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Flecainide converted my fibrillation to flutter

MisterMagoo profile image
28 Replies

I started on 50mg X 2 Flecainide a few months ago after 10 years of no treatment and the effects have been life changing. However the fibrillation had now been replaced by flutter and I'm beginning to feel almost as bad again. My RHR had always been in the low 50s and BP at 125/75 but now they are prescribing Bisoprolol to mitigate the risk of flutter causing ventricular arrhythmia. I'm now wondering if there is any point in my taking Flecainide if it replaces fibrillation with flutter which can lead to a more serious condition (ventricular arrhythmia) and means that I have to take another drug that could push my HR and BP too low and may exacerbate my fatigue. The group's opinions and examples of similar experiences would be greatly appreciated.

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28 Replies
BobD profile image
BobDVolunteer

This is a known side effect of flecianide which is why it should ALWAYS be prescribed alongside a beta blocker such as bisoprolol.

AF is a along journey and it often takes time to find th right combination of treatments which suite each individual.

AussieHeart profile image
AussieHeart in reply to BobD

My EP switched me from Bisoprosolol to Flecainide only but said he was “ happy for you to take the bisoprolol on an 'as needed' basis to see if you have less tiredness with that. “ I took that as a pill in pocket after …

He said there are a number of different ways to take the flecainide

“ If you feel better with the bisoprolol regularly that is okay too -it's a bit of trial and error for most patients to see what works for them. “

That was based on telling me flecainide should make it less common to go into afib and Biso will reduce HR.

I’m still confused what to / when to do and questions like MisterMagoos show I’m not the only one!

And your reply BOb worries me further that my EP had given me the wrong BB that will cause me more angst than I have already… not happy !!!! What a horrible disease we have

Singwell profile image
Singwell in reply to AussieHeart

But what Bob's telling you is standard here in the UK. Atrial Flutter is a known danger of taking forward Flecainide alone. However, there ARE forum members here who take it solo as PiP and my arrhythmia nurse told me that it works well for some people. You could do a post called Flecainide as PiP and see what others say?

AussieHeart profile image
AussieHeart in reply to Singwell

I respect Bobs advice more than my EP’s. I was highlighting to MisterMagoo how confusing specialists guidelines are. Seems to me it’s up to us to work it out! Their guidance is wishywashy.

Singwell profile image
Singwell in reply to AussieHeart

Agreed. My EP said 'it's not an exact science. In the end we have to find out what works best for that patient because people's tolerance levels are different'. Can't be easy for them actually.

CDreamer profile image
CDreamer

Gave me flutter as well as long QT interval. Trouble is what cures can also cure 🙆‍♀️ and we should be informed of those risks prior to taking and be monitored. I’m lucky, I was so it was picked up but judging from this forum, many aren’t.

MisterMagoo profile image
MisterMagoo in reply to CDreamer

Have you carried on with your Flecainide or did you (and presumably your Drs) decide on another course? Is it better to have flutter and long QT rather than AF?

CDreamer profile image
CDreamer in reply to MisterMagoo

Stopped in 2014 and haven’t taken it since. I had pacemaker fitted and refused all heart meds since and have a ‘red alert’ on my file NEVER to be given any Beta Blockers, Calcium Chanel Blockers or ACE inhibitors as for me they are so dangerous as to be life threatening alongside my other conditions and meds I need to take for those.

Flutter for me was far more incapacitating than straightforward AF and long QT is not something you mess with if it’s if it persists.

Bingofox007 profile image
Bingofox007 in reply to MisterMagoo

A prolonged QT interval needs attention and certain drugs used for other conditions need to be avoided ie clarythromycin for infection for one, as they can worsen it. It can be hereditary. It’s not related to AF which isn’t life threatening but can be side effect of AF meds. It’s all such a balancing act. ❤️

wilsond profile image
wilsond

Same here. Was prescribed flec without beta blocker ,in hospital,and within a week blue lighted to another hospital which did prescribe Bisoprolol straight away. 2017I get the occasional breakthroughs of both but generally maintain well,although currently in the grip. I'm posting later on that.

I find flutter doesn't respond as well to meds . It is meant to be much more successful than AF in ablation .

I'm surprised this happened to you as well ,thought it was well known to prescribe the combo.

🙄

MisterMagoo profile image
MisterMagoo in reply to wilsond

Nothing surprises me anymore. I wasn't put on anticoags until after I had a TIA (mini stroke) and even then the initial response was Aspirin. I think I'm in for a fight to get an ablation

mjames1 profile image
mjames1

Hi,

Wonder if you can be a little more specific. For example, how many episodes of afib were you having before the Flecainide? How long were you on the flecainide before the aflutter began? And how effective was it until that point? How often do now you go into aflutter and how long do the episodes last?

