Question

[Kennyb1968]

Has anyone being prescribed just Bispopronol for AFib management? I don't think flecainide is working for me - 2 weeks in and I'm getting asymptomatic AFib attacks every second day or so. They are mild (less than 90bpm) and I can pretty much carry on with no ill effects. The flecainide is brilliant at resolving the attacks in less than 3 hours. My consultant initially didn't prescribe a beta blocker but after I asked he has and I am going to get the prescription tomorrow. I am hoping that makes a difference as a number of people on here seem to find it really effective. This is all to keep me in track for an ablation in a few months.

[mjames1]

Before you went on flecanide what was your heart rate in afib and were you on a beta blocker or other rate control drugs then?

Jim

[Kennyb1968 in reply to mjames1]

No mate - I went on to flecainide initially as a PIP as I had a couple of AFib incidents. The incident of AFib went up to weekly so I was put on a regular dose of flecainide and since then the frequency of AFib has increased to every couple of days. Never taken a beta blocker

[mjames1 in reply to Kennyb1968]

So what was your heart rate in afib before you took the flecainide?

[Kennyb1968]

150bpm

[mjames1 in reply to Kennyb1968]

So at least the flec seems to keep your rate down in afib which is a good thing. See how the beta blocker works out. Fortunately, this is just a bridge for you until an ablation. And while some here seem to be able to do whatever they want on flec without consequence, others like myself still have to watch out and be careful with triggers if they don't want too many episodes. Not saying paying attention to triggers will work in all cases but it does in some.

Jim

[Kennyb1968]

Had 2 cans of coke and a wholewheat sandwich which I gobbled down while driving - few triggers in there I think mate

[BobD Volunteer]

Interesting yet strange that you went straight to flecainide, presumably on instructions of a cardiologist, since here in UK GPs are not allowed to prescibe it without consultant level instructions. Also the drug is usually accompanied by a beta blocker to prevent atrial flutter.

[Kennyb1968 in reply to BobD]

I was prescribed Flecainide by a cardiologist at A&E on the basis I had a clear echo, bloods and chest xray. This was used as a PIP. My current cardiologist just followed that with a maintenance dose when AFib became more frequent on the basis that I will be having an ablation as soon as possible mate.

[mjames1]

Just had another thought. Are you sure those "mild" afib episodes at around 90bpm are really afib? Are you capturing them with a device like Kardia that records and ecg or otherwise documented them? Because if not, it may be something else, like ectopics.

Jim

[Kennyb1968]

Jim - I have just bought the Kardia as I think Fibricheck is misdiagnosing Afib

[mjames1 in reply to Kennyb1968]

Let us know, you may not be in afib at all. Doesn't mean you test the limits and go back to beer in the sun or coke cola in the car!

[saulger]

Hi Kenny, I started (2018) on 1.25mg Bisoprolol x 1 on its own, and it worked for about a year. I was breathless on it and eventually stopped.

Then Flecainide 50mg x 2 and was OK for a while.

Now, only before exercising, I take a sliver (less than 1.25mg) of Bisoprolol (I check that it works by noticing a drop in my resting HR from 53 to 47/48), together with 50mg Flecainide.

The two medications seem to work well together.

Also check that your digestion system/bowels are not playing a role.

Onion and garlic will put me in AFib, as will other high FODMAP foods !

Good luck.

[Lilypocket]

I was prescribed Flecainide with Bisoprolol which is the more usual approach with Flec. My late husband ( who had persistent Afib) was prescribed only Flecainide as he had bradycardia. Perhaps your resting heart rate in normal rhythm is slow? As for your 2 cokes and a sandwich it's more likely the sitting with a full stomach that set it off and not the food and drink ( vagus nerve). That happens to me.

As said above it could be extra-sytoles and not Afib.

Take care 🙂

[secondtry]

My understanding is Flecainide is to stop AF episodes (ie a rhythm control drug) but does not reduce the HR or if, only a little. My first dose of Flec was 100mgs but still had 2 episodes a week so went onto 200mgs which stopped it. I think it is important to have your AF confirmed and to get it stopped irrespective of a scheduled ablation.

[Kennyb1968 in reply to secondtry]

Basically I think flecainide is fine for PIP. But it's not preventing. I think it's time to try a different drug for that

[secondtry in reply to Kennyb1968]

Sure it doesn't suit allcomers.

[BobD Volunteer in reply to Kennyb1968]

You have limited options. Dronaderone (Multaq) . Amiodarone (not long term due to side effects but highly effective) or Propafanone. Just do understand that any and all treatment including ablation is only for symptom control (quality of life) as final outcomes are unchanged.

