Details around flecainide organising atrial fibrillation into an atrial tachy

[kitenski]

Does anyone have any details around how/when this occurs and is it just a case of living with it? The nurses suggested I could try increasing flec from 50mg twice a day to 100mg, but if the flec causes the issues, I'm wondering if it would make things worse?

I was put onto bisoprolol because of this, the arrhythmia nurses specifically said:

when on regular flecainide with organised atrial arrhythmias a beta blocker is indicated. The flecainide can organise atrial fibrillation into an atrial tachy but it has no effect on the AV node, therefore is no rate control

I'm asking because if I ever have issues they always seem to be post exercise and always start with Atrial Tachycardia

[mjames1]

Beta blockers like Bisoprolol are very often prescribed along with Flecainide to help prevent unwanted arrhythmia's. You should also have ekg monitoring after every dose increase. When my dose of flecainide increased from 50mg twice a day to 100, I didn't feel well. An ekg showed Wide QRS and Bundle Branch Block. The ep reduced my dose back to 50.

Jim

[DKBX in reply to mjames1]

I had same outcome but just over time with flecainide. It turned into atypical atrial flutter eventually. Had a fifth ablation to fix that; still in the blanking phase. We’ll see.

[kitenski in reply to DKBX]

how did you get the atrial flutter diagnosed? Does it show on single lead ECGs ie Apple watch or Kardia??

[DKBX in reply to kitenski]

It was found on a 12-lead ecg in the EPs office. I doubt it can be self-diagnosed.

[Cookie24 in reply to kitenski]

I think the watches just indicate afib not a flutter. Am EKG is necessary to distinguish afib, flutter, or atrial tachycardia.

[mjames1 in reply to DKBX]

My understanding is that Flecainide will not cause a new permanent flutter, but just can induce it temporarily, but not 100% sure on that. Your atypical flutter may have other reasons. It could have been hiding behind your afib, or commonly due to multiple afib ablations. Good luck with the atypical flutter ablation.

Jim

[secondtry]

There is a lot of trial and error with choices to stop AF; a perfect example above with Jim, 200mgs/day Flec was no good, while for me the same change up stopped all of the AF and still OK 10 yrs later.

Personally if I was in your position, I would take a second opinion ideally from a cardiologist meaning I guess a private appointment.

[Shcldavies]

Flecainide is a powerful drug that will help some and harm others and I believe not all medical providers are fully knowledgable on its effects. I would not even trust my Dr with advice on it, your best option is advice from a Cardiologist or better an EP. I have had first hand experience of this drug and really recommend you seek professional advice.