Concerned about anti-arrhythmia drug EP wants to put me on

[momkwt]

Because I am going into v-tach with treadmill stress testing, the EP wants to start me on Flecainide, 1/2 of 50mg. twice a day. My problem started last year when I began to experience PVC's (2 or 3 per minute), then I went into v-tach on a treadmill stress test which lasted 8 seconds. I was sent to an EP and had multiple tests, including a heart MRI, which showed nothing. The doctor was looking for ARVD among other things. Another treadmill at that time showed frequent ventricular ectopy. I have very little blockage. The doctor says the problem is from one focus point in the lower part of the right ventricle.
After a year he did another treadmill. I went into v-tach. Unfortunately, the results of that treadmill was lost, so I had to repeat it. I went into v-tach again. The doctor said I had two runs of v-tach during this test, the longest being 12 beats. He put me on beta-blockers, but I could not tolerate them because they drove my pulse down too low and caused chest pains. Now he wants to start me on Flecainide. I remember reading last year about people being put in the hospital when started on this medication because it can cause SCA in some people. I read about the medication on line, and sure enough, it is recommended that a person be put into the hospital to start it. Now I am refusing to take it until I speak to his nurse about it.
Has anyone started this medication without going to the hospital? How can a doctor tell if you are prone to have a problem? I don't want to take a chance with it, and I am not sure I even want to take it at all, even with a hospital stay to see if I tolerate it. This frightens me.

[momkwt]

I have had a very bad experience with my EP's nurse.  To explain what happened when they lost my results of a treadmill test...My doctor and nurse was out of the office and they scheduled my treadmill with another nurse.  After the test, he told me I had gone into v-tach, but he couldn't tell me how long.  I was told my doctor's nurse would call me that week, or Monday of the following week.  I called 3 or 4 more times during a 3 week period, and by the time she finally called, they had lost the results, and I had to have the test redone.  She has waited way to long at other times to get back with me.  I don't know whether to blame her or the doctor.  During this time my stress level and blood pressure rises.  This EP has high ratings, so I hate to have to find another, and honestly don't know what to think.

[DeltaDawn23]

You deserve an explanation of what this all means.  I have had good luck talking with my EP's nurse, even wrote her a letter once.  Do try to get this doctor to answer our questions or look for one who will.  Good luck.

[momkwt]

As an update, I finally obtained a copy of my EP report about my last treadmill test. Can someone please help me with this? I am very concerned. The report says:

In stage II of the Bruce protocol at approximately 3 minutes, the patient began to experience frequent PVCs, followed by a run of polymorphic nonsustained VT. Next the patient had a 12-beat run of monomorphic nonsustained VT (I was told on the phone that the 12-beat run was the longer of the two). At that point, the procedure was terminated and the patient remained in sinus rhythm with occasional PVCs that resolved throughout recovery. (this is not all of report)

IMPRESSION:
1. High-risk exercise treadmill test with 2 runs of nonsustained ventricular tachycardia seen in stage II of the Bruce protocol, accompanied by frequent premature ventricular contractions that resolved in recovery.

This is the first time I have gone into polymorphic VT on a treadmill test (usually monomorphic), and the first time the report said "high-risk treadmill". Can someone help me decipher this report? I don't know if this means I am at high-risk only during treadmill testing or high-risk overall because of the findings. I can't find anything on line.

This may explain why the EP wanted to put me on flecainide.

[kevk]

I started taking Flecainide in 1995 for PVC`s and V-Tach at 150 mg 2 x a day. I started the med at home but had to have  ECG`s done for the first two weak`s to check for QRS prolongation. I have not had any real side effects but the med has worked pretty well for me.

[DeltaDawn23]

When I went on Norpace, an antiarrythmic, my doctor had me start at home, go a week and then come in for a 30 day monitor.  A doctor at another hospital I saw for a 2nd opinion said he didn't think that was necessary, as I would know if I was having an arrythmia.  This is for afib, so different, but I think that it depends on who you ask.  They just increased my dose of Norpace and want me to come in in a week and have an ekg to see if it is causing any problems.  Maybe you should look for another opinion. Definitely examine your options if you uncomfortable with this drug.  Good luck to you.

[momkwt]

Thanks for your reply.  I am a little more concerned because my problem stems from the ventricle, and I go into V-tach.  I found this on the rxmed.com site concerning the use of this drug.....

During long-term clinical studies, some patients have developed congestive heart failure (CHF) while taking flecainide (see Warnings and Adverse Effects).
No antiarrhythmic drug has been shown to reduce the incidence of sudden death in patients with asymptomatic ventricular arrhythmias. Most antiarrhythmic drugs have the potential to cause dangerous arrhythmias; some have been shown to be associated with an increased incidence of sudden death. In light of the above, physicians should carefully consider the risks and benefits of antiarrhythmic therapy for all patients with ventricular arrhythmias.
Flecainide is also indicated for the treatment of documented ventricular arrhythmias, such as sustained ventricular tachycardia (sustained VT), that in the judgment of the physician, are life-threatening.
Because of the proarrhythmic effects of flecainide, its use should be reserved for patients in whom, in the opinion of the physician, the benefits of treatment outweigh the risks. The use of flecainide is not recommended in patients with less severe ventricular arrhythmias, even if the patients are symptomatic (see Warnings). Use of flecainide for treatment of sustained ventricular tachycardia should be initiated in the hospital.

I only copied what was pertaining to me.  I am not trying to scare anyone, but I think people need to look into some of these medications if they are prescribed.  My brother ended up going on dialysis because a doctor left him on pain medication for years and put him on a blood pressure medication (I don't remember the name of it) that damaged his kidneys.  I am going to discuss this with my doctor to see if there are other options.  Right now, my v-tach is unsustained, so I am wondering if the benefit outweighs the risk.

[abc85]

I've been on this for a couple of months now and I started it at home and not at the hospital.  When I first started it and then when the dosage was increased, I had to fax my Dr a 12-lead several days later so they could make sure it wasn't prolonging anything too much.  In the beginning it made me dizzy and I had some weird streaking lights in my vision but those side effects have subsided.  It works very, very well for my SVT.  Most of the issues with SCA with this drug was in individuals who had structural abnormalities or heart failure already.  It's supposed to be a safe drug for those with structurally normal hearts.

[momkwt]

Thank you for your reply.  I am definitely going to ask to discuss this with my doctor before I start the medication.  When you read on line about it, it can give all sorts of bad side effects, even SCA, or it can stop your breathing.  So I don't take it lightly.

[Jerry_NJ]

I don't have any data but can say I've read on this community posts by people who when on Flecainide at "home".  My cardiologist discussed trying that medication fo atrial fibrillation a number of years ago and one reason I decided no to use it was I didn't want to be hospitalized to start the medication.

I have a colleague (another old guy about my age) who has been on Flecainide for a few years for atrial flutter, maybe fibrillation and it has worked well for him. Best I can recall he started the medication without hospitalization.

I think it depends more on the doctor than the patient - don't have any facts.  I do recall when I went on a high dose of Rythmol (425 mg twice a day as I recall it) I was on a monitor.  I started at home but the monitor would alarm if it saw any troubling rhythms.. there were none, and the AFib continued.  I tend to have minimal affects from medication, both desired and side effects.  I know others have very different reactions to drugs.