Atrial Fibrillation (AFib) Support Group

Atrial fibrillation (AF or afib) is an abnormal heart rhythm (cardiac arrhythmia) which involves the two small, upper heart chambers (the atria). Heart beats in a normal heart begin after electricity generated in the atria by the sinoatrial node spread through the heart and cause contraction of the heart muscle and pumping of blood.

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tvanslooten 12/08/2013

I'll try to make this brief. I'm 41 (male) and had my first afib attack in 2006 and had an electrical cardioversion. I was diagnosed with lone afib.

I went 5 years before I had my next attack in 2011. Once again I went to the E.R. and had an electrical cardioversion.

Then in February 2012 I had another attack and went to the E.R. for another electrical cardioversion. So far (knock on wood), I have been in NSR.

I'm not on any meds, blood thinners, aspirin, etc. etc. because I only have these episodes sporadically and when I get them, it hits me hard - 150 - 200 beats per minute - so I know I'm in afib!!

By default, I have always gone straight to the E.R. because the cardioversions have always worked. The problem is, it's a major pain in the butt, frustrating, and expensive!

My cardiologist said I should try the P.I.P. approach (Flecainide) the next time this happens. He said it might help convert me on my own without having to go to the E.R.

Here's my concern. One cardiologist I met with would not give me a prescription to Flecainide. He doesn't let any of his patients take it on their own for the first time. He demands they go to the E.R. first and then take it. If it works and there are no side effects, then he'll give a prescription so I can take it at home.

My main cardiologist didn't understand that approach and said given my young age and good heart health, he has no problem giving me Flecainide and allow me to take it on my own.

I'm a little worried. Why would one doctor demand I go to the E.R. before I take this stuff and another have no problem at all of letting me take it on my own for the first time? What could happen that one doctor would require I be in the E.R. before taking it?

And regardless of taking Flecainide or not, I'm just wondering if I should hold off heading to the E.R. the next time I get afib. As long as I can tolerate 150 - 200 beats per minute (and I can), would it hurt to wait a good 12 hours or so to see if maybe I convert on my own...or is it best to just head to the E.R.? And should I take the Flecainide on my own or take it in the E.R.??

I don't know if this info helps to know, but I have normal to low blood pressure and my resting heart rate is 50 (I used to be an avid runner).

Travis

CLane 12/09/2013

Hi Travis:

I started Flecainide at home. I was prescribed Flecainide daily at various doses/twice daily. I never took it as PIP. I, too, had the question as to why I was told to start this medication at home since I had heard that many doctor's hospitalize their patients to start Flecainide. My doctor always did an EKG before changing the doses to be sure there were no other issues going on before initiating Flec or changing its dose. I was told that because I had no heart disease and am younger ( I was 42 at the time) that it was not necessary to hospitalize me to start Flec. Good luck with your decision and take care, Carrie

Surfrat 12/09/2013

Interesting scenario. I'm wicked surprised that you have had that many electro conversions. I have been under the impression that this was not a common resolve and only used rarely as a last esort. I've been to the ER way too many times (and admitted) and have never had one to date. If you've been directed to run on auto pilot with no meds. (which is also odd), I agree the PIP (Flec.) will be a good possible remedy should you go off at home again. I've used it on one occasion (three big pills) and after 30 minutes it worked. I was however in the ER when this was given to me. I do have a 'scrip though for emergencies on my own as a PIP. Best of luck and keep us all posted. ;) - Thomas

chubabubba 12/09/2013

I'm a female in my 70's and was given Flecainide to start at home. EP didn't seem to think it was a big deal that required a hospital visit. Every EP has their own way of doing things.

marikay234 12/09/2013

Flecainide should not be taken by anyone with heart disease. I take flec every day and my EP wouldn't start it until I had a thorough workup including stress echo. I did start it at home. The reason some Drs want to start it while you are supervised is that while flec can get you out of afib it can also trigger more serious arrythmias that would require prompt treatment. This is most likely to happen in patients with some existing heart disease.
Flecainide works very well for some....I have taken it for almost 3 years and I have a small breakthrough episode 1-2 times a year. I take an extra 1/2 flec and I convert within an hour or so. While it seems like kind of a scary med it has given me my life back.

