Flecainide and exercise

[GordonNZ]

Hi,

I am on 100mg twice a day. Probably using it for 1 week now.

The dizziness has passed but I am battling with exercise.

My routine has always been 10min warmup on spinning bike or treadmill. Then around 1hr weight training and then 20min cardio at the end.

The cardiologist said to leave the cardio for a while.

Anyway, this morning I was feeling terrible, had no strength and out of breath.

Is this normal?

[mjames1]

Maybe but maybe not. I also felt terrible on the treadmill right after my ep raised my flecainide from 50mg bid ( twice a day) to 100 bid. I took an ekg with my Kardia which said "Wide QRS" and sent it to my ep who confirmed and also said I had some heart block.

He told me to immediately lower dose back to 50mg bid and then come in for an exercise stress test before he' let me back on the 100mg.

Flecainide is a very powerful drug that needs to be monitored, often with ekg's and sometimes with an exercise ekg if that is where you are having issues.

Long story short, I never had the exercise ekg because that would have meant going back to 100mg bid for the test, however since then the 50mg bid has been working just fine, exercise or not.

Jim

[GordonNZ in reply to mjames1]

Thank you for that info. I might have a chat with the cardiologist about this.

[secondtry]

I have lived very comfortably with 200mgs Flecainide per day and moderate only exercise. My advice would be to cut the exercise to half what you can mage.

[Jajarunner]

I was on it for seven years and exercised fine in-between cardioversions and ablations. I should speak to your EP or the arrhythmia nurses. Good luck xxxx

[Speed]

Could your AF have been triggered during exercise and you were in AF when you felt awful?

Also, I believe from published research that although Flecainide has no impact on rating HR, as your HR increases, it has an increased impact such that it reduces Max HR by approximately 12%. You will therefore not be able to exercise at the same level of intensity that you would have been used to pre flecainide.

Also, I believe Flecainide should not be taken if there is any structural issue with your heart, so if you get any discomfort / pain in your heart then they like you to have a scan to ensure no narrowing or blockage in arteries in heart.

[GordonNZ in reply to Speed]

Thank you. It does feel as if I tire more quickly. But it is early days so I should take it easy and see how it goes.

[Hidden]

Flecainide reduces the heart rate that can be achieved with exercise, and this will limit the intensity at which exercise can be sustained.

I take propafenone, which is a smilar class of anti-arrhythmic to flecainide (class 1c), and my maximum level of exercise is about 70-80% of what I could do previously. Propafenone may be a little worse with exercise than flecainide as propafenone also has a weak beta-blocking effect. At any given level of exercise my heart rate is lower than previously. I've spoken with my EP about this and he says it's usual for these anti-arrhythmic drugs to limit the ability to exercise to some extent. It's one of the reasons why I have opted to go onto the ablation waiting list, the other reason being a gradual increase in the frequency of episodes of PAF over the last couple of years.

[GordonNZ]

Interesting, thank you.

[Wildrunner]

I’ve had exercise problems ever since I had to increase my dose to 100mg. I’m a runner and could happily continue as normal on 50mg, but as soon as I upped the dose I’m struggling. I feel like I’m unfit, even though I know I’m not and every type of exercise feels like a huge effort! I’ve done some research and it does indeed seem that Flecinaide can have the same impact as beta blockers which lowered my exercise capacity. It’s a total pain and I get tired of hearing people advising others to reduce their exercise. Easy to say if it’s not a huge part of your life.

[GordonNZ in reply to Wildrunner]

Thank you. Yes I was soo frustrated and discouraged this morning. It is difficult to keep going when one struggles like this.

[Speed]

My experience is that Beta Blockers (Bisoprolol in my case) destroyed my ability to exercise at any where near the intensity I was at previously. No more HIIT sessions and even plodding felt hard work. As this had such an impact on my QOL I agreed with EP to drop the BB but continue Flecainide. I take 2x50 mg daily and generally, as long as I keep below 140 bpm (v slow on hills, no HIIT), then I can continue to exercise without triggering an episode. This means my max running pace for 5k, previously 7.5 min miles, is now 9:00 min miles. Disappointing but at least I can still get out there regularly. Still considering an ablation (had 2 to sort A Flutter previously) as EP thinks it’s a Pulmonary Vein issue and so relatively straight forward.

Of note however, having had 2 left side ablations for A Flutter, last one 16 mths ago, my resting HR is higher, at low 60s compared to low 50s previously with similar level of fitness. Used to drop to mid 40s in periods of focussed training.