Flacainide with pacemaker

Flecainide

by Gemita - 2023-06-05 10:44:14

Jam, what have you heard about Flecainide being risky with your pacemaker?  If your doctor has prescribed it, I am fairly confident that it is safe for you to take.  Are you trying to come off Flecainide with your doctor’s help?  I hope so.  

There has been a case of Acute Ventricular Capture Threshold Rise associated with Flecainide, see link below, but why do you think that Flecainide with a pacemaker is so risky for you?

I was on Flecainide for several years and slowly weaned myself of it due to Flecainide becoming pro arrhythmic (it actually started making my Atrial Fibrillation episodes worse after a few years and I also developed Atrial Flutter on it).  I did not have any difficulties stopping the med but I did so very very slowly with the help of my EP.

I see you are on Toprol (Metoprolol) and Eliquis.  I suspect your arrhythmias are active and the cause for your shortness of breath or other symptoms, but I would let your doctors know what is happening.  The higher dose Metoprolol and weaning yourself off the Flecainide is bound to be having an effect

https://core.ac.uk/download/pdf/225371313.pdf

Flacainide

by Jam - 2023-06-05 19:28:07

Thank you for your comment. I read in The National Institute of Health that Using Flacainide with a pacemaker could result in pacemaker latency and intermitten failure to capture. As I mentioned I asked my EP if I could do the Pill In Pocket. He said yes and I tried stopping Flacainide cold Turkey which he said I coul do, When I felt bad I took one 50m and felt better in about an hour. Next day I felt bad again so do the same, This time I felt bad most of the day. I also had my extended release beta blocker increased 50 mg taken at night. I take 100 mg am. I am wondering if the extended . release Toprol is accumulating. I have another app with themEP to see what's going on.

coming off Flecainide

by Gemita - 2023-06-06 01:32:30

Jam, I understand your concerns completely.  All anti arrhythmic meds carry warnings and my doctors tell me that the safer option would always be a rate control med like a beta blocker or calcium channel blocker to control an arrhythmia like for instance, Atrial Fibrillation (AF).  However, it has to be said that some of us feel better on an anti arrhythmic med and may need one to stop an arrhythmia, especially if we find one that suits. I did well on Flecainide at first since I do not have heart disease.  See link below for contraindications, otherwise Flecainide can be a good starter anti arrhythmic med for many of us and most patients tolerate it well.

I was started on Flecainide in hospital to make sure that the starter dose was appropriate and safe for me (2 x 50 mg a.m. and p.m.)  I met many patients in my pacemaker clinic who were very happy on Flecainide and had had years of good AF control from taking it, but of course there are always risks.  You have pointed out a valid “potential” risk for pacemaker patients taking a certain class of anti arrhythmic meds, not only Flecainide, but of course it doesn’t happen to everyone and capture changes, if they do occur, may not always be clinically significant.

What we need to remember is that an arrhythmia if it is not controlled can also cause problems not only for our bodies but also make our pacing requirements (need for settings adjustments) more likely and complex, so stopping Flecainide at low doses “if it worked for you” might not be such a good idea.  I would certainly not stop Flecainide cold turkey in any event.  It can be dangerous too.

Jam, I wish you all the best and hope that if Flecainide doesn't suit you, your beta blocker alone will help to control any arrhythmia you are trying to treat.  I think it is more likely that weaning yourself off regular doses of Flecainide is likely to be the problem rather than the higher dose of sustained release Metoprolol?  If you felt well on Flecainide, I am not really sure why you want to come off it?  2 x 50 mg per day is a low dose anyway.  I tried reducing from 2 x 100 mg per day down to 2 x 50 mg per day for several weeks.  Then reduced to 1 x 50 mg per day for several weeks, then to 1 x 50 mg every other day, before dropping it completely.  I now just use a beta blocker (low dose) daily and I am doing incredibly well.

https://www.ncbi.nlm.nih.gov/books/NBK542291/

Conditions meds and test

by Jam - 2023-06-07 13:44:38

Germita,  I forgot to ask you how long did it take for you to stop Flacainide and did you have any symptoms of withdrawal? My EP did say I could stop cold Turkey and use pill in pockets. Past two days  I have had to take 1 50 mg Flacainide at around 12 o'clock pm each day. Seems to stop PVCs in a couple of hours and I am pretty good until the next day! Maybe I can take once a day ! I have an appt with the PA Friday so see what she recommends. Thanks
 

. 

No symptoms of withdrawal by coming off Flecainide slowly

by Gemita - 2023-06-07 15:10:11

As per my previous comments I stopped Flecainide over a period of a couple months (about 8 weeks) and I didn't notice I was without it.  In your case if you feel well on 1 x 50 mg Flecainide daily, go for it.  After you were originally prescribed 2 x 50 mg, it cannot do you any harm at 50 mg dose and it is better to keep 50 mg in your system regularly than to keep stopping and starting which is more difficult for your body to tolerate anyway.  See what your doctor says but if it helps, then why not?  Good luck on Friday