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.
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...
Pressure like sensation coming and going in my chest each and every day, hard to put it into words the sensation. My breathing was affected laying down especially for some reason during the day. When I would get up I felt as if I had been drugged as if I was wiped out. During the day I felt very low energy. I felt flat out terrible all the time.
There's nothing necessarily "bad" about a wide QRS, as many people over 60 increasingly have that (I gather). In most people, if the online articles and my GP are to be believed, it is of no consequence. It indicates a degree of heart block of some kind - usually a right- or left-bundle branch block. I have LBBB. I was given flecainide and was told it was safe but, like you, I didn't feel "right" and stopped taking it after speaking with my GP. The risk with this drug is the widening of the QRS can lead to other issue, including ventricular arrhythmias, but the risks are very low indeed (at least I have read that).
That all said, I am leaving it off until I next meet with the specialist.
My concern is that (a) the QRS has become wider in the week I have been using flecainide, and (b) the cardio person told me that she wanted an EKG at the end of that week to see if the QRS was wider.
Stupidly, I suppose, I did not ask what the size of a bad increase might be. Mine was 98 to 116.
Also stupidly, I suppose, I thought that within almost 2 business days, the EKG would be faxed to her, that she would look at it, and that she would get back to me. I followed up on the morning after the EKG and was treated in condescending fashion by a lower staffer.
She wanted a 12-lead EKG, so I had to go to a *real* doctor place. I went to my usual GP. I should have driven the 200-mile round trip to the cardio place, and had the decision (if any) conveyed immediately.
I could not transmit my own Kardia or Wellue tracings -- even though a Wellue recording can cover 24 hours, second by second.
I am too trusting and too lazy, I guess.
As for bundle-branch blocks, it's been said for at least 15 years that I have RBBB. I've been told, in effect, that it's not to be worried about. I'm now becoming more interested in this.
Because my heart rate has gone down a lot, and because she said she might cut my metoprolol from 25x2 to 25x1 (at night only), based on having bradycardia (which *has* been found a few times), I have cut my metoprolol to 25x1 (at night only).
I'm guessing that a few days of inappropriate flecainide won't matter, and clearly, it is having an effect that seems salubrious on the surface.
I might make the long drive and pop in.
And I guess I should be talking to an EP. This cardio group has three of them.
My cardiologist/EP is very highly regarded and told me that despite my LBBB I would be fine with flecainide. And yet, I find this on Google AI
“Flecainide Contraindications
Flecainide is contraindicated in patients with left bundle branch block…”.
In RBBB, which you seem to have, I gather it depends on the exact nature of the heart block. That’s probably true for me, too. But I have been frightened off it. The specialist assured me when I asked that it was safe fir me to take following my cardiac MRI, but I remain cautious and concerned.
Thank you. I hope to get some info tomorrow when regular business resumes.
Do you happen to know what the typical dosage is for "PIP flecainide"?
The cardio person wrote in her notes, "He wanted to discuss flecainide pill in the pocket. This would require emergency room monitoring for his first dose and since his atrial fibrillation is paroxysmal he would most likely benefit from daily dosing."
So my cardio person would not support me taking PIP flecainide, but did support 50x2. Therefore, I'm guessing that PIP doses are rather large.
+++++
I quickly got some answers to my questions. In a 2003 article, I read that 300 mg was a PIP dose administered in a hospital, after extensive analysis of other conditions, and with 12 hours of monitoring before approving the PIP approach outside the hospital. I would barely qualify for PIP, it seems. Unwelcome side effects were not terribly frequent, but frequent enough to be of concern.
I'm sure there are later studies, but for now, I guess I'm OK with PIP being declined. Maybe it will be reconsidered, based on my reaction to the maintenance dose.
I don’t think there is a dosage recommendation for PIP. I was prescribed 50mg x 2 daily - not as PIP. I took just one and had a day completely free from all arrhythmia (I usually get lots of atrial ectopics daily). But… I did get some heavy beats and my Apple ECG showed my LBBB seemed worse. It worried me. My GP told me to stop taking it and to email my EP. He phoned to confirm all was well but after the call I got cold feet again.