Steveinnsr 12/09/2013

I also find it interesting that you have been cardioverted so early on in your Afib and with so infrequent episodes. In my nearly 20 years of Afib(15 in frequent to daily Afib) I never once went to the emergency room or considered cardioversion. Cardiologists seem to have a varied protocol for when medical intervention should be considered. My Cardio doctor((not my EP) suggested that unless I was in Afib for 5-7 days that I didn't need to seek help. I was comfortable with that and rarely went more than a couple of days in constant Afib. When episodes become frequent I think most people build up more of a tolerance for mild to moderate symptoms and tend to push through until converting on their own. It takes some work to develop mind over symptoms and develop the mind set to relax rather than become anxious.

I started Rhythmol at home. In the early days all antiarrhythmic meds were started in a hospital environment. Over time doctors began allowing home/patient start up for certain drugs. I'm sure age and heart condition plays a major role in that decision. There's no denying these are powerful drugs and precautions are a must.

You said that you were not on any anticoagulation. If you have an increase in episode frequency going forward then I would suggest you talk about this with your doctor and also consider finding a very good electrophysiologist if you haven't already.

Steve

nhnmnh 12/09/2013

My EP gave me a prescription to start Flecainide at home, but arranged for me to have an EKG strip done when I was going into the hospital for a day surgery three days later--with the surgery conditional on him seeing the EKG results first to make sure the rhythm was not worse.

shefland 12/09/2013

well I have had 11 cardioversions and 2 ablations in the past 4 years, I live "up north" in Minnesota, I am wary of the hospital, keep me for 3 days just for the conversion! in Mpls at the heart institute its outpatient treatment, about 4 hours or so then you are on your way home So I will not go locally unless I really have to..I am getting better at waiting but inevitably I need to go and get converted, as others know it just happens, no warning, nothing

IZEileen 12/09/2013

I'm a 72 year old female put on flecanide last year 50mg. twice a day.I asked my EP about starting it at the hospital and she said not necessary. So far I have had no problems. I wish you well with your decision.

yogacat 12/09/2013

It is so interesting, the variety of protocols each Dr. has, don't you think.

My first Cardio Dr. told me Not to go to the ER. I was diagnosed there, and whatever they gave me to convert, didn't work. I was sent home and converted on my way to his office early the next morning.

A year later, I I was in Afib for several days, and was told to go to ER on the 5th day. I converted soon after being told this.

At one time, Cardio dr. wanted me to take Flecainide. He told me there would be a test he wanted to take, but I would not have to be hospitalized. He also told me I could not take Flecainide as a PIP. I know others do.

My heart rate is always 100 or less because I take Metoprolol when I go into an episode. I think I wouldn't want to have the high rate for any length of time. I have Bradycardia, but my rate goes up to 140 when in afib.

deleted_user 12/09/2013

I am 39 (male). I go into afib about once every 7-10 days. Ever since this started (2 years ago) I have been able to get myself converted by running. I can usually convert back to a NSR in about 10 min. I have found recently that if I do sprints I go back into NSR sooner (maybe 5 min). Maybe try this if you are still in decent shape since you were a runner at one time.

I think one of the most challenging things I have found out about afib is that I don't think any doctors treat this the same way. There is no consistency. I talked to one doctor and he could not believe I was going into afib at my age. He was ready to give me all kinds of meds (no blood thinners). Next doctor did not seem to concerned at all. He said it is benign. He seemed ok with me managing the way I have been for past couple years.

