AF medication

[Jimbobarelli]

so I had AF episodes every 3/4 months that increased to every 6 weeks which were stopped with PIP 200mg of flecainide . In July the doc put me on a 2x50mg a day as well . He doesn’t think I need blood thinners so just an aspirin with it. Within a couple of months the episodes came ever 10 days .ive just gone 18 days between episodes . I’m just wondering what experiences others have. Did the additional daily dose increase the frequency ? Or is it just the inevitable deterioration in the AF mean that will happen ? I’m hoping others will say “ yes it settles down and they stop completely “…. And I have some hope to cling on to …☹️

[BobD Volunteer]

AF is almost always a progressive condition so sorry but it is unlikely to settle down. On the aspirin front I also beleive it can cause more harm than good and that you really need to do a proper CHADS2Vasc2 assessment regarding proper anticoagulation.

[Jimbobarelli in reply to BobD]

I have . I’m a 1.

[BobD Volunteer in reply to Jimbobarelli]

Fine, good but aspririn has no place in stroke prevention with AF whilst having the potential to cause harm (GI bleeds) .

[CDreamer in reply to Jimbobarelli]

Asprin is an anti platelet and good after the fact, of little or no use as a prophylactic. Be really careful as daily asprin can cause ulcers which result in bleeds. If you insist on taking then ensure it has a coating to protect your stomach lining.

When you say ‘the doc’ - what sort of doctor? GP, general cardiologist or Arrythmia specialist? The

[Jimbobarelli in reply to CDreamer]

he is a Consultant Cardiologist at a Cardiothoracic Centre and honorary Senior Lecturer at a School of Medicine.

[CDreamer in reply to Jimbobarelli]

That surprises me.

[Autumn_Leaves]

It’s really hard to say how or why AF progresses (or doesn’t). Some people on this forum have very well controlled AF with medication alone and some report only very rare episodes, but that isn’t necessarily everyone’s experience. You need to discuss your treatment options with a cardiologist, preferably a specialist in arrhythmias, and find a way of managing your AF that you can live with. Sorry, it’s not much of an answer. Please remember it’s not your fault, it’s not because you’re not doing things “right”.

[CDreamer]

To answer your original question - no my AF did not ‘settle down’, it became progressive with episodes becoming more frequent and more symptomatic. 50mg is the lowest dose - I was prescribed 100mg x 2 daily of Flecainide with an additional 100mg when episode came. This regime sort of held AF back for about 12months then became useless, 2 ablations gave me 3 years AF free, AF returned, now controlled by pacemaker.

Be aware that any substance which cures can cause so Flecainide can also cause arrythmias.

Everyone’s AF journey is different, some more straightforward than others.

Have you considered ablation? I would have thought that’s going to be your best option before AF becomes established. Did your consultant discuss various treatment options with you?

I was also wondering why thoracic cardiology centre rather than an arrythmia centre? Have you other heart issues?

[Jimbobarelli in reply to CDreamer]

. I am very fit . Have played sport , boxed , rowed , cycled all my life . Diet is ok ish but all my bloods, cholesterols are very good . Resting pulse low 40s .

My echogram done when I first had the episodes showed “…. patient who has had three episodes of atrial fibrillation has now had an echocardiogram performed. This showed good left ventricular systolic function. The aortic valve was satisfactory and there was mild mitral regurgitation. There was some enlargement of the left atrium. In conclusion, the echo is satisfactory, and he has good LV function.”

Are we saying a cardiothoracic specialist isn’t going to be too hot on AF treatment ?

[CDreamer in reply to Jimbobarelli]

Are we saying a cardiothoracic specialist isn’t going to be too hot on AF treatment ?

Pretty much.

Arrythmia specialists are Electrophysiologists or EP. They are qualified consultant cardiologists with extra training.

There are various specialities in cardiology for CVD - vascular systems, structure - muscle, valves etc, imaging - angiograms & imaging for ablations etc and arrythmias - electrics. A very few thoracic surgeons do mini-maze hybrid ablations for those in persistent AF, as far as I know only in Sheffield & 1 hospital in London.

Papworth offer Pulse Field Ablations. Other good source of info for AF is BartsAf.com good blog on ablations by one of their EPs.

Sounds as though you would be an ideal candidate for ablation - fit, fairly young, no other cardiac issues.

Go to the AFA and read all you can on treatment options. There was a Coffee morning this morning for Q&A by top EP on ablation and who may benefit, plenty of information & videos on the site.