Tambacor

[VTBen]

Thank You for taking my question.  I have never been able to find a staright out answer answer to this question outright in any medical articles.  Is it safe to treat NSVT, particularly RVOT VT with flecinade or similar drugs?  I have read that it is contradicted for VT even in a healthy heart.  The inserts actaully say this.  What does medical research show as far as risk of death due to the medicine in the setting of RVOT VT or other NSVT or even PVC's for that matter?  I've read plenty of studies about sodium channel blockers in the presence of heart desease, but nothing offical in the  absence of heart desease.  I've heard 1 in 1000 deaths as well as other abstract numbers from other doctors.  I have had 6 ablations with over 60 burns epicardilly and endocardily for short runs of VT with dehibilitating PVC's.  Bete blokers don't work for me, so It would be nice to have another option besides just dealing with it.



1: So I guess my questions are, has there been any research or is there are any concrete stats regarding death from proarrythmia in the presense of a healthy heart for PVC's or RVOT VT?



2:  If not what has the medical community at least observed with this drug when used to treat PVC;s or NSVT.  Is it safe?  I know my condition is not lifethreatening, but I see so many people here disabled by PVC;s.   If this drug is relatively safe, why not treat more people with it?



3:  Does exercise increase the risk of proarrythmia when taking this drug?  or does one have to continue living a modified life style with it?



Thanks for any answers.

[CCF-M.D.-BJ]

Ben,



Basically, we as physicians like to try to keep the cure better than the disease. Any medication has potential have the same side effects, when these side effects outweigh the benefits of the medications we obviously try to refrain from using the medication.



Typically, RVOT VT responds to medication and to ablation. In your case, with 6 unsuccessful ablations, your condition isn't perfectly  typical and medications may not have the same effects as someone else with RVOT VT.



1: So I guess my questions are, has there been any research or is there are any concrete stats regarding death from proarrythmia in the presense of a healthy heart for PVC's or RVOT VT?



There are only case series reported in the literature. These are generally small in number so defining specific stats out of these is difficult. There is a general risk of increasing ventricular arrythmias in especially in patients with preexisting PVCS or VT  so it should only be prescribed by someone comfortable using the medication.





2: If not what has the medical community at least observed with this drug when used to treat PVC;s or NSVT. Is it safe? I know my condition is not lifethreatening, but I see so many people here disabled by PVC;s. If this drug is relatively safe, why not treat more people with it?



Safety is on a case to case basis and related to the risk of having the disease. No medication is perfectly safe especially the anti-arrythmic medications.  There are a lot of other options out there with a better overall safety profile that are used to treat arrythmias that are used preferentially.





3: Does exercise increase the risk of proarrythmia when taking this drug? or does one have to continue living a modified life style with it?



There is no specific data with respect to this question. The activity recommendation would have to come from someone familiar with your specific case.



good luck

[Momto3]

FWIW...In 2003, I took tambacor (flecainide) and then rhythmol (propafenone) to treat pvcs, nsvt.  My doctor felt the benefits outweighed the risks since the chronic pvcs were thought to have caused a cardiomyopathy.  After 7 months on sodium channel blockers, I had 2 ablations (3 months apart). My EF returned to normal, and the pvcs are insignificant.



Because of the potential for proarrythmias, I started on the flecainide in the hospital.  My doctor didn't expect a problem but it was considered a safer way to introduce the RX. The medication worked great at controlling the pvcs, but I decided to try the ablation, hoping for a more permanent "cure."  My ablations were for RVOT and LVOT.



I'm looking forward to reading the doctor's opinion as I understand sodium channel blockers are generally not prescribed for pvcs.  However, in my case the were thought to be safe, and I found them to be very effective.  Have you tried flecainide?  If so, how effective have you found it to be?

[PikaPika88]

Yes, I would like to see the doctor's comment.  I also like to see many many of you raise the side effect and acting of this drug.  I got the battle with Tambocor. All the doctors didn't believe it because the whole world hasn't reported the case like me!  Please comment, young or middle age or old, it could react differently.

