For my PAF, I was prescribed flecainide 50 x 2, to be taken with Metoprolol 25 x 2.
This follows 5 months of the Meto having a dramatic effect on pulse rate, but little effect on PAF episodes.
The prescribing person referred to an echocardiogram and to lab tests. She declined to recommend pill-in-pocket. She did not think I needed immediate monitoring.
I was told to have an EKG a week later. The EKG was to look for a change in my QRS duration.
I was told to come back in four months: no mention that I should follow up on the EKG, and no recollection that she told me that she would follow up. (Maybe these things are assumed?)
From my reading of the EKG, it looks like my QRSd is now 119, up from 98 the week before and up from 100 about 30 days before.
During the week on flecainide, I have definitely felt different, and not pleasantly. Over 120 hours, according to my Wellue 24-hour monitor, my heart rate has averages in the 50s, with some very brief mid 40s.
That gives me a bit of confidence of not going into afib, but I read that QRSd over 120 are bad.
It's Friday now on the west coast of the U.S., and I doubt that I will hear back from the cardio place.
Has anyone had their flecainide/Eliquis dosages revised based on their QRSd readings?
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Corazon17
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It's not unusual for your QRS to be widened from Flecainide. Whether you should stop, reduce dose, or continue on current dose is really up to your EP's judgment.
When I got a wide QRS determination on my Kardia, my ep told me to reduce dose and come in for an exercise stress test.
A QRS of 119 is normal and I doubt if they would be concerned even if it was was 130 or a bit higher, given you're on Flecainide. Of course I'm not a doctor, so listen to your EP on this.
Of course I will listen to my EP on this. Actually, I don't have an official EP yet. The physician's assistant -- who prescribed the flecainide and told me to come back in a few months --said that I could get an EP. And I will.
My main question is more "meta," if you will. How much am I supposed to initiate follow-ups and contact? This cannot be answered here, I suppose, except, perhaps, by people telling me to relax or to get on their case. I'm in the U.S., so that makes a difference, I suppose.
It's my fault to the extent that I did not ask what sort of QRS result would be good or alarming. Internet research suggests that I'm in alarming territory, but maybe that would be for wide QRS *not* caused by drugs. Which I think you are suggesting.
I'm also from the US and FWIW I just looked up my QRS duration when I was on Flecainide and it was 144 and there was no talk of taking me off of it. So I guess the numbers you looked up were off any drugs.
What happened was I was exercising on my treadmill and not feeling great so I took an EKG with my Kardia which showed wide QRS.
I emailed it to to my ep who said it also showed a block of some sort, which I think is why he told me to cut back on my Flec dose and come in for an exercise ekg if I wanted to remain on the higher dose.
I ended up not taking the stress test but just cut back my flec from 100 2x/day to 50 2x/day.
I was on daily and PIP Flecainde for about a year and it worked well as I only had to use the PIP dose a couple of times.
That said I didn't want to stay on it for life. I was also in my 70's and my health was otherwise good and didn't want to take a chance on getting the ablation in my 80's where my health status could be different. If I was younger, I may have stayed on the Flec longer but looking back, I'm glad I had the ablation regardless of age.
The ablation was a success, and I only had a single afib episode in a year and a half, but I still carry some Flec pocket just in case.
Did the Kardia inform you directly of your wide QRS, or was that seen by the EP?
Was it the six-lead reading (with thumbs and knee)?
I had one of those (out of hundreds of measurements in the last five months), with 65 BPM.
I don't recall feeling unusual, but may have, given that I took a reading. About 24 hours before, I had finished 11 hours of A-fib.
Interesting point about getting the ablation in your comparative youth. I'm 77 and maybe should get 'er done, too. My cardio person thinks I'm a perfect candidate, and apparently there would not be a problem for me to have one. It would be in Eugene, Oregon, at what seems to be a fine place for that -- huge place, like a factory, with a couple dozen doctor types in the heart realm.
Yes, the Kardia give me the "wide qrs" notification as I'm enrolled in Advanced Determinations for a monthly fee.
While I have the 6L, I only used my fingers for a single-lead reading. In any event, Kardia only uses lead one for their determinations.
I can't remember if I repeated it using six leads. (fingers and knee). It was the first Wide QRS reading I ever had. In the following two years I might've had one more, also when on Flecainide.
They used the term "perfect candidate" for me as well because I was paroxysmal, otherwise healthy and normal bmi.
Good luck if you go ahead with the ablation in Eugene. Just make sure it's a high volume center, which is key. If not, I would travel to one. High volume means your ep should be doing. a minimum of 200-300 ablations a year.
While the results are not dramatically different, the trend now is toward pulse field ablation (PFA) and if I was getting an ablation now that's what I would be looking for. a shorter procedure with a slightly better safety profile. Also less operator dependent.
I have a wide QRS as I have a left bundle branch block. For obvious reasons I am unable to take flecainide.
My comment though is on the width - mine is very wide and I’m ok. This is a snap shot and depending on where you believe the end of the P wave is and the commencement of the Q, mine is anywhere in excess of 160. I feel breathless but not where I struggle to breathe. I’m very much alive and living with it though.
Before my ablation I was put on flecainide in which brought on terrible side effects for me. If you"re interested in knowing more on flecainide you can go to cleavelandclinic.org to start.. Blessings...
In the EKG I saw a bigger number for the QRS duration. I was told by the cardiologist P.A. that a bigger number could mean the drug should be discontinued. Now I am trying to find out if my bigger number is big enough.
But so far I have been unable to get in touch with her, despite 1.5 business days of the EKG result being known, and my conversation with an assistant of hers. Now it's the weekend, when no one expects to hear from anyone, at least in the U.S.
Side effects apparent to me are a lower heart rate that has very fewer "bumps" to a higher heart rate. Sometimes in the 40s; average over many hours in the mid 50s. I feel less energetic and a bit faint. After the third day on flec, no AF episodes. But my episodes have been about 1 in 8 days over the last 5 months, so this absence of episode is not new.
I have read -- and this P.A. told me -- that flecainide can be quite bad, even to the extent that is often started on people over a day or two in hospital. On the other hand, my dosage seems to be tiny compared to what people come to.
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