Flecainide for chemical version

[ObiDyer]

Persistent AF for over two years punctuated by NSR for 8mths after first cardioversion but only 2 weeks after second. Now on digoxin & sotalol which controls the rate well but limits activities. Clinic suggest trying Flecainide to see if it will chemically induce NSR. Any experiences with this approach?

[AAJJTt]

Hi, I been in chemical cardio version for 4+ years. Heart attack (NTSTEMI type II) and that was my introduction to Afib (paroxysmal); the eventual conclusion was the untreated and undiagnosed arrhythmia caused a small transient clot that entered my heart. Prior to this, I was totally oblivious.

Flecainide 50mg (am) and 100mg (pm). Additional PiP too - 100mg + beta blocker; never used. It’s been well tolerated, no known side effects - functions (liver, kidneys, etc) ok so far. Currently very fit and healthy. Had one breakthrough Jul 20 which spontaneously synced back to NSR with no additional meds. Have been ‘Afib free’ since - no sustained arrhythmia or more breakthroughs.

At my next review, one of the topics of discussion is moving from daily Flecainide to PiP only. Not 100% sure about this, I kind of like the status quo, Flecainide has been a good solution for me. I say ‘Afib free’ optimistically, I hope it’s gone but suspect it’s just in hibernation (albeit chemically induced).

[secondtry]

After Persistent AF for that period it may be a tad late for Flecainide except at a high dose which you probably wouldn't want. Discuss with your cardiologist carefully (private appt if necessary) as I was having 2 episodes a week and 200 msgs Flec (a medium dose) has worked for me for 10 yrs.

[Tapanac]

Yes I had a chemical infusion of flecainide and then take 50mgs twice a day. I found it a miracle drug. Good luck

[Tplongy]

I have persistent AF with no other co-morbidities. CVin Nov 22 after 1st diagnosed failed totally. Was put on Flec in Feb 23 and 2nd CV in June 23. NSR returned for 5 hours and then AF returned. After discussion with my cardiologist yesterday after 24 hour holter results, she said to stop the Flec as it clearly wasn't working. However, it is thought I had AF undiagnosed for likely 2 years before it was finally caught, so therefore it is well entrenched.

I had no real issues with Flecainide during this period, other than quite a bit of face flushing and vivid dreams, which went away, so I hope that it works for you.

[Tplongy]

sorry, meant to say 2 x 50mg doses a day...

[mjames1]

Flecainide can be a very effective anti-arrythmic. Unclear if they will be using it in conjunction with another cardioversion, daily, or as a single dose either IV or by mouth.

In my case, daily Flecainide pretty much kept me out of afib for about a year until I decided to have an ablation.

You mention "persistent afib" but based on what you said, hard to say if that will make any difference in outcome. As a general rule, if you have been in afib continually for over a year (long term persistent) than your chances of a successful outcome drop some.

Jim

[Halfheart]

The probability of flecainide working drops away markedly after a week of afib. Nothing to lose by trying though.