I have just had an emergency pacemaker. It is set at 60 I’m told but whenever we take my BP snd pulse it always says 70 I had to have it as my heart rate was in the low 30s
Pacing unit says it is my heart taking over with the atrial fibrillation and tachycardia so my EP said to double my flecainide. I’ve been on my present dose since 2018 snd it’s always been fine .
I’m not happy to do this as originally the consultant wanted to stop flecainide as it was a toxic black box pill and another doctor (and Google) says it throws out the rhythm of the pacemaker
Does anyone here have any ideas please
Thank you
Pat x
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Tapanac
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I have a pacemaker for a similar reason. Mine is set to activate if my heart rate drops below 50, only happens rarely. The rest of the time my heart rate is usually between 60-90 or higher if walking or exercising. I am in permanent AFib.
Different if you have had “Pace and Ablate” in that case you would be pacemaker dependent.
Oh thank you, but I was concerned when the other doctor said about affecting the rhythm of the pacemaker snd then google
If you have a permanent pacemaker—Use with caution or preferably not at all. Flecainide may interfere with the pacemaker and will require more careful follow-up
Ha ha my son said if you do mention anything you think you know about flecainide whatever you do don’t mention Google. The consultant will turn right off!!!!!
Dr Google saved me from having a pace and ablate, which I knew instinctively was the wrong treatment for me (health heart and tachycardia, not bradycardia). This was confirmed by a second opinion with the right cardiologist/EP. A successful ablation was the right treatment and has worked superbly - so far.
Up to date, approved and regulated prescribing and patient information for licensed medicines
“Flecainide is known to increase endocardial pacing thresholds, i.e. to decrease endocardial pacing sensitivity. This effect is reversible and is more marked on the acute pacing threshold than on the chronic. Flecainide should thus be used with caution in all patients with permanent pacemakers or temporary pacing electrodes, and should not be administered to patients with existing poor thresholds or non-programmable pacemakers unless suitable pacing rescue is available.”
It does seem Flecainide can and does alter the way your pacemaker may respond. I wouldn’t be happy to use Flec with a pacemaker. Also depends on the type of PM and how it’s programmed of course. I think this is something for specialist input so at the very least - question the whys & wherefores a lot more.
Flecainide is a toxic drug and you will need careful monitoring but the Pacing clinic are very good at that. Have you a bedside monitor or phone app?
Yes I have a bedside monitor and goes through to the paving unit. Amazing little thing like an iPhone. Trevor’s is the size of a handbag!!!
I am worried about the flecainide so when I see the EP this week hopefully I will ask him, but he was the one that said double the dose!!! He said the pacemaker would keep my heart rate from going too low but the flecainide snd bisoprolol would stop it from going into tachycardia
I don’t want to mess up the pacemaker though as having enough trouble with it as it is
Just last Friday my specialist told me that he was putting me on a waiting list for a pacemaker/ and or a defibrillator! This was a shock to me as I had no idea that my heart failure diagnosed in January would still be almost as bad after taking Solatol and Eplerenone! Apparently my ejection factor in January was 20%, and when I had another Echocardiagram a few weeks ago it had only improved to 30% odd and is not likely to improve. I have suffered AF for years now and been quite happy after an ablation about 2009, jogging along on Flecanaide 50mg twice a day. Don’t know why my left ventrical stopped pumping other than I had had a chest infection! I am told that my quality of life will improve with the pacemaker. I am an active 83 year old lady, what do other people think?
I think your pacemaker will give you a new lease of life. It sounds scary when they say heart failure but generally it means it just doesn’t function as well as when we were young.
The pacemaker will keep your heart from going too slowly
I would suggest that you call or email your Cardiologist or surgeon via their Secretary and ask for more advice from them voicing your concerns because of the contraindications that can happen between flecainide and pacemaker use.
Perhaps a second opinion from another doctor would also be a good idea too just so you can be confident before making any drug changes.
Flecainide increases the ventricular capture threshold of pacemakers , this is shown in numerous medical research studies. it's not just on Google , and as such its use needs to be done with caution .
I'm not sure what you mean by 'via their Secretary'. Don't all calls go firstly to his secretary. ?If I phone my Cardiologist, if he's not too busy, she puts me straight through to him - otherwise I leave a message with her for him to phone me back, which he does. Or is this a different system whereby you tell her your problem, and she acts as an intermediatory, and you never speak directly to the doctor?
If you haven't already got the Cardiologists direct number you need to ask to be put through to the Secretary of your named Cardiologist via Hospital Reception .If you just ask to be put through to Cardiology you don't speak to a secretary straight away you get a receptionist and often they waste your time trying to take messages or don't put you through.
