I am a 70 year old active fit Canadian male who was diagnosed with lone paroxysmal atrial fibrillation about five years ago. After my initial diagnosis by a cardiologist I was prescribed flecainide, apixaban, and rosuvastatin. The flecainide has kept me free from afib symptoms for more than four years and enabled me to engage in moderately vigorous exercise (mostly in my single scull in the spring, summer and fall, replaced by an indoor rowing ergometer during our long Canadian winter). Recently, since moving from Winnipeg to Toronto, my new cardiologist has prescribed various tests, including a transthoracic echocardiogram (which showed normal results) and, in two days time, an exercise sestamibi test. I am interested in other people's experience with the exercise sestimibi test and seek insights as to why my cardiologist might have prescribed it. My cardiologist is very thorough, but not the best communicator. When I asked him why he thought I needed the exercise sestamibi test he said "to go down the rabbit hole". From research I am fairly sure my AF is due to a lifetime of (over)training in rowing and sculling and thus, likely, an "electrical" vs "plumbing" issue. When moving to Toronto a year ago I had asked my new family doctor to referred me to an Electrophysiologist so that I could get evaluated on whether I'm a suitable candidate for an ablation. However, the protocol here seems to be to first refer new patients to a cardiologist to undergo extensive tests, presumably to rule out any "plumbing" issues. Any insights from people on this forum would be greatly appreciated!
Exercise Sestamibi test: I am a 70 year... - Atrial Fibrillati...
Exercise Sestamibi test
Not sure I would want to undergo such testing unless I had chapter and verse as to its purpose and not just ‘to go down the rabbit hole’, especially if all other tests weren’t showing up anything and you are asymptomatic and you are reasonably sure that AF is triggered by over exercise - sounds reasonable.
I could understand it if ablation or surgery were suggested or in the pipeline?
I’ll be interested in any replies from anyone who has had this test as I am unfamiliar with it, ECG stress test maybe, angiogram prior to ablation or other surgery is not unusual but not heard of that one for AF.
Here's my summary of the information provided to me about the sestamibi test. The test is "extremely safe" (1:10,000 risk of coronary complication) and designed as part of a regular check up, apparently for blocked arteries, but also to assess suitability for surgery. It consists of two parts. The first involves the intravenous injection of a radioactive tracer (Sestamibi) and then a 20-minute imaging of the heart using a gamma camera. During this time I will lie still in a stationary position. The second part involves an exercise test (usually on a treadmill) during which the radioactive tracer is injected; following this is a 15 minute imaging of the heart with the gamma camera; during this time I lie still in a stationary position.
I'll report back after the procedure to let folks know how it goes!
A slight aside, I’d be interested to know if you think the flecainide has had any impact on your exercise regime?
It has lowered my age-adjusted heartrate (I'm 70) from 150 to around 130. No matter how hard I push, since beginning flecainide my heart will not go much above 130. That being said, I can go for hours at 60-80% of my "flec-adjusted" heartrate. That being said, Phil Maffetone's training method suits me well. Despite such limitations, I'm tremendously grateful that I can continue exercising vigorously for long distances (20-40 km) at a steady state rate in my single scull.
Had to resort to google to understand this as not come across the term here in UK.
Basically it sounds like a normal angiogram crossed with an exercise stress test and whilst I have had both (several times) at different times I have never had both together. That said it is important to understand the blood flow around the heart muscle under working conditions as this can dictate what treatmant may be appropriate. For example Flecainide is contra indicated if there are any structural or as you say plumbing issues. Sounds like your cardiologist is being thorough.
I think that the tracer is injected into an artery in my arm, but otherwise yes, it seems like an angiogram. I had a similar test called a "thalium stress test" in conjunction with an echocardiogram about 35 years ago. At the time my overly-conscientious family doctor referred me for the stress test It involved a radioactive tracer, a treadmill and a heart scan. By way of background, I had trained intensively in competitive rowing and sculling for nearly two decades and was on our national rowing team in 1980. While I never received the results of the stress test (presumably part of the "no news is good news" practice of medicine), I did have a conversation the technician administering the echocardiogram. When I told her about my background in high-performance sport and asked whether she saw anything unusual about my heart she responded by saying that the heart is a muscle, and like any muscle it grows larger and is strengthened by intense exercise. From this I assumed that my family doctor all those years ago (I have a different one now) had confused athlete's heart with cardiomyopathy. Since that time I have continued to scull, though I no longer race. The reason I joined Health Unlocked is that 4-5 years ago I developed lone paroxysmal atrial fibrillation (likely a result of all my cardio training). Hopefully my cardiologist has not fallen into the same pitfall as my previous family doctor all those years ago!
Hi . After my Atrial Fibrillation procedure I was prescribed Bisopropol which made me light headed and very fatigued . I told my Doctor who put me on FLECAINIDE. One taken before sleep at night and one on waking in the morning ( 8 -10 hours gap ) I’ve had no problems taking these. After an about a month my Atrial Fibrillation % went from 50% regularly to 2% regularly and occasionally 5%. As you can see a dramatic change which has worked well. Good luck and be patient as it took a number of weeks to take affect.
My experience with Bisoprolol and Flecainide mirrors yours. For me Flecainide had left me symptom free for about four years and enabled me to return to an active and vigorous life.
Out here in BC I'm lucky to see my cardiologist once every 6 months. He has been reluctant to prescribe any meds other than apixaban. I have no knowledge of the tests you mention. I've had two conversions in four years.
I don't expect any more from socialized healthcare...
Not sure what has triggered my attacks. 83 yo non-jock here but walk about 40 miles a month... Good luck.
Monitoring patients on Flecainide
Does Flecainide Work for Persistent Afib
Exercise or not 
Cardi version and not Flecainide ?