Most here are prescribed an AV Nodal Blocker like a beta blocker or calcium channel blocker

awith Flecainide. From what my ep said, not sure it will prevent flutter, but if the flec changes afib to flutter to say a high rate 1:1 flutter, the nodal blocker will help keep the flutter at amanageable heart rate. So for that reason I was initially put in on 120mg diltiazem ER daily along with Flecainide 50mg twice a day.

Now that I've been able to reduce my flecainide to only 25mg twice a day, my ep allowed me to go off the diltiazem. But should I go into afib I was instructed to take fast acting diltiazem tabs along with an extra PIP dose of flecainide,

Jim

MisterMagoo profile image
MisterMagoo in reply to mjames1

I can't answer with specifics, I need to invest in a decent monitoring device. But I was in and out of AF for a decade before anything was done and felt my health and vigour decline. When I was put on Flecainide I realized how much I had declined as the effect was transformative. After about 6 months on Flecainide (without either anticoags or beta blockers) the flutter has kicked in. It feels constant and more pronounced than AF and I'm reverting back to a knackered old man.

mjames1 profile image
mjames1 in reply to MisterMagoo

Yeah, you really should get it sorted out because good treatment depends on a good diagnosis. Sounds like you need a holter and/or home monitoring device like a Kardia, to see exactly what is going on. Maybe they just have to increase the dose of flecainide or use another drug. Hopefully you are seeing an ep who can help and get you back to where you were.

Jim

MisterMagoo profile image
MisterMagoo in reply to mjames1

I'm seeing an Arrhythmia Nurse next week but I've been seeing one of those for years without any progress so I'm going to have to get assertive on them and ask for another consultant referral. The last time I saw a cardiologist they talked about the possibility of ablation but they appear to have gone quiet on that. I know they say AF treatment is a journey but I feel I've been stuck at the back of a stationary 100 mile traffic jam and keep getting hit from behind.

Singwell profile image
Singwell in reply to MisterMagoo

With this history you should be seriously considering ablation. Can't understand why you've been in this position for 10 years. Go dig your heels in.

MisterMagoo profile image
MisterMagoo in reply to Singwell

I think it's all down to NHS funding in my local area. Had to go private to get a bone on bone knee replacement and pay up front to have a debilitating double hernia treated. It's a case of if you're not actually at death's door, come back when you are.

Singwell profile image
Singwell in reply to MisterMagoo

Tell them it's making it difficult for you to work. That did it for me.

Singwell profile image
Singwell in reply to mjames1

Oh, useful info!

Singwell profile image
Singwell

Flecainide which is an anti arrhythmic, is most commonly prescribed with a rhythm control drug such as Bisoprolol. Makes it safer. There are other rhythm control drugs such as calcium channel blockers that could be used instead. Or you could ask yo reduce your dose of Bisoprolol. It's an issue with many meds - you take one but you then need another to counteract potential negative effects of the first. I take Flecainide with Diltiazem, and that seems yo do the job now that we've got the right dosage

saulger profile image
saulger in reply to Singwell

Did you mean "rate control drug" for Bisoprolol?

Taichid profile image
Taichid

I was given flecainide to reduce high heart rate but it did the opposite effect of inducing tachicardia and ended up in CCU. Put on beta blocker and pacemaker 3 days later.

Finvola profile image
Finvola

I had short runs of AFlutter which my cardiologist said was caused by my Flecainide dose (200mg daily). Interestingly, once my Bisoprolol was substituted for Nebivolol a few years back, the AFlutter stopped. Probably was co-incidence as the Nebivolol dose is twice the awful Bisoprolol dose of 1.25mg.

Palpman profile image
Palpman

I have never had AFib but had at least 2 episodes of re-entry AFlutter per week.I was put on 100mg x 2 Flecainide and had no episodes for over a year then was cured with an ablation.

2018NSR profile image
2018NSR

Flecainide can cause a secondary arrhythmia and many cannot take it . I did for me. I would ask your EP to review this med for you.

cherrieberrie profile image
cherrieberrie

I had AFIB put on metoprol and six months later dr. added flecianide which started my full blown flutter. Dr. said no it didn't start flutter, just happen. I wonder!!! Had Ablation in March and 3 weeks later started blacking out from heart pausing to long. Now I had to have a Pace Maker in April. I didn't want this stupid pace maker, just wondering if i should not have done anything and just take Eliquis. But will never know now.

MisterMagoo profile image
MisterMagoo in reply to cherrieberrie

Sorry to hear that CB. I am coming round to your point of view - just take the anticoagulant and live with Afib. It's sub optimal but I'm in control and not dependent on an unpredictable drug regime. I have decided to see Professor Ng at Glenfield hospital for a second opinion

cherrieberrie profile image
cherrieberrie

Please keep me posted on your visit with second opinion and I hope it all turns out the way you hope it will. Best of luck

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