Flecainide and SVTs/Ectopic Burden

[Peg99]

Hello Everyone

I wrote a Post here last March as we were worried about the choices being offered to my Husband for the management of his PAF (anticoagulant, pacemaker, ablation). Many of you kindly answered our questions and gave us the benefit of your experience and my Husband felt pretty confident when he saw his Consultant in June. However, as is so often the case, having dealt with our earlier concerns, we now have some new ones and we’re hoping that some of you will be kind enough to help us again.

My husband, age 75, has been taking 200mg Flecainide every single day for 35 years ( prescribed by consultant cardiologist)---originally to try and make sure that infrequent and short-lasting salvos of SVT did not cause panic or anxiety to affect his career which involved public speaking/chairing meetings/etc. On flecainide, the SVTs have not caused any major problems and have remained infrequent and “weak”, and mostly asymptomatic. He has been monitored over the years and echocardiograms have shown that his heart is structurally fine.

In early 2023, a routine heart rate monitor for 7 days (a “Zio Patch”) showed one episode of AFib ( lasting over 2 hours in the night), which was asympotmatic, + many SVTs/ectopics (14%). The A-Fib episode caused his current consultant cardiologist, after many years of “laissez-faire” to immediately become very anxious about the continuing use of flecainide----he wanted it to be gradually stopped. He also prescribed lowest dose of beta-blocker ( bisoprolol) but it caused bradychardia as low as -40 bpm and was stopped. A calcium channel blocker was deemed to be likely to cause similar problems and was advised against. An anticoagulant was recommended but my husband has a history of stomach bleeding ( not serious but occasionally noticeable ) caused by longstanding hyper-acidity/reflux/hiatus hernia, as well as nasal bleeding ( not serious); and these factors made anticoagulants a risk and have not been used, nor does my husband want them to be.

Jumping to 2024, a 14 day heart rate monitor (“Zio Patch”) showed no AFib episodes but indicated 30% permanent numerous SVT/ectopics (SVT/ectopic beats in isolation, in couplets and triplets with <1% isolated ventricular ectopic beats) which in total left my husband with only 70% of beats in sinus rhythm . Ablation or pacemaker have been discussed but neither my husband nor the consultant is very keen on effectiveness of either in this particular case and have been decided against. Consultant shows little or no interest in SVT/ectopics but is solely concerned about the one AFib episode 18 months ago and the continued use of flecainide, on the grounds that he fears the pro-arrhythmic properties of flecainide may lead to a stroke and would like my Husband to stop taking it.

We understand that “traditionally”, a beta-blocker/calcium channel blocker is used for AV node protection against the pro-arrhythmic properties of flecainide but being unable to tolerate them is not, in our view, a reason to stop what has been an effective drug for SVTs over 35 years. Flecainide is one of the main drugs of choice for someone diagnosed with AFib and it has made my husband’s SVTs/ectopics mostly asymptomatic for 35 years. To our mind, without flecainide, how much worse would the SVT/ectopics be ? How many more Afib episodes would he have? And no-one seems worried about the loss of 30% of sinus rhythm---shouldn’t we be concerned about that , especially as only one episode of A-Fib has been noted but the SVT/ectopics are there continually ?

The current position is that the Consultant “understands” my Husband’s views and it’s been agreed that he will not be taking an anticoagulant and he will continue with the flecainide 100mg twice a day; with it being made clear to the GP that both decisions have ultimately been made by my Husband.

We would welcome your views/opinions on any of the above please. In particular,

- is my Husband being foolhardy in refusing to stop the flecainide as the tablets may be keeping Afib episodes in check and possibly keeping the SVTs/ectopics asymptomatic?

- is the loss of 30% of sinus rhythm/the increasing burden of SVT/ectopics a cause for concern?

Sorry for the long post but I’ve tried to give you as much info as possible.

Thanks for reading, BTW I've posted this on the BHF and Afib forums in view of the crossover of subjects.

Peg

[bluemoon572]

Questions for the cardiologist: There are methods of tying off or clipping the left atrial appendage which obviates the need for anticoagulant use. After years of taking flecainide has the cardiologist agreed that your husband has demonstrated no proarrhythmic effects such as prolonged QRS or prolonged QT intervals and would he/she agree to periodic monitoring for these? Does the cardiologist agree that calcium channel blockers, diltiazem & verapamil have less tendency to cause profound bradycardia than beta blockers?Unlike PVCs,frequent PACs don't damage the myocardium.

[Peg99 in reply to bluemoon572]

Hello Bluemoon and thank you for your response.

To answer your questions - dealing with the atrial appendage as you mention has been briefly discussed but not pursued at this time as Afib is so infrequent Hubby does not want to undergo any procedures; ECG is OK and is monitored at least every 12 months (this will continue); and, Cardiologist agrees that CCBs are less likely than BBs to cause bradycardia but both he and GP think that Hubby wold have problems with them.

Thank you for taking the time to reply.

Best Wishes, Peg

[aviation1]

To be frank - I would look for a second consultants opinion, the old saying - you ask 3 doctors and you get 3 answers ! Having said that, this forum is extremely helpful.

[Peg99 in reply to aviation1]

Thanks avaiation1. You're right, of course and we're posting here to get the benefit of real people's experience which sometimes can be more useful than the 'correct'expert opinion.

Thanks again.

Peg

[HUModerator Administrator]

Hi Peg99,

Just a reminder that content on HealthUnlocked does not replace the relationship between you and your doctor. Please avoid making any changes to your medication or advising others to do the same, without speaking to a health professional first.

Many thanks,

HUModerator

[Peg99 in reply to HUModerator]

Thank you Moderator. Don't worry, wouldn't dream of taking action without speaking to consultant.

[TaylorW]

I took Flecenide after Heart Rate was recorded at 195bpm but all AF Detected. I took One tablet and thought I was going to Die. Never took it again. With AF according to the Gov website on Drugs...Dont take it...But check your self...Good Luck...