Latest Cardio appointment - confusion

[ian16527]

Had my latest Cardio outpatient app yesterday followed by a call today. Supposed to see the EP but he was called away so saw a Specialist nurse.

Had ablation last May and was on Flecainide 100mg x2 daily which was reduced on the 6month app to 50mg x2 daily. Next appointment in 6 months - well 14 months later and it was yesterday.

The Nurse was not well prepared with my history so I went through it and discussed coming off the Flec and use it as a PIP as before if AF returns and also the apixaban . I cant tell if the ablation has been successful really whist on the Flec as still getting ectopics and some SVT's for a few secs often throughout the day.

So after discussing it with the EP she phones today whilst I was out, saying to stop the Flec, and regarding the PIP, if I have another AF session to go to A&E for 300mg of Flec.

This therefore is not PIP, and I mentioned I was put on PIP at 100mg 8 years ago - she then replied this was not the correct way!!

So I thought the idea of a PIP was to keep me out of hospital. And I was also told that the max dose daily is 200mg which I forgot to mention to her.

If previously had to go to A&E with every AF just before the ablation I might as well have stayed in the car park.

I am waiting for the letter but hoping that I wont need the 300mg of Flec 🙄

Also anyone had any after effects of stopping the Flecainde?

[BobD Volunteer]

The max daily (24hours) dose of flecainide is 300mg not 200mg.

[ian16527 in reply to BobD]

Thanks Bob, where did I get 200mg from I wonder

[BobsBeat in reply to ian16527]

200mg is max if a person weighs 150lbs or under.

[wilsond]

Max 300 . Pip can either be 100,see if it settles,then 100. That's what I did previous to ablation. When I stopped flecanide abruptly,on the misguided advice of my GP, almost instantly back in to AF! This was 4 months after,awaiting my review.

So still on 200 mg per day but it works now.

Hmm I think I'd want to query your advice here. Is there a follow up review planned?

[ian16527 in reply to wilsond]

Yes , next review next June 2025 - I have just received an email

They have told me to stop the Flec straight away. Was it 4 months after the ablation?

Not sure if you can taper it or any benefits by that

[wilsond in reply to ian16527]

It was not by my Electrophysiologist, it was my GP, well meaning but.... I have chronic back pain. He thought because I was still on flecanide,I couldn't take NSAIDs, so told me to stop! ( actually nothing contraindicated with flecanide, it's the anti coagulation that's the issue!)Anyway,the abrupt cessation had an immediate effect.On a Friday night obviously 🙄

So I put myself back on it straight away,rang Arrthymia clinic Monday 8 am. The sharp intake of breath when I told her what occurred told me everything. I had done the right thing apparently.

A stiff letter was sent,which I have a copy of. EP agreed when I saw him 5 months later,said if not for that blip could have now tapered off.Tapered being the word !

So I would be wary,double check. Every case is different of course.

All the best

[southkorea]

I use PIP and my palpitations usually stop after a few hours. Going into A&E every time would be horrendous!

[Model52]

I stopped the daily 150 mg of slow release Flecainide a year ago and had no side effects whatsoever. When I have an AF attack now, I take 300 mgs of the fast-acting kind and that usually stops my AF within 2 to 8 hours.

Before, I sometimes had to take an extra dose of 200 mg fast-acting on top of my 150 daily slow-release when AF broke through that regimen, but these 350 mg in total often caused a pre-syncope at the moment of conversion to sinus rhythm, which felt uncomfortable.

It had to do with the QTc-interval getting too high (over 500) which poses a risk for torsades de pointe. So I would advise to stay below 350 mg max.

[ian16527 in reply to Model52]

Thanks

I only ever used more than 100mg once as recommended by my then Cardiologist during an episode, She said if not in sinus rhythm after 2 hours take another 100mg, but this made me feel quite ill, hence why I would be reluctant to take 300mg as a bolus dose

I found that if I took the 100mg straight away it didn't work, If I waited 2 hours then took it it would work within the next 2 hours. Strange