Flecainide as Pip how soon will it work?

[OzJames]

After nearly 10 months of no AF I got a little dehydrated in the heat and had a rushed lunch, back in AF… so upset with myself… anyway i rang the hospital clinic and they said take 100mg of Flecainide now which I did about 30 mins ago then another 50mg at the 2 hour mark if not settled. My HR is 85-90 in AF. If not self converted she will put me in for CV tomorrow. What I didn’t ask is do I keep taking the Flecainide in the morning before CV. I will also start my apixiban and increase my dose of metoprolol from 8mg to 12.5mg. Can’t believe my wife and I are flying to Bali in just over a week….. After 5 years of no AF in August 2022 I went into AF the week before our last Bali trip!!

[Hidden]

Obviously you must follow the advice of your Doctor but should it happen again, I suggest you ask your Doctor if you perhaps should take the maximum daily dose of 300mg. Doctors views vary everywhere but here in the UK under normal circumstances, there is a tendency to prescribing the high dose immediately rather than drip feed to the higher dose. We are all different, but after several years of NSR, I woke up with AF, as prescribed by my Doctor, I took the highest dose permitted and returned to rhythm before 10am. The fact that you have quick an easy access to having a CV may explain why a lower dose is used, we normally have to wait weeks!

Try not to worry, assuming you made it to Bali 5 years ago, I guess there’s no reason to believe you won’t make it this this either👍 and clarifying the higher dose of Flecainide might be helpful whilst you are away……..

[OzJames in reply to Hidden]

Thanks and if I do go into Sinus do I stop taking the Flecainide? I forgot to ask!

[Hidden in reply to OzJames]

As you know, we are not qualified to answer such questions. All I can say is that provided Flecainide has been proved to be a drug that someone can take without problems, it’s not uncommon for doctors to prescribe a regular 2 x 50 mg maintenance dose PROVIDED the patient also take a daily dose of either a beta blocker or calcium channel blocker. As far as I know, CV’s are not carried out when a patient is in sinus rhythm.

I think you need to contact you clinic direct for clarification…..

[mjames1]

Your doctor is following a similar Flecainide PIP protocol to mine of 150mg being max 24 hour Flecainide dose. Under no circumstances, should you take more without consulting your doctor. This is one drug you do not want to self administer or take Internet advice about.

Jim

[OzJames in reply to mjames1]

Thanks Jim that makes sense, My usual Cardiologist is on holidays so I’m meeting the fill in Cardio I can check in the morning with her. They found a bed for me at the hospital as I’m still in AF and will most likely do a CV in the morning.

Interestingly my son is a doctor in emergency and I was telling him I was dehydrated this morning and then ate lunch too quickly and he said AF happens when it wants to, I didn’t want to argue with him

[mjames1 in reply to OzJames]

Lol. It's amazing how doctors have such strong opinions on conditions outside of their specialty. Not just your son.

[OzJames in reply to mjames1]

True and yet the night doctor just popped into my room checking medications and she said keep taking the magnesium and CoQ10 it’s good for you! 😆

[pip_pip]

AF happens when it wants to, I didn’t want to argue with him.

Your son is right. The conditions you set just triggered what was on the way. Unfortunate.

Just carry on with the meds prescribed. It's not clear if you take flec regularly. If so just carry on. If not don't take anything extra unless advised to. If your in sinus you obviously won't have the CV. If you're in difficulties, ER beckons. Sorry

Phil

[OzJames in reply to pip_pip]

Thanks Phil the Flecainide is for PIP but Doctor had me come in to do CV and had another Flec this morning before hand. Though I’m still in AF my HR is pretty even 65-80. Hopefully the CV knocks it back in sinus

[Speed]

My prescribed routine (I believe relatively Standard in UK as long as certain no other underlying heart issues) is on top of my 2 x 50mg Flec each day, with onset of AF, take 100 mg flecainide and if not NSR within 2 hours, take a further 100mg. I believe it takes 2 hours for the body to full absorb and max the “concentration in the body”. Told under no circumstances to take more than 300mg in any rolling 24 hrs. I have occasionally followed this over 72 hrs before NSR.

[OzJames in reply to Speed]

That makes sense thanks for response. I ended up going into AF at around 2.30pm on Friday, Apple Watch sent me Alert 4.30 I took 100mg and waited 2 hours then another 50mg as advised by locum cardiologist at local hospital. In the morning 7am took another 100mg nothing changed and I had CV at 8am. They got me 3rd try first was only 70 joules and ultimately it was 200 joules. The whole process was quick. My head still spinning! She wants me to stay on 50mg Flec for 4 weeks until review along with Metoprolol and Apixaban at the end of 4 weeks. I might contact my Cardiologist office next week to confirm if that’s ok.

[Rvlindahl in reply to OzJames]

Does the CV hurt? I know little about it.

