Flecainide vs. propafenone

[alfrae13]

I have paroxysmal afib that comes on every few days. I am on propanolol ER and when it occurs I take flecainide 100mg PIP. It stops after a few hours. But lately flec has not been too effective. My cardiologist wants me to switch the propafenone 225mg. as PIP. Has anyone had any experience with this? Also is anyone using propafenone as maintenance?

[mjames1]

If I understand things correctly, you're not on any maintenance (daily) anti-arrhythmic, and only use Flecainide as a PIP, but it has stopped working as before.

Given the fact that your afib episodes are now every few days, even if switching to PIP Propafenone worked, that's a lot of PIP conversions per week. Personally, I would not want that many episodes a week.

It would then seem that you would be better off on a daily anti-arrhythmic, be it Flecainide or Propafenone with a PIP dose when and if needed and hopefully far less frequently than every few days. When I was on daily Flecainide, I only need my PIP dose every six months or so.

I would also think it makes more sense to start with daily Flecainide since you already tolerate it and then only switch to daily Propafenone if the daily Flecainde doesn't work, as Flecainide is the tried and true standard. But maybe your ep has their reasons.

Jim

[alfrae13 in reply to mjames1]

I was on flecainide 50x2 Did nothing. But when I went to 75x2 I started feeling aweful and shaky. I don't think I am tolerant to flecainide as maintenance. What I am doing may not be text book but it seems to work even if inconvenient

[Corazon17 in reply to alfrae13]

Can you clarify? Are you staying with 75x2, despite feeling awful and shaky? And is 75x2 working? How is it working; are episodes fewer and/or shorter than with 50x2?

[alfrae13 in reply to Corazon17]

no I stopped and went back to PIP

[BobD Volunteer]

Firstly drugs like flecainide do not "stop working". There are no receptors in your body in the way there are for narcotics. What has happened is that your AF has developed, your atrium has re-modelled and PIP is no longer a suitable treatment. Switching from one PIP anti arrhythmic drug to another is a waste of effort in my view.

That said propafaone as a daily maintenance drug for me did delay the need for ablation but that drug also failed to control my AF adequately after a relatively short period of time. When I got to 3 x 300mg daily it was time for more ablation. Thankfully after my third in 2008 my AF was terminated and I no longer need antiarrhythmic drugs of any kind.

[Corazon17 in reply to BobD]

So for you did propafenone adequately control your AF for a while?

And then did you need to increase the dosage in order to continue getting adequate control?

If so, can you tell us how many stages you went through to get to 3x300 and how long it took?

I am now on day 3 of 2x50 flecainide -- six doses so far. I had a 10-hour episode of AF during this time. At points the HR was low for me (in the 80s). Maybe the flec is working a bit? Is flec expected to take a while to kick in?

My cardiologist (actually, his PA) seemed to believe that the flec would have a quick effect, even to the point of halving my beta blocker.

She told me to come back in six months.

She did not suggest a supplemental PIP flec in the event I had an episode in between the a.m. and p.m. doses. (I gather that some people here do take PIP flecs even as they take daily flecs.)

[BobD Volunteer in reply to Corazon17]

Most important that you understand that 300mg in any 24 hour period is the absolute maximum you can take . Any more is poison.

Propafanone is a completely different drug with different dosage regimes and we are all individuals so my experiences are not releevant to you but no, only ablations (three over a three year period) fully sorted my AF.

[Corazon17 in reply to BobD]

Thank you for another courteous reply!

Yes, I do understand that we are all different. I would not take action on my own based on someone else's results. But I *would* be more hopeful that something else will work better for me if that something else worked better for someone else.

You say that your AF was terminated in 2008, and that you no longer take antiarrythmic drugs. Do you take anything at all for AF? If it is terminated, why are you here? Don't get me wrong -- I want you here, but am curious. Maybe I don't understand. Do you still take rate-control and anticoagulant drugs to stave off afib that would otherwise occur?

