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.

[Nodoubt2 in reply to Jimbobarelli]

Hi there

I personally found that flecainide made my AF far more frequent. I was on 2x50mg daily and after 3 months on it I took myself off it - against my cardiologist advice I would add.

Whilst I was in flecainide i was having AFib almost every other day, but short attacks, maybe only a couple of hours long. But symptomatic so very annoying.

I stopped the flec Nov 4 th last year. Since then I have only had the following AF

One attack late December whilst I had Covid

One attack in April lasted a few hours reverted with 200mg of flec

4 attacks over 5 weeks in June* - 2 reverted on their own during the night before I even woke up, 2 I took flec as PIP reverted within 2 hours.

* was sailing in Spain and think dehydration is most likely trigger for me ….

None since then

So for me flecainide most certainly caused more Afib . It works effectively for me now as a PIP.

Who knows what Afib has in store for me in the future but for me, so far, I feel I’ve done the right thing coming off it

Good luck with your journey

[secondtry]

Hope as requested: I had debilitating AF at 60yo occurring twice a week on Flecainide 50gms x2 daily. This was increased to a medium dose of 100mgs x2 daily and that stopped it for 10yrs.

nb Over the 10yr period I also made improved lifestyle choices in every direction.

[secondtry in reply to secondtry]

PS My diagnosis was Lone PAF ie no other comorbidities.

[Jimbobarelli in reply to secondtry]

Thank you !

[Karendeena]

I can't get my head around why you are not on an anticoagulant. Aspirin doesn't work for AF.I don't like to be the deliverer of bad news but it's unlikely that your AF will get better as it almost always progresses. It's a mongrel condition. I was like you until my EP finally brought it home to me. My AF wasn't controlled by medication so I went the ablation route which seems to have halted it, for now at least

[Jetcat]

I’m chads 1 Jim only because of one higher than normal blood pressure reading at my cardiologist appointment !! He put me straight onto anticoagulants for stroke protection.! Originally 6 months after my last ablation 3rd around 3years ago I was removed from anticoagulants by my EP And although he’s the expert I didn’t like the idea not being on them because having afib increases stroke risk a lot unfortunately even if we only have isolated episodes. My echo in January showed slight atrial enlargement which is normal in afib patients he said. and normal valves

[WildIris]

For me, a strict vegan diet reduced my episodes from every few days to about one a year, pretty slow rate and fairly easy to stop if I'm at home. I was in kind of bad shape before though, and had several health problems. I have an apparently rare allergy to apixaban. My GP suggested daily baby aspirin because I was developing minor holes in my memory, like forgetting how to work a table saw, and he thought I might be having mini-strokes. The aspirin seems to have worked in that I can now work a table saw again.