Atrial Tachycardia and Flecainide

[MeganMN]

I was diagnosed two years ago with SVT- Atrial Tachycardia and had an ablation. I had successful resolution of the Atrial Tachycardia and then it suddenly returned in December of 2022. I went in for another ablation and it was unsuccessful as the EP could not induce the rhythm. I was super bummed about it because I have a really difficult time with the medications. Two years ago I was able to take Propranolol and then Metoprolol, but this time, the Atrial Tachycardia was not responsive to wither of those. I ended up in long runs of it (1-3 hours every night). The doctor tried Cardizem but I had some yucky side effects, so he recommended Flecainide. I am now on 100mg once in the evening and it seems to be controlling the rhythm, for the most part. However, I am having daily headaches, mild nausea, some mild visual disturbances, and my exercise tolerance is just crummy. I have only been on the 100mg dose for a week and am really, really hoping that some of the side effects lesson. I know there is such a varied response to medication, and I am just really disappointed in the failed ablation and hoping that the EP will consider trying again in the future. He recommended 6 months on the Flecainide and stated that sometimes people can wean off of it and not need to take it forever. I cannot really find anything that talks about that and I am really hesitant to be on this medication forever. No specific question here, just looking for support/thoughts. Thanks!

[mjames1]

Is that a 100mg slow release capsule or a 100mg tab? I'm guessing it's the former, so if you still don't tolerate after a couple of weeks, ask for a trial on the 50mg fast acting tab, twice a day.

As to getting off Flecainide, it's possible but I would say not probable unless you make some major lifestyle changes that might have been impacting your tachycardia.

Have you sought the advice of another ep? Ablation seems as much of an art than a science and some ep's might be better than others in chasing down arrythmia's.

Jim

[MeganMN in reply to mjames1]

Thank you for the reply! I started on 50mg tab once in the evening, then added another 50mg in the morning, then switched to the 100mg tab in the evening when it still wasn't being controlled. Now the rhythm seems to be controlled but I just feel gross. As for lifestyle changes, I quit alcohol, quit caffeine, started exercising more, and am trying magnesium and some other supplements. I am 47, healthy, homeschool three kids, and have a busy farm. My lifestyle seems pretty solid, intermittent fasting for the most part for dietary stuff. I am scheduled with a Naturopath to look at possible Adrenal Insufficiency or causes, or other brainstorming to see if any thing else will affect the SVT. I have not sought a second opinion, that may be the next step. Thanks for the thoughts!!

[mjames1 in reply to MeganMN]

If it's any consolation, I had a very bumpy first ten days on Flecainide and then things got better. And when I say "bumpy" I mean afib episodes as well as side effects. Hopefully, both your tolerance to the drug and its effectiveness will get better, because 50mg twice a day may have fewer side effects than 100mg at night. Trial and error.

Are you taking it with a beta blocker by any chance like bisoprolol or metoprolol? I never tolerated beta blockers very well, so I take my Flecainide with Diltiazem and feel much better.

Given the type of arrythmia you have, I would think ablation is the eventual way to go, if you find the right ep.

Jim

[MeganMN in reply to mjames1]

Thanks Jim, I may look at a second opinion, although I really like my current EP. I will wait it out for now, as the 50mg twice daily did not control the rhythm and the 100mg nightly does. They had me try the Flecainide with Propranolol but it made me so dizzy that I could not tolerate that for more than a couple days. Beta Blockers have always messed with me as my blood pressure is already fairly low. I seem very sensitive to CNS effects of the Beta Blockers. I will ask more about that (perhaps if I could take 50mg of Flecainide with a Beta Blocker). My EP seems game to experiment with things so that I do not have to be miserable. We will see. thanks for the help.

[secondtry in reply to MeganMN]

Well done you seem to be taking a lot of the right action, be persistent it takes time for things to settle.

Everyone has a different reaction to drugs. My experience was 50mgs Flec x2 per day didn't stop the episodes but 100mgs x2 day (a medium dose, 300mgs/day is max) did the trick. I still felt very strange but after 3 months and starting a Mg compound and Co Q10 (recommended by my Naturopath) QOL gradually returned and has got much better over the last 5 years.

Homeschool 3 kids plus farming could be contributing to breaking the AF threshold. May need some brave action to moderate the stress and all other matters in your lifestyle. My theory has always been that AF is caused (for the majority) by a variety of factors not just one. As you usually don't know where the biggest influencers are you have to address all possibles.

Lastly, because I was 60yo fit, no comorbidities, lowish BP & HR my UK cardiologist advised not to take any BB or CB with the Flec as 'it would make me feel unwell'. This approach is not unique but not common; I doubt it applies to you but you may want to run it past your EP.

[SeanJax]

your treatment seems to work right now but in my opinion you need to slow down because you live at 200 mph between the farm and home schooling three kids. Stress and overwork contribute to your condition. Easy said than done huh? After a while flecainide stops working and what next ? But don’t think too far. Best wishes

[Cundara1234]

Hey, Megan I also had SVT - Atrial Tachycardia. I had 230 pulses per minute on several occasions. It lasted for a few minutes but it was catastrophic. I had a hard time bearing it. They weren't sure if it was Atrial Tachycardia or Atrial Fibrillation. I went for a physiological examination and they managed to provoke atrial tachycardia and then they performed an ablation. After that, such tachycardia did not return. But I still had SVES and VES (extrasystoles). This bothers me a lot. Everything else on the ultrasound and holter was fine except for those extrasystoles which are hard for me to bear. I tried several medicines such as bisoprolol, Propafen, Flecainide... nothing particularly helped. These days I got angry and stopped all medicines. The cardiologist advised me to try Cardizem. I have never used it. I read that it can cause a rapid pulse as a side effect?! I'm afraid of that, so I haven't even tried it. I haven't taken anything from the therapy since yesterday. We'll see how it will be later. How is your Atrial Tachycardia manifesting now?

[MeganMN]

Cundara1234 thank you for the reply. Yes, the Atrial Tach. Is hard to deal with for sure. I know it isn't a 'lethal' rhythm but isn't much fun. Before starting the Flecainide, I was having episodes that were lasting 3 hours or more. The Flecainide is stopping it but I am having horrible daily headaches and now dizziness. The Dr. Today said that they might try lowering the dosage and adding a Beta Blocker but most likely they will try again for another ablation later this summer. For the extra beats, I used to take Propranlolol and it helped immensely to just make me less aware of he beats. That might be something fairly mild that you could ask your doctor about. I am also going to see a Naturopathic doctor this month to see if there is anything else they might recommend, as there are some natural medical news that I am curious about but do not want to take without a doctor okaying it. Will let you know how this goes.

[Cundara1234 in reply to MeganMN]

Thank you very much. I hope you are well. Let me know the news and how you feel.

[MeganMN]

Thank you. I met with the Naturopath and tried a few things. Hawthorn actually stopped the SVT but made me too dizzy, so now I am back at square one. I meet with the EP again in a week and would like to try another ablation but am also nervous that they will not be able to induce the rhythm again. We will see. Very frustrating.