Since then, my GP has said that taking it as PIP might be worth trying, but, again, at 50mg.
The reason I am reluctant is partly that day’s feelings, partly the things I’ve read, and also because my AF, although getting more frequent, is not overly troublesome in its effect. My rate often peaks at around 130, although if I exercise at all, it becomes uncomfortably high.
I’m waiting an ablation - but I’m not even sure about that given that I am dealing well enough with my AF. That said, my daily ectopic beats are harder to put up with than the fortnightly AF.
What a palaver! It’s so difficult to manage one condition when the treatment can worsen another condition. I hope the ablation brings about significant improvement for all aspects of your arrhythmias. I seem to get a fast PR segment, but there’s no indication of WPW and I seem to be in NSR, no tachycardia. So no idea whether it’s an artefact or not.
I do like that word, "palaver". It was one of my dad's favourites! My dictionary says it entered English via Portuguese from West Africa meaning, "negotiating with the natives".
I am hopeful for the ablation doing something wonderful - although, as I say, I sometimes question whether it's worthwhile at all.
I wonder what can cause that fast PR interval of yours, then? Probably, as so much heart related, you will never know and it will come to nothing.
The ablation might improve things a lot, but as we know from reading other peoples’ experiences, results can vary in effectiveness. I’ve tried looking up the short PR segment but there is a “normal variation” explanation too, so I’m none the wiser. It doesn’t seem to be the LBBB or RBBB pattern, which I suppose is a good thing.
Hi - I have this and my ECG’s QRS segment often looks much like yours but varies a great deal. What the ECG shows is actually showing, I gather, is two peaks overlaid on top of each other, one for each ventricle, with, in our case, the right ventricle contracting first. That’s why there’s sometimes a dip at the top.
I also have the symptoms you describe. Unlike you, however, after a cardiac MRI, I was prescribed 50mg flecainide and assured the MRI showed it was safe for me. No explanation was given why and I decided not to take it after one dose which, although it gave me a day free of AF or palpitations, dud create some oddly heavy feeling beats that were broad on my Apple ECG.
I asked my specialist to confirm to my GP that it was safe, but I heard no more.
I have since read that it’s only certain types of bundle blocks for which flecainide is contraindicated but I am not sure.
Did your specialist say anything to you specifically about your not being able to take it? I’ve just been left worried and confused.
I hope the angiogram goes okay. I would have thought all would be well give the other scans you’ve had over time, but it’s best to be sure. I’ve never heard of “sodium channel” disease.
I can only guess our two conditions are different but with the same end result of LBBB. That said, Google's AI comes up with flecainide being contraindicated for anyone with LBBB, against my specialist's comments. I have read that the QT interval in some people is wider and that precludes most anti arrhythmic drugs, also. Could that be the difference that matters? I just don't know.
I ought to email the doctor again to ask for clarification, but as he seems to have ignored the last, when I asked him to confirm to my GP the safety of flecainide, I have been reluctant to do so. This is partly also because I cope better with my AF following the reassurance the last MRI scan gave me.
I am on a waiting list for ablation for the AF and the ectopics. Of course, the LBBB can only be helped, if needed, with a resynchronising PM, but he said I didn't need that. He did say one option was P&A, but I didn't all this was over the phone and I struggle to get my points over in phone consultations. I am thinking of paying for another private appointment.
Thanks for the reply, Anne. It was well considered and helpful. I have seen the specialist privately until this year, but then he put me on his NHS list for the ablation and MRI. I think I'll email him again and ask whether a private appointment would be best. He's a nice chap who knows me well enough.
He tends to ignore my LBBB more than the ectopics, into which he seems to bundle the AF as part and parcel of the same thing.
I have looked elsewhere on the HU site for LBBB but elsewhere it tends to be where heart conditions are the focus and the phrase "heart failure" crops up too often for comfort! I have been assured I don't have that, but it's an ever present fear.
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