You don't always talk to the Cardiologist themselves if it's a simple question and the Secretary often acts as an intermediary phoning back or emailing with the Cardio's answer. Which is good because it saves the Specialists time and usually gets you an answer quicker. The Cardio only rings back if they think they do need to do more about the problem in those circumstances.
Thank you yes I will contact my GP in the morning as he is very good although, of course, not a cardiologist or EP
Our younger son has been on to the consultant’s secretary and hopefully she will call me in the morning to make an appointment to see him face to face. Although I’m not sure what his attitude will be questioning his wanting to double my dose of flecainide
After reading a lots of responses to my post I would like to come off it now
thankyou I am worried about the flecainide so when I see the EP this week hopefully I will ask him, but he was the one that said double the dose!!! He said the pacemaker would keep my heart rate from going too low but the flecainide snd bisoprolol would stop it from going into tachycardia
Also I’m not sure how he will react to my more or less questioning his decision to raise the dosage Consultants don’t like being told do they
I don’t want to mess up the pacemaker though as having enough trouble with it as it is
I'm just usually very polite and say that I just wanted to double check because I had received differing advice about flecainide and pacemakers , don't mention Dr.Google but if you search on the internet you will see recommended medical research and pharmacy sites that also point out the potential risk so you can say you read them.If the person you are seeing us the person whom chose to double the dose I think I'd still be wanting confirmation from another cardiology doctor too. It's better safe than sorry.
I have had a pacemaker since December, set at 50 but regularly goes up over 100 , also take 100 flecainide twice a day, along with other meds, awaiting Av node ablation, but so far so good!
Hello, they are considering pace & ablate for me. They have tried everything, so there is nothing left but this. So many people have pacemakers which are amazing. We are lucky to live in this day & age. with amazing surgeons. It's the word dependent that worries me, but we must think that hopefully all our worries will go when we have this done. Best wishes
Pacemakers failures are almost unknown and you will be monitored through the technology now available - mine is an app on my iPhone. You will not be 100% dependant so after the AV ablation as they always leave a small margin which will keep you alive until you can get medical assistance.
Once the battery life starts to decline they keep a very close eye and plan to replace but that will be 10-15 years hence after implant. My app currently shows 6 years, implanted in 2018. There is a good safety margin.
Thank you. I have just been worried that flecainide interrupts the pacemaker mainly. I have just heard that the cardiologist might see me Thursday afternoon, but as he is so busy not sure if the time
Fine tuning the pacemaker in combination with a a mixture of of medication can take more time than some cardiology departments have. There's a lot of trial and error as I'm finding out.It's worse when you are running at 100% dependency.
I'm battling ectopics with the PM so it's a fine line between using Bisoprolol (10 mg daily) to calm the ectopics and the PM trying to keep the heart rate up.
I definitely don't want to be on beta blockers for a long time and I'm pinning my hopes on a better PM next time that can cope with the many PVCs.
My feeling is that if they want to tinker with medication and PM settings then there should be better monitoring.
I see the consultant in three weeks time and that will be the first F2F in 18 years.
I'm not talking about the now defunct check up clinics.
I haven't a clue what the home monitor sends out, but it has yet to prove it's usefulness when things go wrong.
Maybe it does send stuff out, but no-one gets back.
I was told the pacemaker stops the heart beat going too low, but not from going high, you can still get AFib! Too low can cause a CA, which happened to me, that’s the reason 8 had th PM
My only words to you would be to get a second opinion. My son dxd with AF. He was cardioverted once by him. He has, though, gotten a second opinion and this second EP is who he is staying. Make sure you EP and other doctors not only listen but hear your questions and concerns. This second EP is total opposite of first one. Best to you! One other thing is medicine after using for a time should be evaluated for benefit vs risks!!
Hi Tapanac, I was hospitalised October 2023 with "fast AF", heart rate of 174bpm. I have a permanent twin lead pace-maker set to maintain heart rate at MIN 60bpm. Normal pulse rate was previously ~75 bpm. The fast heart rate it turned out was the resalt of an internal infection and sepsis, but this was not diagnosed until I had been put on Amiodarone (horrible drug) and 2 x 5mg per day of beta blocker, Nebivolol. These last two drugs have absolutely creased me. The effect has been to slow my heart rate to such an extent , my pacemaker is permanently working, to maintain 60bpm and the drugs are trying to get it lower. Consequently heart rate will NOT go above 60bpm, and NOT respond when I make any attempt to exert myself, i.e. walking/gardening. Now can't even get a NHS cardiology appointment to even discuss the problem with meds, never mind my permanent AF!
My understanding of a normal range for heart rate is 60 -100, and if in this range probably should be questioning the need for rate control drugs.
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