Bisoprolol with flecanide?

[M-Lumino]

Hello Forum

Just had a question about research/ facts around flecanide taken with bisoprolol. My EP nurses seem to differ in their advice about the risks of flecanide increasing the risk of creating other arrythmias. Some of the nurses have stated that bisoprolol can reduce this risk so important to take the two togther. Others have differed in this view.

Is there any research or expertise here that would be able to shed any light on this?

Currently taking (during blanking period) 1.75mg Bisoprolol and 50mg Flecanide at 5pm (with Edoxoban) Previous to the ablation, I was on PIP Bisoprolol and Flecanide, but seem to have had much more unpredictable af since procedure so trying to stay in sinus rhythm taking daily meds (really not what I want to do, but grateful they seem to be working)

I'm due to have a 24 hour ECG reading (post blanking). Do EPs usually ask you to come off your meds to establish 'success' or not?

Many thanks. M

[BobD Volunteer]

It is normal to stay on meds for a period post procedure to allow the heart to heal in peace and quiet and yes beta blockers are important to prevent possible flutter induced by flecianide.

[M-Lumino in reply to BobD]

Thanks Bob. Appreciated.

[Singwell]

I'd add to Bob's comment that if you were previously on Bisoprolol and Flecainide it'd be a good idea to keep that combination during the blanking period. Advice on what follows can vary enormously - EPs have different practices plus we're all individuals. After I'd been AF free for 9 months I titrated off both Flecainide and my calcium channel blocker. When AF returned after 19 months for for the occasional and thankfully less symptomatic visits my EP was happy for me to take a small dose of Flecainide solo to see it off. I have Digoxin as a back up if needed. But so far that's never happened. (In this case the Digoxin is doing a similar job to the BB in rate control.)

[M-Lumino in reply to Singwell]

Thanks Singwell. Appreciated

[Vonnegut]

As I’ve written here before, I was told by the EP who prescribed Flecainide for me to take as a PIP, I would not be at risk of stroke unless an episode of AF continued for a long time with a high heart rate and only to add the lowest dose of Bisoprolol if my heart rate exceeded 140 twenty minutes after taking the 100mg of Flecainide which only happened a few times- all checked with my Kardia, of course. Now that I take Flecainide regularly I have been AF free for a few years and have reduced the first dose of the day. I’ve never been offered an operation and at 81, I’m fine not having one!

[M-Lumino in reply to Vonnegut]

Great to hear you've been clear. Thank you.

[secondtry]

As has been said, you need a trusted medics help to determine if Flecainide is for you and if Biso should be added.

After 12 yrs on sole Flec and now 71yo, my cardiologist says less not more need for Biso. However in the last year PAF has started again but much less symptomatic. So work in progress as to the next move 🫢.

[OzJames in reply to secondtry]

I wonder if taking a beta blocker with your Flecanide might reduce or eliminate your AF episodes

[secondtry in reply to OzJames]

Thanks, if I get regular HR over 125, I will run that idea past my cardio.

[OzJames in reply to secondtry]

my regulate resting HR was 65 I had no indication for metoprolol but my cardiologist suggested I go on a low dose not for high HR but to tamp down the adrenaline spike that sometimes kicks off an AF episode. He prescribed 12.5mg twice a day I’ve actually brought that back to 10mg which in Bisoprolol equivalent is 1mg. I take that with 25mg of Flecanide.

BTW I flipped into AF just over a month ago and it was at the same time I got a cold sore (HSV) Looking back at my history the same thing happened about a year ago. After doing some research I found a study that showed a significantly higher incidence of AF amongst people that had the HSV virus. I guess it was the inflammatory effect of the virus. It would be an interesting poll to take among the members of this forum

[ShGrace in reply to OzJames]

I agree the inflammation is the biggest thing, changing my diet and taking omega-3 with turmeric I have felt so much better

Looking to keep losing weight being overweight is a factor too, which is tough once you get into your 70s it doesn’t come off as easy as it used to when you’re younger

[M-Lumino in reply to secondtry]

Thank you

[Vonnegut in reply to secondtry]

That’s sad but as we know, we are all different and do hope you find something that helps you and your heart as much as Flecainide has helped mine.

[Halfheart]

There is a specific reason why they prescribe a beta blocker if you are taking flecainide. Flecainide can induce flutter (in the atria) at around 300bpm which could possibly be conducted at a 1:1 ratio to the ventricles, which would be very serious. The beta blocker does not prevent the flutter, but it does stop it being conducted at 1:1, slowing it down to 2:1 or 3:1 or 4:1 ie 150bpm, 100bpm, or 75bpm. The risk of the 1:1 conduction is not very high, especially if you are older, so sometimes cardiologists don't bother about prescribing the beta-blocker.

[M-Lumino in reply to Halfheart]

Appreciate the reply. Thanks.