call to my EP and he advised me to go to my local A&E. I was given an ECG and advised I had AFib.
My flecainide was increased to 2 x 100mg in order to try to cardiovert me. However before I left A&E my symptoms got worse (extreme breathlessness on any movement) and the hospital ( not my request) admitted me for observation.
A second ECG analysed by a cardiologist found I had reentrant atrial flutter, rate controlled by the diltiazem ( not afib) . A conversation with my EP by the hospital reduced the flecainide back to 2 x 50. This reduced the severity of the breathlessness somewhat but the rate was still 140 now very constant
At a subsequent review appointment with the EP he advised that I had never any trace of A flutter on previous ECGs and concluded that the flutter was promoted by the flecainide.
I had a second ablation 4 weeks after the first to stop the flutter. ( 140 for 4 weeks, mostly in bed owing to the breathlessness ).
However the point is without the rate control my heart rate in re entrant flutter could have been 300bpm, which I think would have been quite catastrophic!
I know we are all different, and I am aware people on this forum do take flecainide without rate control , but I would be very wary of taking flec without it. I suspect you must have a perceived rate problem to be given the rate control in the first place?
By the way I am a flecainide fan despite my experience. I had it intravenous in order to cardiovert fom being stuck in hospital with afib 165- 195 resting bpm for most of 8 days. After that I was on daily 2 x50 flec and was never in afib whilst taking it except the day after I missed taking my evening dose and went onto afib walking downstairs the following morning! ( doh!)
Even for the 4 weeks I was in flutter I kept taking the 2 x 50mg as I believe my EP wanted to protect the ablation for the Afib, during the blanking period. He stated that a flutter ablation was usually much easier, succesful and safer than an afib ablation.
I have not had either for 4 years since then.
I am not medically trained just advising my personal experience.
My Afib was random ( but increased in frequency over 20 months). I never found any triggers but doubt it was vagal.
Best wishes.
I’ve been on flecanide for a few years with no beta blocker and largely has controlled my AF.
I had a period of 200 days recently on 2x100 flec of no AF. I’ve gradually reduced medication to 2x50 and am now getting the odd AF episode once per month
I then take a 100 flec PiP and a 1.25 Bisoprol PiP to get me out of it which usually takes an hour.
Bravo for the 200 days Afib-free achievement. I wish to emulate you...Do you take an anticoagulant ?
Definitely something to question. When I had my ablation chat and mentioned coming off the Diltiazem (calcium channel blocker), the EP said - you need to take some type of AV node blocker in tandem with Flecainide as it increases the heart rate and might lead to problems with flutter. However, post ablation I was chatting with my arrhythmia nurse one day and she said that a few people did take Flecainide on it's own, implying not as PiP.Hope others can shed more light
Hello Motov, Saul again.
Check these images out. They are from my home ECG monitor called WIWE. It is made in Hungary and is a one-lead affair. It also analyses your ECG pattern and the intervals between several complexes. When I was on Flecainide, until seven or so days ago, the prolongation was outside the normal range. Since I stopped the Flecainide completely, it is almost back to the normal range (a smidgeon outside).
I now aim to keep the Flecainide 100mg + 1.25mg Bisoprolol for emergency, when an AF episode starts and none daily (but you may be different and please take professional advice).
That’s actually the approach I would prefer! If I can get the episode back to one a month and come off meds apart from the Warfarin and just use the Flecainide as a PIP along with the beta blocker at 100mg and 1.25mg respectively I’d feel happier. I’m forever searching and reading on supplements and diet to curb my episodes. Mine are all definitely vagal in origin and standard triggers like stress, caffeine and alcohol don’t usually cause me any issues. Over eating, late eating and heavy carb laden food do it for me every time!
As you said, you are young enough not to be recommended an AC.I have a feeling (touch wood) that I can finish the month with just the one episode on 2nd January, when I was still on the 50mg x 2 Flecainide.
I believe that, in my case, the Flec was making it worse so that a run of ectopics would go on to be come an AF episode. Since I stopped, I've had some ectopic beats and no AF.
Do have a look at vit D and Mr Carr's diet of low calcium and low carb, and to bring vit D3 to 64 ng/mL. Cheers. Saul
I am so curious about the pill in the pocket route. When my I was having monthly afib outbreaks five years ago, my Cardiologist in Florida suggested the pill in the pocket routine, but he told me to take 300 mg in the event of an outbreak. When I said the thought of taking that much at one time, he instead doubled my dose from 50mg to 100mg daily. I was also at the time taking one half of a 25 mg Metoprolol pill daily. Later after moving to another State, the new Cardiologist suggested that he though my occasional outbreaks were due to the Metoprolol. He had me discontinue it. Four years later, I have had no episodes at all.
Hi Motov. See my images at the bottom of the page. I forgot to address it to your good self. Saul
Hi Motov. Just to relate my experience - I've had PAF since 2007. The medication I was advised to take then was 1 x 200mg modified (i.e. slow) release flecainide. I used to take this prophylactically (i.e. when I expected to be at risk of AF), as I thought I had a reasonably good handle on my main trigger (hard/sustained exercise). This then shifted to 2 x 100mg normal release when the MR version was unavailable. In 2015, after a run of bad AF episodes, I moved to daily doses of flex, plus 1 x 1.25mg biso was added to my medication, subsequently increased to 2 x 1.25mg. I took the medication at 8.00am and 8.00pm. Recently, I've been advised to drop the evening dose of biso, so am back on 1 x 1.25mg biso and 2 x 100mg flec. If I'm honest with myself, I think that my AF has followed a course of its own choosing, seemingly irrespective of what I take. Of course, what I don't know is what would have happened had I not taken any medication.
Hi Motov Certainly quite reasonable to take flecainide without beta blockers. I had paroxysmal AF in my 30s, now just turned 70 and have taken 100mg twice a day for 35 years with no side effects or need to take "blood thinners". Professor Pentecost (look him up) put me on it after other drugs made matters worse. Worked, and still works, like magic for me. I much prefer this to being on beta blockers and blood thinners, both of which have unwanted side effects.
I have had a similar experience taking only 100mg Flecainide twice daily. I had previously taken it with 25mg metoprolol daily. I was told to stop the Metoprolol almost five years ago, and I have not had a single episode of Afib since! I have just been told to cut my daily dose to 50mg in the morning, and 100 mg in the evening, as my HR is low. ( 60 ) I am hoping this works.
I’m the other way around, 50mg Flecainide in the evening and 100mg in the morning. I take warfarin too but I’ve been on this for eight years as I had an unprovoked VTE and was diagnosed with Factor V Lieden. I take magnesium, vitamin C and vitamin D daily too. I’ve not had an episode now for nearly three months but have experienced a couple of runs of ectopic beats or missed beats but I’m way better than I was before when I was getting nightly episodes of afib which was exhausting and stressful! I’m not entirely convinced it’s down to the increased Flecainide dose as it could possibly that both my magnesium and vitamin D levels have increased after months of supplementation? I gave a follow up appointment with my cardiologist next month where I want to explore the idea of reducing my daily Flecainide dose? One other thing I have discovered is long term use of Warfarin will burn through your magnesium reserves and ultimately your vitamin D levels in quick time, which begs the question, does long term warfarin therapy trigger paroxysmal atrial fibrillation??
That is something I have also wondered. It seems different EPs might have either views or in fact be neutral. I believe the Flec and Bis go hand in hand in most prescriptions but it is certainly not all patients.
Flecainide daily or as PIP???
Flecainide?
PIP and Flecainide 