[Tellingfibs]

Apart from Warfarin, I have been prescribed nothing other than Bisoprolol. I was diagnosed in 2017 and began taking 1.25 mg, which was soon increased to 2.5 mg. I stayed on that dose until March last year when I had a few Tachycardia events ( not faster than 127 bpm ) and a few Afib episodes that my Kardia picked up. GP increased mg dose to 5 mgs. I was fine until October when the same happened, but a different GP was too nervous to increase my Bisoprolol, so I had to wait until January to see my cardiologist. He increased it to 7.5 mgs and referred me for a Cardioversion. This time, the increase didn’t help and three weeks later a different GP ( again ! ) increased it to 10 mgs daily. It was successful within a few hours at restoring NSR, so much so that when I went for my Cardioversion, they had no need to do it. My Kardia picks up a few seconds of Afib once every couple of weeks, but I wouldn’t know about those episodes without the Kardia as they are so brief. Apart from sleepiness when resting in the chair, Bisoprolol has presented no side effects. I hope this helps you.

[kalgs]

Yes I was . It was the only drug I was prescribed. It helped limit my AF episodes. It didn’t stop the AF but certainly controlled it . I had a Cyro Ablation 9 months ago .

[Ppiman]

I have a suspicion that the majority of people with AF are given only bisoprolol in the UK. That's what I have and only then on an as-need basis. My attacks are infrequent and "mild" with a lowish heart rate. Last night my Kardia registered 80bpm, for example, although I had taken 1.25mg tablet late afternoon.

Steve

[BobD Volunteer in reply to Ppiman]

Steve , Yes Bisoprolol does seem to be the fall back drug . Part of this is that GPs are not allowed to prescribe rhyhm control drugs without instrcutions from consultant level so unless you get to see a sympathetic cardiologist or EP that is that .(plus anticoaguants as appropriate obviously.)

I don't think it was around when I started my AF journey in 2004 as I started on atenalol , had flecianide PIP added by local hospital cardiology and switched to propafanone on first meeting with EP. Sotalol was quite popular for a while then fell from grace but seems to be making a comeback recently.

[Ppiman in reply to BobD]

Thanks Bob. I was told I couldn’t take sotalol or flecainide for some reason. Bisoprolol has become my comforting friend, for sure!

Steve

[pusillanimous in reply to Ppiman]

I would think too in South Africa Biso is the 'default' drug by Cardios, regardless. When I was diagnosed by chance that was all I was given, I was given nothing else and even my BP med was taken away, because he considered my BP was too low in the hospital. That was a mistake. I had to ask for an anti-coagulant because all my sisters in the UK have it and see EPs and had told me to get it- we only have one EP in the whole province where I live, and since he does ablations , he is busy all the time. I now have another Cardio who listens to me and I take 120mg Verapamil hydrochloride and 10mg Lisinprilin (Not sure of the spelling but it's very common for BP) and I can take 125 mg Biso if my HR goes over 100 and I feel it's not going down, which is very rarely. My eldest sister has just survived AFib until her 90th birthday which she had last week!!!!!!!!

[Ppiman in reply to pusillanimous]

My eldest friend is 88 and has had permanent AF for years, treated only with warfarin. His heart rate is pretty normal though.

Steve

[Kennyb1968 in reply to pusillanimous]

My Dad has survived it to his 89th birthday and he had had it for 70 years!!!!!!!!

[JOY2THEWORLD49 in reply to pusillanimous]

Hi

The Default drug for AF here in NZis METROPROLOL.

But horrid and made me tired and breathless.

Under a H Specuialist 1 yr 3 mths after Stroke and Thyroidectomy after that 4 mths later I was tried on Bisoprolol. 10mg only reduced from 185 to 156.

Went to Private H Specialist he tried Diltriazem 180g. Too much H.Rate fell 100bpm.

Twinked in CONTROL

'120mg Diliazem AM and Bisoprolol 2.5 pm

BP 123/72

Day avge HR 93.

Joy 73 (NZ)

So Thyroid Cancer gave me AF and AF caused the stroke.

[Mowgli44]

I was already on bisoprolol 2.5 mg daily together with other BP meds. My GP has added another 1.25mg on to it since recently being diagnosed together with Edoxaban. As yet and it is early I am still having episodes. She has not referred me to a consultant and this is something I need to discuss with her. Do most GPs deal with this themselves?