[ScottH]

Hi -



I experience exercise-induced VT. I am 53, and have had the problem my entire life. I have lost consciousness dozens of times while exercising. I started seeing a new cardiologist about 10 years ago. He tried to ablate, but without success. He implanted an ICD, explaining that the VT was life-threatening unless I stopped trying to exercise, and I did not want that. The ICD does nothing to suppress the onset of my VT, it is just "insurance" as he says. But what did help me tremendously was that he started me on rhythmol (propafenone). I was for the first time in my life able to exercise at even a moderate level of exertion. About 5 years ago he switched me to tambacor (flecainide) plus mexitil, mainly because he thought it might help with some other problems I have (PVC's etc). It has also been able to suppress the VT (although did nothing to suppress PVCs etc.) I continue to exercise, even run long-distance.



Like "momto3" I started these meds in a hospital setting for a few days, to be sure no bad effects. There were none. In fact, the only side-effect I have ever had is that the meds can make be a little dizzy. But I have found that if I take them with a meal, that eliminates the problem.



I hope you find something that works for you.



Best wishes.

[davidc]

3: Does exercise increase the risk of proarrythmia when taking this drug? or does one have to continue living a modified life style with it?





Though the doctor answered that there was no research on this

subject, I found a paper which addresses the issue -



"Amplification of flecainide-induced ventricular conduction slowing by exercise: A potentially significant clinical consequence of use- dependent sodium channel blockade"



S Ranger, M Talajic, R Lemery, D Roy and S Nattel,

Circulation 79, 1000-1006, 1989.



I found it worthwhile to read and discuss with my cardiologist,

as I am taking a low dose of flecainide for Atrial Flutter,

and also exercise regularly. (And I find the flecainide

really helpful.)



The last sentence of their abstract:



"We conclude that

exercise causes a rate-dependent augmentation of flecainide's effects on ventricular conduction by

enhancing state-dependent sodium channel blockade, potentially causing ventricular arrhythmogenesis

in predisposed patients."



Note that their results are based on just 16 patients, who

were taking ~250 mg/day of flecainide, most of whom were not

also taking a beta-blocker.  So while the study is academic,

it is at least a good conversation starter! YMMV.

[VTBen]

Thank You very Much For the Feedback and Information Everybody!

[starketcher]

I am 47, structural heart, overweight by about 40 lbs (which has been recent). I started having PVCs in July and due to symptoms had a cath. Doctors told me it was stress and sent me home w/o any meds. GP prescribed 25mg atenolol and the PVC kept coming. GP sent em to EP and I wore an event monitor in Dec.



The monitor indicated all the beats were PVC but they were a huge amount of them. EP prescribed 50mg flecainide am/pm. The PVCs have all but stopped. Ocassionally, I can feel "light" ones.



After reading about the Flecainide, I am hesitant to take it! Advice??

[wmac]

Long time no talk v-ben. Well here we go again you and me seem to always have the non typical....You are having trouble with the nsvt again. I do every month. Its funny that the doc said that rvot responds well to meds and ablation.. If so why arent we cured??? this all just makes me nuts. Im going on five years now and man its really getting old for me. Anyway email me sometime so we can chat.
wmac

[UncleJohn]

Tambocor (flecainide acetate)
In 1984, I was put on this as part of a medical study with some 700 other folks.  Why?  I had a Holter Monitor 24 hr. study that showed ventricular tachycardia (VT)at the rate of 240 beats per minute (BPM) for 12 percent of the time.  My cardiologist was banking on the slowing down of my heart rate as a stabilizing factor in eliminating the VT.  Prior to starting this drug, I had a resting heart rate of 55-60 BPM.  Tambocor reduced my resting heart rate to 44-46 BPM, but after 18 months, the study was terminated as the participants taking Tambocor were dying at a much higher rate than the control group cohort.  

My heart rate NEVER returned to the previous 55-60 BPM.  I now had a diagnosis of bradycardia due to sick sinus syndrome and was put on a "pacemaker watch" or regular monitoring to see if I needed a pacemaker.  12 years later, during my regular Holter monitoring, my BPM dropped to 28 at 4 a.m. and I was outfitted for a pacemaker shortly thereafter--Medtronics Kappa 400 dual lead.  

All the MD's I have talked to say that Tambocor was not the reason my heart