I was told by both that I should go to ER if I stay in afib for over 24 hours but I have heard of so many people who are in afib all the time and I have no idea why they are not getting converted. Is it impossible to convert some people? I dont get it anymore.

pacyetep 12/09/2013

If you are in afib all the time electrocardioversion never holds.

deleted_user 12/10/2013

Hi There,

I have paroxysmal a-fib, and I usually have an episode , every 11-24 days. Just started in May. Ended up in the ER in May, but, they do not opt for cardioversion, unless, there is no other way. They gave me an IV drip of some type of rhythm meds (I didn't know anything about afib, at that time) and I converted. That's the only time, I ever went to the ER. I went to a cardiologist and one EP. Battery of tests done, heart is structurally sound.

Im 58, have been on beta blockers and one baby asprin. But, I don't tolerate the BB (get very very sleepy, as I have a natural low pulse to begin with) , very well, so, we are trying a different approach. and just took my first PIP of Flecainide, 4 days ago. I had no side affect from the drug. Unfortunately, it also, didn't help me convert either. But, I will give it time.

Hang in there.

SeanOpositive 12/10/2013

I'm 36 years of age. In September, one EP started me on Flecainide at home, but he was persistent that I take metoprolol in combination as they work in concert - rhythm control and rate control. Perhaps also to control side effect? I could have been my own nervous anxiety, but I discontinued Flecainide after 2 weeks since I had more palpitations/a-fib. After an aborted ablation (due to clotting on transseptal sheat), a second EP started me on Rythmol at home, also insistent that I take in combination with metoprolol. That combination really dropped my pulse and diastoly so I withheld the metoprolol. However, 3 weeks later, Rythmol is having no effect at reducing my a-fib episodes, so we will likely try a new med.

Also, my first EP's nurse told me that Flecainide takes about 5 days to load, at least on the dose I was on - 50mg twice daily. What is the PIP dose???

Stop Afib!
Sean

SameDayNurse 12/10/2013

I have been on Flecainide 50mg twice a day for over 5 years now....it has also given me my life back. My heart guy said this is one of the only drugs of this class they WILL start at home on a person with tests having proven the heart to be otherwise healthy some of the other meds require a hospital stay beyond the ER. I use Flecainide in a booster dose if I have an episode and have never had to go back to an ER since initial diagnosis 9 years ago. Best of luck in finding the part of the puzzle that gives you the freedom to enjoy your life.....jan

tvanslooten 12/10/2013

Wow...thanks for all the replies. Interesting perspectives from everyone, for sure. Let me address some of the comments, however.

I am very symptomatic when I have afib so I know instantly when I'm in afib. Luckily, I have only had 3 episodes since 2006. There would be no need for me to be on drugs or blood thinners given where I'm at with afib right now.

Since I've only had 3 episodes, my immediate reaction (because it's all I've known), is to head to the E.R. and have a cardioversion. It's like a routine Dr.'s visit for me....lol. Every time I have gone in, it's been the same procedure. They triage nurse confirms my afib and then they immediately send me to a room. Then the nurses freak out (literally) and try to convert me with various I.V. stuff, which of course I never respond. Then the E.R. doctor comes in and says they'll need to cardiovert me. I have the cardioversion and then I'm good for another year or more:)

Not once during this process does the E.R. doctor suggest drugs or self conversion. Their immediate response is always to cardiovert me. I couldn't imagine them telling me to go home! And my cardiologist also tells me that what I'm doing is fine BUT he does recommend I try the PIP approach so that's how this Flec stuff came up.

Someone asked me what the dosage of the Flec was. When I have my next episode, I'm supposed to take 300mg. Personally, I don't see how a one-dose shot will work but maybe it will. I'm just nervous to try it. I think I would rather deal with the inconvenience and expense of a cardioversion. I'm just crossing my fingers I won't have to make that decision for a while. My goal is to make it to March 1, 2014 without an episode. If I do that, I will have gone an entire year afib-free.

Travis

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