flecainide + nebivolol

I am a 51 year old man. My BP is under control, and so is my cholesterol, through drugs.

Last month I had my second ever episode of atrial fibrillation, the first one was in 2003.

On both occasion I had to go to an emergency room, and was hospitalised. The Afib was very fast, did not respond well to drugs, and was eventually resolved trough electric cardioversion.

My heart works very well otherwise. The holter test did not reveal anything wrong. The cardologist says that we need to try to prevent further episodes, and prescribed 100mg flecainide + 2.5mg nebivolol.

I have never taken drugs for the heart before, and am a bit concerned.

Can I start taking these medications with confidence? Will they give me more trouble than benefits?
Thank you in advance.

[Koregol Prabhakar, MD]

Dear Salieri,

You have very valid and genuine concerns. Now your atrial fibrillation (AF) gets classified as Paroxysmal Atrial Fibrillation (PAF). There are few issues that need to be further probed. They are:

1. Were these only episodes of AF that you had, or were there silent episodes that you did not realize?

2. Does your ecg show any evidence of electrical phenomenon called pre excitation?

3. Your risk of stroke needs to managed.

First thing is if your episodes have been nearly 8-9 years apart you don’t have to take medicines on continuous basis as most of the anti-arrythmic drugs like Flecainide do have significant side effects.
Nebivolol is relatively safe.

In my opinion you are eligible to what we describe as pill in the pocket approach, that is you take drug at the beginning of your symptoms.

However if your cardiologist is of the opinion that your arrhythmia was so complex to treat and he wants you to take medicine regularly then EPS (Electrophysiological Study and RF Ablation is safe) strategy is alright.

You may also need to be on blood thinning medicines (Warfarin/Acitrom) to prevent stroke.

Please discuss all these with your cardiologist.

Hope that this information helps and hope that you will get better soon.

Thank you for using MedHelp's "Ask an Expert" Service, where we feature some of world's renowned medical experts in their fields. Millions have benefitted from our service to get personalized advice for them and for their loved ones.

Best Regards,
Dr. Prabhakar