frequency of ekg when on Flecainide

[yzmd]

How often should a ekg be taken when on Flecainide and what affect does Flecainide have on the ekg?

[mjames1]

My ep's protocol was an ekg along with an exercise stress test to qualify for Flecainide. Than an ekg one week after starting flecainde. Then an ekg one week after any dose increase and/or if I start feeling unwell. I should add I'm in the US.

I've also read that an ekg under exercise is also advisable periodically although I was not offered that until I asked after my ep reviewed my Kardia strip showing a prolonged QT interval and block.

Jim

[healingharpist in reply to mjames1]

I'm in the US, also (Ky). I assume those of you speaking of QT prolongation are on Flecainide daily? Does this effect seem to occur with PIP? I am only on flec PIP, 150 mg per episode, every few weeks or so. I had an ECG before starting flec 3 yrs ago, but no treadmill test, and no testing after being on it for awhile. I get no noticeable side effects from flec (except numbness in feet/legs, which a neuro dr. says is from flec, but 2 cardiologists disagree), and I do get an ECG occasionally... but now wondering if I should have had a physical stress test at some point. Any thoughts?

[mjames1 in reply to healingharpist]

QT prolongation is common with Flecainide and does not necessarily mean you should stop taking it. I was on daily Flecainide when it was picked up, but suppose it could also happen PIP.

Different doctors in the US have different monitoring for Flecainide. On one hand, you do not want to take an unnecessary tests because of false positives, but on the other hand you want to be safe.

Maybe your doctor based on your age, history and echo's, did not feel an exercise stress cardiogram was necessary. With my EP, it's part of the protocol. Again, EP here differ.

Jim

[healingharpist in reply to mjames1]

Thanks for your thoughts, Jim. I keep in touch w/ 2 cardiologists (1 is an EP) and they see my ECG's & echo's, & never a mention of QT... one even suggested "you cd always go to daily flec" which I don't want right now. "Sufficient unto the day..." and all that . So, I won't poke the hornet's nest. Cheers and NSR, Diane

[mjames1 in reply to healingharpist]

Yes, we don't want to "poke the hornet's nest" too much, especially as we get older. Invariably, they will find (like a high mileage car) that we need more than an oil change and the tests often are borderline, which may lead to more testing, stress and often over treatment.

Jim

[BobD Volunteer]

I am not aware of regular ECG testing for patients on flecainide here in UK after the initial starting protocol.

[mjames1 in reply to BobD]

Maybe not with your doctors, but please see "Finvola's" response below. Also, other UK members have reported ekg monitoring on Flecainide.

Also see this from Royal Brompton/NHS

"Once you start taking flecainide you will need to have regular ECGs. Flecainide slows the conduction in the heart and this change will be shown on your ECG. But we will want to make sure that the conduction has not slowed down too much. You will normally have an ECG about one week after starting flecainide and then after each increase in dosage. "

Very similar to my protocol in the United States.

rbht.nhs.uk/our-services/at...

Jim

[Finvola]

My cardiologist orders an ECG every six months, examines it and reports back to me. I've been taking Flecainide for nearly 10 years.

In my case, Flecainide has prolonged my QT interval, so I imagine that is what is being monitored - so far, so safe.

[CDreamer in reply to Finvola]

Prolonged mine as well. I used to 6 monthly and I also sent Karelia traces but that was private consults.

[secondtry]

I am on 200mgs Flec & request an ECG annually which my doctor allows on the NHS. I then keep a copy and show it to my cardiologist in my annual private check-up in case of issues as mentioned above.

[StuJ019]

I was taken off Flecanide in June as QT s were too long , was kept in hospital for ten days until they settled. My Bisoprolol dose was increased. My AF episodes have increased compared to when I was on Flecanide but not as bad as I expected as my cardiologist had told me on a previous appointment that it was only the Flecanide that was keeping my AF at bay.

[Finvola in reply to StuJ019]

It's good that it was caught Stu but a pain that you had to give up Flecainide. I think that my path may be similar in the future - the far, far future hopefully. Best wishes in coping with your episodes and yours is an example as to why monitoring with ECG is essential for the use of Flecainide.

[StuJ019 in reply to Finvola]

Thanks , I was admit to hospital with a stomach issue and that’s when it was discovered by ecg, the surgeon called the cardiologist in straight away who was very thorough and explained why he had to stop the Flecanide immediately and was very understanding about my reluctance to come off Flecanide but I realised I had no choice. So yes definitely should be monitored.

[mjames1 in reply to StuJ019]

Did an EP take you off of the Flec, or just a regular Cardiologist or GP?

For convenience sake, I had my Flec monitoring ekg taken at a facility where it was read by a GP. He wanted to put me in ambulsnce snd send me to the ER/A&E

I realized he wasn't qualified and emailed the ekg to my ep. He said it was within normal limits and I should continue taking my current dose of Flecainide.

So if it wasn't an EP that took you off of Flec, I would have an EP reevaluate.

Jim

[Tommyboy21 in reply to mjames1]

Every time I get my ECG taken the person taking it gets flustered. I have to tell him it's always abnormal even in nsr. But they always send it to cardiology who always say it's safe. Better to be safe than sorry I suppose.

[mjames1 in reply to Tommyboy21]

GP's really can't read ekg's and rely on the machine's AI analysis. A good ep doesn't even look at the machine's AI because they know how to read an ekg better. One day that may be reversed, but not yet.

Jim

[SuziElley]

Been on it two years and the only ECG I’ve had was before surgery for another matter entirely……

[Palpman]

My cardiologist told me that I should only start worrying if my QTc increased to over 500ms. Taking Flecainide alone at 200mg pd is normally not enough to lengthen it to over 500ms unless you had inherited longer QT.

If you take Flecainide together with another drug such as anti anxiety or anti depressants could also lengthen QT.

Mine increased to 479ms before I stopped my Sertraline and it slowly returned to 425.

Now I check it on my Kardia on a regular basis.

[Autumn_Leaves in reply to Palpman]

Thanks for your informative post. I am about to give Flecanide a try to help with my increased frequency of AF episodes post-Covid. I have a Kardia. Did you have to learn how to calculate the QTc? I don’t think the app can do that for the user (unless I am blissfully ignorant). Is there a good learning resource online that you know of?

[Palpman in reply to Autumn_Leaves]

I measure the distance on the Kardia and as my heart rate is about 60 it does not need calculations. One small block is 40ms.

If your heart rate is outside the 60 range by 5 you must calculate QTc using the QTC app from Playstore.

[bean_counter27]

In Australia.. had a battery of tests and scans before starting Metoprolol and Flecainide, including at least one to ensure I hadn't previously had a heart attack.

Since then I've only had ECG when I visit cardiologist (now only annual events) or prior to surgery (requested by anaesthetist). I think that included when Flecainide dose was increased to 100mg BD (starting dose 50mg BD) but not when I went to 150mg BD. I was instructed to go to 150mg if still having episodes on 100mg BD, so went on increased dose without seeing cardiologist beforehand.

I have a Kardia 6L (great device), Withings Scanwatch (does ecg and advises whether AFIB detected) and recently bought a Wellue ECG Recorder with AI Analysis. Only early days with the Wellue but the reports it produces are pretty impressive - but yet to share with cardiologist and find out his thoughts. I plan to use it to see whether I am having AFIB events that would otherwise go undetected e.g. while sleeping or asymptomatic (can wear for 24 hours). Does anyone else have one of these and if so, thoughts and any feedback from your doctor(s)?