#flecainide

Side Effects of Flecainide: An A-Fib Patient’s Perspective

Carol, from Salem, Oregon, wrote me to share how taking the antiarrhythmic drug, flecainide, affected her. “When I initially started taking flecainide for my A-Fib, I experienced annoying visual disturbances, especially when there was a difference between a light and dark environment such as a stage or when going from a light to a dark room. I would see afterimages, many of them. For example, in…

So my Cardiac Ablation (this video explains that it is) has been set for the 8th November. Following consultation with my cardiologist, we discussed the 2 main options that remained with regards to treating and controlling my Atrial FIbrillation.

The first option was to remain on my medication (Flecainide (anti-arrhythmia agent) and Bisoprolol (beta-blocker)).

The second option was to have the ablation.

Because my artrial fibrillation is not caused through any chronic illness my cardiologist believed that whilst both methods were valid approaches towards the treatment of the afib, the ablation probably tipped the scale in terms of risk/reward. There are some risks associated with the medication (for example if I developed a blood clot) which apparently tipped the ablation in my favour, in addition to the fact that it has been like caused through the development of an athletic heart, caused by endurance exercise.

There are obviously some risks with the procedure but again these risks outweighed the option of remaining on the medication. 

10 months ago I went into Atrial Fibrillation which I wrote about at the time and my subsequent MRI scan and my subsequent lifestyle changes which I had to follow.

All has been going fine and 4 weeks ago I visited the cardiologist again having worn a 24/7 heart monitor which I wore on my London to Paris in 24 hours ride and for the week preceding my appointment.

The heart monitor picked up about 2000 instances of an ectopic beat (a little additional beat to the normal rhythm) which given that my heart had beaten over 780000 times during that period gave no cause for concern.

As a result, I was keen to progress things because I felt so good and well that instead of just keeping on the Flecainide (anti-arrhythmia agent) and Bisoprolol (beta blocker) - which is not a long-term solution due to side effects as you get older - the cardiologist agreed that I could taper myself off the drugs, the Flecainide first, and then the Bisoprolol, and have the Flecainide as a pill in the pocket in case the need arises to use it.

So I dropped immediately down to 1 dose (50mg) instead of 2 a day, and then today I finished with the Flecainide entirely. In 4 weeks I will stop with the Bisoprolol and hopefully be (and remain) drug-free. I have no idea whether my heart will maintain the normal sinus rhythm of its own accord (it’s been in sinus rhythm for the last 10 months) but I feel that I had to give this a try. The conclusion may be that if I revert back into AF that I need to undergo Ablation, but unless I try this I feel we’d never know.

The biggest change to my lifestyle in this period has been to give up alcohol completely which seems to have caused my friends and loved ones more of an issue to get their head around than it has myself, although it must be noted that my daughter is using her “permanently available taxi service” with liberal abandon, which actually I really don’t mind.

The cycling is going well, I have more energy, and save for a sore back at times I believe I am sleeping better. My ride distances are definitely up (long may it continue) although I’m not pushing myself so hard. My heart rate seems to top out at about 85% of max these days, which I think is down to the Bisoprolol, so it will be interesting when I come off that to see if my heart rate goes higher, or whether somehow I am subconsciously tapering my top limit as a way of self-preservation. Ironically, it doesn't seem to affect my overall performance as I have achieved a considerable number of PR’s etc. on Strava through the year.

It does make me think though. In recent times I have had an increasingly poor relationship with alcohol. It would definitely change my mood and for whatever reason I could feel myself getting angrier when I had a drink, so I am actually very blessed in a way that I have had a pretty good reason to give it up, which has made the whole process all the more bearable. I’d even go as far as to say that it has been easy, for me anyway.

So touch wood, the next 4 weeks things carry on as normal and then I’ll come off the Bisoprolol , go drug-free and see again where things end up. If coming off the alcohol turns out to be the answer then it might be a viable option for others who suffer from AF, to come off the booze and see if it helps to regulate matters once again. 

Believe me when I say that if you have a pretty decent reason (and I think AF is) to give up the booze, then it does make that process all the more achievable.

June 21, 2016 - We took a 2 hour train ride to Tsukuba University Hospital, a large teaching hospital northeast of Tokyo. It was so new and modern compared to Keio University Hospital. We started with the director and co-directors of the pharmacy  department sharing some of their research with us. One was about how the SCN5A promoter haplotype affects flecainide (a heart medication) concentrations in Asian patients. Basically this is studying how a differentiation in a gene can affect drug concentrations. Asian patients often have certain SNPs or “different genes” that affect how a drug works in their body! So even though drugs may be used a certain way based on clinical trials, the Japanese often have to make their own trials to see how it works in their patient population. The other study we discussed looked at how CYP2D6 genotypes affect metabolism of flecainide based on age. We then toured the dispensing room, and visited the cardiovascular, brain surgery, pediatric and hematology floors of the hospital to speak with the pharmacists and observe their daily work.