[Lucymoo]

Morning, yes I was prescribed it for a number of months, I think over a year whilst awaiting for an ablation increasing from 1.25 to 10 mgs a day. I didn’t have any problems with it except for tiredness……stopped after an ablation last year but back on it again. Now on 2.5 mgs a day no problems. Had flecanide for about 3 months as well prior to my ablation. Use it now as a pip.

[Corkel]

I was given 1.25 Bisoprolol when I was diagnosed in 2019 at the same age as you. I was also prescribed flecanide as a PIP. Im yet to take the flec and still managing my afib on the Bisoprolol and diet. I don’t drink coke, wine or any beer and now only drink decaf coffee and try not to eat too much bread. So far so good. Wishing you well .

[Carnationmac]

Hi, I’m on 10mg of Bisoprolol and 62.5 Digoxin plus anti-coag Apixaban. All given to me by my GP. I’m in permanent AF with occasional palpitations. A part from getting tired and slightly breathless when walking I find they are fine. I have an appointment with the Cardiologist at the end of the month, so I’ll see what she says.

[hausjac]

Ive had AV re-entry tachycardia for over 40 years as I have an accessory pathway in my heart so I was initially put on Disopyramide after trying Flecainide which gave me tunnel vision, I was then put on Bisoprolol 10mg about 30 yrs ago which combination I've taken ever since even though I was diagnosed with PAF last year as well. It works for me but Bisoprolol is not everyone's choice of drug. It took a while to adapt like anything but now i wouldn't stop it

[KMRobbo]

Not medically trained but flecainide is a rhythm control drug , where bisoprolol is used mainly as a rate control drug . Flecainide is to put your heart back into rhythm and keep it there . Bisoprolol is to keep the heart rate down if you are in afib, and to reduce the rate if you go into another arrhythmia which flecainide can promote. ( eg atrial flutter).Consequently you need to find out what the high HR you are getting actually is befire adjusting meds.

For example

I used diltiazem as rate control as I did not tolerate beta blockers.

I developed AFlutter AFTER a successful afib ablation which was promoted by the flec i was still taking in the blanking period. I was quite breathless in AFLUTTER . However my local hospital thought I had reverted back into afib and gave me 200 mg more flec ( i was only 50mg x 2 daily previously), after which my flutter got a lot worse- faster and more breathless. Then another ECG showed re entrant flutter and they reduced the dose back to 50mg after speaking with my EP.

This reversed the symptoms back to previous but did not stop the flutter so I had to have another ablation to stop that.

Also please note my EP kept me on my maintenance flec dose throughout. I assume thus us because it was more important to protect the afib ablation as it is a more complicated , more difficult and less successful and less permanent ablation as compare to the flutter which is 95% successful, and almost 100% permanent if succesful.

[Leggylady]

Hi Kenny, I was prescribed a blood thinner and Bisoprolol 12 months ago when I was diagnosed. I have had one episode last November and otherwise have been ok. Lyn

[javo123j]

Hi Kenny. I'm on just 1.25ml of Bisoprolol. I've never been offered flecainide probably because I do not have a high heart rate during attacks.

[Cos56]

Hi, Sorry to hear you’re still getting episodes.I take a beta blocker called metoprolol 25 in am and 12 in pm along with Flecainide 50 twice a day. Of course, Eliquis 5 twice a day.

It has been miraculous. A perfect combination for me. I’m doing this for 6 months already with no episodes and no side effects I notice. We’re all different but the same, lol, maybe a beta blocker in combo is the answer.

Wishing you the best!

[Kennyb1968 in reply to Cos56]

What a lovely positive message - thank you

[Morzine]

I would like to add when u take bisoprolol don’t be surprised if you feel very energy lacking, it takes a time to settle down weeks in fact with me. Plus getting dose right…we r all in diferent doses in the range ….I’m on 1.25, I was 2.5 but I was zonked energy wise the reduction made a huge step up in gear, still not top gear but hey ho life’s good! I am on flecanaide I think they go hand in hand.Bisprolol seems to lower the pulse rate anyway give it time don’t judge it the first few weeks,

Sue

[JOY2THEWORLD49]

Hi KennyMetroprolol didnt control my AF (186 avge during day)

Bisoprolol brought this down to 156 (avge during day)

Still not in control.

But night average stayed the same Avge 48. Metroprolol gave me 2 x 2 sec stops.

Now changed by private heart specialist.

120mg Diltriazem am. 2.5 Bisoprolol (Must be separated).pm

CONTROLLED SINCE DEC

93 avge day

48avge night

BP 123/72

JOY (73, NZ)