Safety of Flecainide

I am taking 50mg Flecainide with 12.5 mg Metoprolol for Paroxyml Afib.

The initial dosage was given to me in hospital.  However two weeks after my release I was given a chemical stress test.  It showed a negative response upon rest.  My caridiologist suggested I undergo a catheterization, but due to the fact that I do not have insurance the procedures cost was prohibitive.  My cardiologist said at the time that this procedure was not absolutely necessary as the blockage ( if any ) was minimimal.  However he said he would like to know for sure.   He suggested I get the procedure done at some later date.  
Well I still have not been able to obtain insurance that I can afford, due to the pre-existing condition.  It has now been a year and two months since starting on flecainide.  My ekg showed no abnormal results,  my sinus rhythm is fine, and I have had no further episodes of afib.  The fact that I have not had the catheterization, and my doctor still says there could be some kind of "minimal" blockage has my cardiologist telling me that " at some point, you have to do something".   I presume he is referring to the catheterization.
My question is, exactly what danger is there in the fact that he has continued me on flecainide, despite a negative stress test?  He has not bothered to explain this other than people with blockage should not take flecainide.  Yet he is reticent to take me off of it.  He said " you have to weigh the risks".  So should I be concerned or not.  I have been doing fine now for over a year, and am quite active.   Walking, and bike riding long distances with no adverse effects---so far.

[LindaTX]

If you have a structurally normal heart, it could work just fine for you for a long time.  I was on flecainide for yrs with no problems but I did notice when I would do a hard aerobics class, it would feel like my heart rate had a "governor" on it.  It would only go up to say 125-130 instead of 150-160.  Don't know that it made a big difference. I was able to work out with no problems.  After a long while or a short while they eventually stop working.  I probably adequately managed my a-fib on anti-arrhythmics for at least 12 yrs.

[Jerry_NJ]

Based on what you have given us, I think you should ask for a milder anti-arithmetic than flecainide.  I say this on the warning you have about that mediation and a blockage.  I do not know that is the case, and it may be the case for other meds as well.  But, from what you have told us you may do fine with a simple beta blocker... talk it over with the doctor.

Your profile shows you'll be eligible for medicare in a couple of years, it will cover the catheter procedure.  I lived with conflicting views on the need for a catheterization   following some poor results on a nuclear stress test.  I had insurance then and now.  The radiologist said I needed to be check using the catheter method, the cardiologist said I didn't.  So, I didn't - and ended up paying more for life insurance a couple of years later.  Then even later I had a catheterization done after again getting a  poor nuclear stress test result.  The catheterization showed I had no blockage.  

That's my experience, it may no apply to your case, still given you minimal trouble with AFib it could be a good caution to get off of Flecainide and on to something "softer".    

[Kenny1948]

That's my problem.  He won't take me off the flecainide.  He said that would involve hospitalization which I cannot afford.   He won't do anything unless I have insurance.  The cardiologist from the hospital,  he is also the one who administered the nuclear stress test.  He claims flecainide is the best thing for me.  I also take Toprol ( metoprolol )  he claims that makes the flecainide safe to take.

I had hoped a medical professional would see this post and advise me.  Any doctor I see around here would still be with the same hospital chain.

[Jerry_NJ]

Yes, Toprol (Metoprolol) is what I had in mind for a milder medication, you're already on it.

Propafenone would be the next step "up" in my knowledge.  Then Flecainide.  Still you say you are doing fine from a symptom perspective.  

As for medical advice, it is rare that this community sees any posts by an MD.  You may want to try your post on: http://www.medhelp.org/forums/Heart-Rhythm/show/91 which is an "experts forum" and does see some responses form an MD.

[LindaTX]

Hi Kenny....rhythmol might be a better choice. Even though in the same class I think it is a little milder. I had a bad reaction with the flec in the hospital with a run of v-tach.  The Dr kept me in and switched me in the hospital.  It worked for about a yr and the rhythmol turned pro-arrhythmic on me.  Finally had an ablation this week and I'm glad I did.

[Kenny1948]

My cardiologist told me that ALL medications come with their negative side affects and reactions.  He claimed that flecainide was the best antiarrythmic around, and that was why he had me on it.  As he said, "It's working exactly like it's supposed to, you haven't had any recurrence of afib since you started".  He said he could put me on something like rythmol but those medications do not work as well.  My cardiologist is a DO not an MD.  I don't really know what the difference is.
What I was concerned about was the negative stress test and it's relation to the flecainide.  He never explained that to me!  He still is pushing me to have the catheterization.  That would cost $16,000 at our hca hospital here.  It is money that I do not have!
What I really want to do is get a second opinion.  I saw an EP in Tampa, but they said under the circumstances what my doctor is doing is the correct thing.  They did not have the stress test results though.  He did not send it to them.
They said they only dealt with ablations, and without insurance I was not a candidate.

[LindaTX]

If you have a structurally normal heart, it could work just fine for you for a long time.  I was on flecainide for yrs with no problems but I did notice when I would do a hard aerobics class, it would feel like my heart rate had a "governor" on it.  It would only go up to say 125-130 instead of 150-160.  Don't know that it made a big difference. I was able to work out with no problems.  After a long while or a short while they eventually stop working.  I probably adequately managed my a-fib on anti-arrhythmics for at least 12 yrs.

[Kenny1948]

Thanks to all of you who posted! Since an echo of my heart, showed it to be structurally sound.  I will simply have to hope that everything is ok, and go on with life.  If I want a second opinion, I guess I will have to find a doctor who is willing to take me without insurance and get his or her opinion.  It's just that I really know nothing about flecainide.  It was the book  " Dangerous Medicine"  that put a scare into me about taking it.