[OzJames in reply to Rvlindahl]

No it doesn’t hurt, to give you an idea the shock you get is measured in Joules they can start at 70 Joules and it depends on weight. I’m about 74kg and and I think they once did 150-200 Joules when 70 didn’t work. This is much much lower than you get in an emergency heart restart. You are sedated through the whole process which only takes a few minutes. If you’ve been in AF for more than a day due to risk of clots forming they usually do an internal ultra sound to check for clots called a TOE which means trans oesophageal echo just before the CV again you are sedated. You wake up not knowing anything

[Garaidh]

Good to know you're feeling better today after the CV.You mentioned you holiday and I think that = stress (good or bad stress / excitement!). It's such a trigger with me.

My approach now is to buffer stressful times with an extra 50mg of Flec. I take Bisoprolol so will have an extra one if I feel stressed.

I am cleared to take up to 300mg Flec a day but generally take 2 carefully timed (reminder app!) 50mg doses & I seldom have breakthroughs. No side effects at all. In peaceful times I can reduce that further. The secret is to have the drug in your system before the stress hits, ideally!

My Bisoprolol dose is very small 1.25 (and I'm big) but if I feel stress raising my pulse I'll take another one.

I completely stopped alcohol. That unquestionably helped - especially it made going back into NSR smooth and safer.

I also have a drug on hand, Loprazolam, which can help really well with a stress crisis and helps add to the 'buffer'.

With the above system, I'm 99%+ Afib free - a huge improvement!

Have a lovely holiday 😊

[OzJames in reply to Garaidh]

Thanks for reply, I’ve normally taken metoprolol twice day the equivalent to your dosage of Bisoprolol A few months back it was agreed to reduce to 8mg which is equivalent to .8mg of Bisoprolol. I too have stopped alcohol but occasionally will sip from my wife’s glass if it’s nice red. I just remembered I had a root canal a few days before with about 8 local injections not sure if that contributed to the AF.

Doctor suggested I go back up to the higher dose of Metropolol for a month ti help things settle along with the Flecainide for a month then review whether we can drop the Flecainide

[secondtry]

Flecainide is best taken on an empty stomach and then don't eat for an hour. Sounds like you have vagally mediated PAF judging by the possible trigger of the Bali trips.

All things considered you may choose to discuss with your cardiologist whether you can take 200mgs Flecainide (a medium dose) daily instead of just as a PIP when AF occurs; my cardiologist favours that approach and after 2 episodes a week it worked for me.

[OzJames in reply to secondtry]

Yea that sounds like a good discussion at the one month review. It possibly was the holiday planning or maybe my root canal on Tuesday where I was jabbed with 8 local anaesthetic needles and got quite a few intense pangs of pain during the procedure. It was suggested by the hospital Cardio today I stay on the 50mg Flec whilst overseas and discuss with my Cardio…. if I can get onto him!

[Singwell in reply to OzJames]

It does sound like a sensible approach- that following the event you take a maintenance dose for a bit, especially whilst away with changes of temperature and humidity etc. I know people say AF just comes because once we have it, we have it. But in my experience the 'trigger' is an aggregate. So maybe the 8 injections plus the heat and eating quickly tipped you over the edge. Hope all stabilises now and that you're able to have a lovely holiday.

[OzJames in reply to Singwell]

Thank you and I guess it’s easy in hindsight I should’ve realised the trauma at root canal I had would change things and taken it easy.. The Interesting thing whilst doing the ECG at the hospital there was ectopics picked up as well which may have started during the root canal and I find that is a precursor sometimes to AF

[OzRob in reply to OzJames]

I think overheating is a major trigger for AF. I live in Far North Queensland, my first ever episode a few years ago was at 3am in a sleeping bag on a very hot rainy still night.

The hammock fly was not waterproof which caused major stress as I was soaking wet.

Heat, stress, the thought I was dying on a remote island without any phone reception was not an ideal situation to be in. I was lying there visualizing my own funeral where people were saying he died doing what he loved to do, hiking and camping.

I have Vagal AF, not sure if overheating is a trigger for both forms of AF.

[OzJames in reply to OzRob]

Hi Bob I’m a bit like you mate, I was rushing around getting sons unit ready for sale, never had a drop to drink for 5 hours and it was about 30C then got into an argument with building manager. I checked my Apple Watch much later and saw that my heart rate Variability really spiked when I was talking to him, so yes, stress, over heating and in my case overeating straight after

[OzRob in reply to OzJames]

You can't overheat or stress in Bali! We go there each year; this year will be 3 weeks over Christmas. It takes only about 4.5 hours to fly from Cairns.

[OzJames in reply to OzRob]

Yeh it’s a good place to relax we’re doing 3 nights in Ubud and 8 nights In Seminyak. You’re that close it’s like a weekender! 😆

[GardenLover2]

I am so sorry to hear your AF has returned so close to your trip. I hope it settles and you have a good holiday. Sorry I can’t help you with your question as not on that medication.

[OzJames in reply to GardenLover2]

Thanks for the good wishes, I looked at the calendar and it also happened about a week or so before our last Bali trip a year ago. Moral of the story…I shouldn’t go to Bali 😊

[alfrae13]

I go into afib about once a week. HR is usually below 90. I take 100mg.flacainide and go to NSR within several hours

[OzJames]

that’s good to hear, I eventually took 50 and 50 within first 15 minutes and then another 50 in 2 hours and I didn’t convert. I guess we’re all different so it was over to CV