Flecainide for Arrhythmogenic Mitral Valve Prolapse?

Hi all! I'm 37 and I have Arrhythmogenic Mitral Valve Prolapse (and an ICD). I saw my cardiologist for my annual visit today and he recommended to change my medication a bit...because he has seen other female patients (with the same condition) do well on the combo he's recommending. The idea is that I would change the medication and then do a Holter in 3-4 months to see if there's any improvement with my arrhythmias. He's mainly concerned because at my last device check (which I do every 6 months), there was a run of 9 beats...which, if had gone to 20, I would've been shocked. For 4 years, I have been taking 5mg Bisoprolol twice a day. He wants me to reduce my Bisoprolol to 5mg once a day and add Flecainide (150mg) twice a day. I guess my question is...does anyone have experience with Flecainide? I feel like I've read negative things about it on here in the past...

P.S. The good news is that my most recent echo says that I have "mild regurgitation," so no surgery for me to fix my valve (yet!...and hopefully many years to come!)

1 Comments

Flecainide is a good starter anti arrhythmic med. Worth a try

by Gemita - 2023-10-19 23:38:16

Lildanishgirl, I successfully took Flecainide for atrial fibrillation for several years with minimum side effects until it became pro arrhythmic when I developed Atrial Flutter.   The only side effect I had was blurry vision.  At first I thought this was caused by my cataract, but it was due to Flecainide, particularly at higher doses.

Looking at your proposed dose, 150 mg twice daily is a fairly high starting dose.  They started me off on 50 mg twice a day.  You could ask if you could start on a lower dose and build up gradually to the desired level?  

I have attached a couple of links, not to scare you, but to help inform you of the potential effects of Flecainide.  I was told it is a great starter anti arrhythmic med for many of us and usually well tolerated and I certainly found this to be the case.  Have a read of the attached first link.  Flecainide is contraindicated in patients with structural heart disease, coronary artery disease or heart failure.  

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

Flecainide can rarely interfere with pacing therapies resulting in inconsistent pacemaker capture (see second link), particularly if toxicity occurs.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8302776/

I was told anti arrhythmic meds are certainly not as safe as a rate control med like a beta blocker or calcium channel blocker, since all anti arrhythmic meds have the potential to become pro arrhythmic.  Are you saying that you had a run of 9 beats of non sustained VT and your doctor wants to prevent these from becoming prolonged and more frequent?  I have runs of NSVT too, as well as more persistent atrial tachy arrhythmias.  I am treated with Bisoprolol alone now.  I have had a great response to pacing.  Very rare I know, but I am not complaining.

Anyway, good to hear from you again and I hope the little one is doing well?

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I just want to share about the quality of life after my pacemaker, and hopefully increase awareness that lifestyles do not have to be drastically modified just because we are pacemaker recipients.