Aa
flecainide for a-fib, a-flutter
I am a 39 year old active female that had mitral valve repair for cleft anterior leaflet (birth defect) with severe mitral regurgitation and a maze procedure for a-fib in July 2009. Prior to my surgery I was on sotalol to control rate and rhythm. (No other cardiac meds worked - had been cardioverted for a-fib). I had many complications after the surgery - TIA, AV node injury with complete heart block (don't have a pacemaker, it resolved after 3 days in ICU), numerous arrhythmias (all svt's), pleurisy, pericardial effusion, pneumonia. I also developed a competing junctional rhythm that lasted until recently. I am taking 75mg toprol daily which is the highest dose I can tolerate due to low blood pressure. This is to control sinus tach and svt's. I am 9 months post op and just learned that I am a having a-flutter and a-fib in addition to my nonsustained atrial tach. My local EP suggested putting me on Flecainide which scares me. My EP at CCF had told me that antirhythmics could be very dangerous for me a few months ago and was not worth the risk. My EP said that I will eventually "learn" to go into a-fib and stay in it because my heart has not fully remodeled. He also is considering an ablation for the a-flutter. Please help. I am terrified of this medicine and the ablation. I have been through too much already.
I appreciate your comments.
The symptoms with my a-fib and a-flutter are not as strong as the one big episode before the surgery but my heart rate is lower, thanks to Toprol. (Before the surgery it hit 200) Also I am bouncing in and out of it (longest sustained episode on monitor was a few hours). My EP says that he needs to keep me out of it or my heart with remodel in a-fib over time and never stay in sinus rhythm if he lets it go. (That happened before surgery)
He says the a-flutter can be ablated and that the meds don't work as well on it. He said a-flutter usually originates in the pulmonary artery.
The surgery gave me new arrhythmias which are slowly resolving but now I have this. I feel very trapped.
Are you frightened by using flenaicide? It says not to use it in people who have or ever had structural heart problems.
I am not currently on coumadin. I was prior to surgery for a short period but did very poorly. Was therapeutic one day out of 60 days. My INR would not budge for weeks and then it shot to 9.3 in three days. Vitamin K brought it down and then they never got it to 2 again. I stayed out of a-fib for two months on sotalol (after cardioversion) so they switched me to aspirin. They were going to give me a tissue valve to avoid lifelong coumadin because I was so problematic. Right now I take daily 325 aspirin.
Thank you.
The symptoms with my a-fib and a-flutter are not as strong as the one big episode before the surgery but my heart rate is lower, thanks to Toprol. (Before the surgery it hit 200) Also I am bouncing in and out of it (longest sustained episode on monitor was a few hours). My EP says that he needs to keep me out of it or my heart with remodel in a-fib over time and never stay in sinus rhythm if he lets it go. (That happened before surgery)
He says the a-flutter can be ablated and that the meds don't work as well on it. He said a-flutter usually originates in the pulmonary artery.
The surgery gave me new arrhythmias which are slowly resolving but now I have this. I feel very trapped.
Are you frightened by using flenaicide? It says not to use it in people who have or ever had structural heart problems.
I am not currently on coumadin. I was prior to surgery for a short period but did very poorly. Was therapeutic one day out of 60 days. My INR would not budge for weeks and then it shot to 9.3 in three days. Vitamin K brought it down and then they never got it to 2 again. I stayed out of a-fib for two months on sotalol (after cardioversion) so they switched me to aspirin. They were going to give me a tissue valve to avoid lifelong coumadin because I was so problematic. Right now I take daily 325 aspirin.
Thank you.
COMMUNITY LEADER
So sorry you are having so many complication.
To calibrate, I underwent mirtral valve repair with a (min) maze in November 2007. I had a good 5 days in ICU and the usual 6 weeks of very light physical activity following surgery, and did not develop any complication. However, while I went in with AFib, I came out in NSR, but that lasted only about 30 days, then back into AFib. I've tried the electrocardio version following a long observation and a high dose Rythmol to try to convert me to NSR. The electrocardioversion converted me, but it lasted only 7 days. My EP and my cardiologist both say my symptoms are too minor to risk ablation for AFib, that has to take place in the left atrial, a more risky chamber to get the catheter into, I am not sure that is necessary for Atrial Flutter, maybe that is accessible in the right side, and thus lower risk.
My EP said we could go to stronger meds, and the next step up is Flecainide which I have so far declined I take 100 mg (50 mg twice a day) of Metoprolol ER to control my HR, I too get into trouble with the BP getting too low if I take more, it works well for slowing my HR, but nothing for stopping the AFib. I also take an anticoagulant, Warfarin, are you on one? If not I suggest you ask your doctor if you should be... in your case taking an aspirin may be enough, you age is in your favor.
I have read a number of posts that included discussions of Flecainide, and I think the results have been generally good. I am considering giving it a try when I have my next regular appointment. I'd like to start at home, one aspect I didn't like was the "need" to start in a hospital managed environment, some do start without that. There are stronger arrhythmia drugs, and I haven't tried any of them yet.
To calibrate, I underwent mirtral valve repair with a (min) maze in November 2007. I had a good 5 days in ICU and the usual 6 weeks of very light physical activity following surgery, and did not develop any complication. However, while I went in with AFib, I came out in NSR, but that lasted only about 30 days, then back into AFib. I've tried the electrocardio version following a long observation and a high dose Rythmol to try to convert me to NSR. The electrocardioversion converted me, but it lasted only 7 days. My EP and my cardiologist both say my symptoms are too minor to risk ablation for AFib, that has to take place in the left atrial, a more risky chamber to get the catheter into, I am not sure that is necessary for Atrial Flutter, maybe that is accessible in the right side, and thus lower risk.
My EP said we could go to stronger meds, and the next step up is Flecainide which I have so far declined I take 100 mg (50 mg twice a day) of Metoprolol ER to control my HR, I too get into trouble with the BP getting too low if I take more, it works well for slowing my HR, but nothing for stopping the AFib. I also take an anticoagulant, Warfarin, are you on one? If not I suggest you ask your doctor if you should be... in your case taking an aspirin may be enough, you age is in your favor.
I have read a number of posts that included discussions of Flecainide, and I think the results have been generally good. I am considering giving it a try when I have my next regular appointment. I'd like to start at home, one aspect I didn't like was the "need" to start in a hospital managed environment, some do start without that. There are stronger arrhythmia drugs, and I haven't tried any of them yet.
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