Flecainide after Heart Attack

[Drounding]

I have been taking Flecainide for many years and it has helped tremendously in management of my PAF.

I had a heart attack a little over a year ago, my medications remained much the same still including 100mg Flecainide am and pm.

I have had some recent chest pain and am in hospital awaiting an angiogram. The cardiologist visited me today and went over my medication and told me to stop the Flecainide as it is contra-indicated after a heart attack and can seriously affect my heart.

My new regime is to now take 5mg Bisoprolol am and pm (I'm already taking 5mg am).

I'm concerned that my AF episodes could now become more frequent.

Is anybody else in this situation?

Thanks

[jeanjeannie50]

After looking at my ECG my cardiologist said for me to stop my Flecainide as it looked like it was causing more problems than helping. I felt so much better without it and when going back to the cardiologist he said my ECG looked so much better.I also remember my EP when he discharged me quite a few years ago, suggesting I do my best to get off or lower the strength of Flec. He gave the impression that it wasn't a good drug to take.

Jean

[Budken in reply to jeanjeannie50]

A quick question, were you taking anything besides the flecainide?

[jeanjeannie50 in reply to Budken]

Yes, the beta blocker Metoprolol which I still take now, I'm also on the anticoagulant Warfarin.

[secondtry]

Stopping the Flecainide seems a good move for you. My cardiologist, if memory serves, told me 10 yrs ago when I started on it that it was a tried and tested drug and fine if you have a healthy heart.

More or less AF if you stop Flecainide? That is a difficult one and I was interested to read Jean's reply.

I think it is best to accept that there is a lot of guesswork between medics and that we the patients therefore need to make the difficult decisions.

eg My AF/Flutter/pauses pattern has changed this year; my cardiologist says stay on the Flecainide (200mgs) but refers me to an EP for a 'more nuanced view' (not sure whether this is a medical term for passing the buck 😁) on whether to go for an ablation. The EP predictably said ablation with very little discussion on alternatives and cautioned Flecainide can mess with the heart's electrics; this after 10 years on the drug and no problem. So you see why I say it's the patients final decision as there is no clear path.

I am left with decision whether to reduce the Flecainide dose very slowly (in case that proves beneficial) or just wait until my arm is forced to have the ablation.

Hope this rather too long post gives you and others something useful.

[Abbyroza in reply to secondtry]

Whatever happens, you should never have your ‘arm forced’ to get an ablation. It is an invasive procedure with considerable possible risk and side effects, a less than stellar success rate and a serious dose of harmful radiation. I would consider it only if my AF would become VERY symptomatic and permanent, thereby affecting my quality of life tremendously. And so would one of my best friends, a retired cardiologist with AF himself. He calls ablation ‘the cash cow of the cathlab’.

[secondtry in reply to Abbyroza]

Thank you for helping balance out opinion. I am on your side of the fence at present 🤔.

[dmac4646 in reply to Abbyroza]

Like any procedure there are risks but I would hardly class them as high - also radiation is much reduced from earlier days - in the UK the NHS is hardly recommending ablation as a "cash cow" .

[Abbyroza in reply to dmac4646]

The radiation dose is still -at least- the equivalent of 200 static X-ray shots, that is still a considerable amount. Moreover so as ‘ablations’ tend to come in plural. One is rarely enough.

[dmac4646 in reply to secondtry]

There is no doubt that Flec can be a very effective drug but it is not risk free by any means - it really can mes with the electrics and having been on it for 10 years and suddenly was in ITC for 7 days with cardiogenic shock I have experoenced the side effects.

[secondtry in reply to dmac4646]

Thanks Mac for the heads-up. My concern is of course a sudden issue like you had. Can I ask did you have any associated issues prior to getting CS eg poor echocardiogram result, inactive or over active lifestyle or other comorbidities, maybe stress. Any extra info appreciated.

[MWIC]

I had a HA before diagnosis of AFib - private appt with Cardiologist(EP) and diagnosed - all I can tell you is he advised me should I ever be in A & E first thing to make clear to the A&E team was NO Flecanide to be given under any circumstances due to previous HA - I will continue to remember this advice - I’ve since had an ablation Dec 23 and so far AFib free

[Cliff_G]

The no Flecainide after a heart attack came from the original CAST trial which showed it was dangerous after an MI. The people on that trial were not stratified as to risk, but a later trial did stratify and found that whilst Flecainide was still contra-indicated in those at high risk (principally atherosclerotic heart disease), Flecainide produced better outcomes than no Flecainide in those with low risk.

I went back on Flecainide after my latest ablation, 7 years after an MI which was secondary to an aortic dissection. My EP said that they are more relaxed these days about Flecainide after MI, but they do check carefully, and he did check my echo for contra-indications and pronounced me OK for Flecainide, particularly as my heart pumping function was very good.

My non-medical view is that with a recent MI and unless the risk factors have been well-modified (such as atherosclerosis) then you may be in the risk group. But it's probably worth having that conversation especially as Flecainide has helped a lot in the past. If the doctor is unaware of the above current thinking, then it may be a reason to seek a second opinion, and what might be needed to get back onto Flecainide.

[Drounding]

Thanks for the interesting replies. I'm going to wait until after the angiogram. After that I'll be in a better position to discuss the further use of Flecainide or not with the cardio.

[Drounding]

Some further feedback.

I had my angiogram yesterday which I'm pleased to find out shows good blood flow and negligible narrowing. I did not actually have a second heart attack. No action required.

The consultant doing the procedure disagrees with the earlier information given to stop Flecainide for me. This is probably based upon the know confirmed good structural operation of my heart.

He says I should continue with my current medication of Flecainide am and pm.

I know there are risks with Flecainide but I'm happy to accept this due to the added quality of life I get with reduced AF episodes.

It's been an interesting few days for me.