[BobD Volunteer in reply to Corazon17]

I'm here because I care. Twenty years ago when my journey started there was nothing "on line" or anywhere for that matter about AF. I was scared and felt abandoned. Luckily when I moved house in 2004 my new GP's mother had AF so she actualy knew what it was and was able to direct me to people who understood even though it meant lots of travelling to London from my home here in Devon as there were so few EP centres back then.

When the hospital asked me if I would help them set up a patient support group I jumped in with both feet as I felt so strongly about making sure others never felt as I did. That led to me spending some time with BHF working on the original arhythmia nurse project and through that I met a huge number of top people in the field so when AF Association was formed in 2007 I volunteered and I'm still here.

I may not have AF but various othercardiac issues followed and I now have a pacemaker and other problems. I take no meds for arrhythmia but I do take warfarin (for life) .

[Corazon17 in reply to BobD]

Thank you. I must get in the habit of checking bios before I ask people to use their valuable time to answer questions that might already be answered in those bios.

What a fine group this is. The people are so damned articulate and generous with their time. I suppose that's on account of age and the better education in the U.K. It is truly a pleasure to read the prose here.

[NewOne2023]

When I got diagnosed in Oct'23, they've put me on daily bisoprolol and propafenone as a PiP. But I got so much short episodes that in the end I was on regular propafenone daily, and in the course of few months (Oct'23 - March'24) my intake was ranging from 2×150mg daily to 4×150mg daily. For the first month after starting meds daily I had no episodes but after one month I got another short episodes of afib (like few minutes) and at that point my EP told me it's a good time to go ahead with the ablation, the sooner the better. Strangley, after that visit with EP in December'23 I didn't have any episodes so far. Nevertheless, I did cryoablation in March'24, but since I didn't experience afib since Dec'23 I couldn't tell the difference after ablation. But since thw propafenone didn't kept me off afib 100%, I decided to listen to my EP and go with ablation. The good thing is that now I'm off all meds including apixaban. I'm 41.

[secondtry]

Suggest you get approval from your cardiologist to go 200mgs Flecainide daily; that is a medium dose of a relatively tried & tested heart drug.

I moved from 100 to 200mgs Flec daily when I was getting 2 episodes a week (Lone PAF) and it stopped mine for 10years with improved lifestyle choices.

[alfrae13 in reply to secondtry]

I don't tolerate flecainide as maintenance

[Corazon17 in reply to secondtry]

200 mg stopped your AF for 10 years?

Does this mean that you're still taking 200 Flec a day?

[secondtry in reply to Corazon17]

Yes. In my 11th year a mix of arrhythmias started, which may or may not be down to the Flec.

[Vonnegut]

We know that we are all different but Flecainide taken daily has put an end to episodes of AF for me and I have recently reduced the first dose to 50mg with 100mg taken at night.

[frazeej]

On propafenone maintenance (225mg, 3X a day) for ~3 years. Attacks were 2-3 times a week, some as long as >24 hours. Currently maybe one/3 months, lasting 5-20 minutes. No side effects apparent. Guess you could say I’m pretty happy!

JimF

[Corazon17 in reply to frazeej]

Do you take a heart-rate drug, too?

With that earlier burden, was it ever suggested that you have an ablation?

[frazeej in reply to Corazon17]

For rate control I take Metoprolol. Previously I took atenolol, but they switched me. I was happier (better rate control) with atenolol, but not enough to make an issue of it. I asked about ablation, my cardioguy said not recommended at this time. I agree totally.

[alfrae13 in reply to Corazon17]

I am 95 years old so ablation is not a good option

[Corazon17 in reply to alfrae13]

Yup, being 95 would be a factor, methinks.

I'm 77, and my "doctor" (a P.A.) says that I'm a "perfect candidate" (her words), thanks to an echo that was not terrible.

Perversely, perhaps, I had half-hoped to hear that I can't have ablation, because, in general, I am not a big fan of complexity and choice. My procedure would require long overnight travel, soon to be during winter (possible road closures over mountains).

[Cookie24]

I take Propafenone 425 XR mg. Flecainide did not suit me.

[ijregner]

I was on propafenone for some time and it was not successful but it could be perfect for you.