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Doctor G.
Doctor G., Doctor (MD)
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I am unsure about taking flecainide with symptoms as 1270 PVCs

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I am unsure about taking flecainide with symptoms as 1270 PVCs a day with 168 AVCs and 1 4beat tachardia.Have high blood pressure taking Zebeta and Benicar.Diag.with L Vent Hyper.
Submitted: 8 years ago.
Category: Health
Expert:  Doctor G. replied 8 years ago.
Just to be clear, you have 1270 PVC's a day, with symptoms?
The 4 beat tachycardia was PVC's?
Customer: replied 8 years ago.
To be clear the symptoms noted on the last Holter test were 1270 PVCs 168 PACs some couplets some triplets and 1 4 beat burst of tachyardia (ventricular.)I do not have that many everyday and can go a few days with barely any noticed PVCs.Other times like starting this past Sunday it will go on and on like what I posted for the Holter.No smoking or caffiene for 2 plus years and occ red wine only alcohol intake.Ativan sometimes helps. Zebeta and Benicar help with blood pressure and maybe keep PVCs down.Execise M T Th F walk 1.25 miles then run .5. Sat Sun hike 1 mile uphill then back.Pvcs after and multiple when in middle of (attack of them)Last stress test 1 PAC only but I knew going in that would happen as I can feel the bouts of PVCs and none were present that day.Ultrasound on Carotid O.K. as were other tests for blockage. Ejection Frac 50 Left Vent Hyper noted on first ultra sound .at wits end
Expert:  Doctor G. replied 8 years ago.
Are the beats of PVC's unifocal or multifocal?
Your age?
Did you ever have an electrophysiology study done?
After you answer this, we'll discus the flecainide and why the doctor wants to use this particular drug in your particular situation.
Customer: replied 8 years ago.

On the first Holter monitor the PVCs were unifocal but on the last one(in April )they were not.I am 49 1/2 years old.I have not had an electrophysiology study.I have looked into Flecainide and the cautions are worrisome as I do not wish to lower the Ej FR.more and I do not have tons of PVCs every day.Also the possibility of a new arrithymia seems not worth the risk.I was told to start the Flecainide and not to exercise for one week then come back for another stress test which seems logical.The info I have found says most times when this drug is started people are in the hospital on a EKG.Once I start this I suppose I would never be taken off it.One last thing,I have read lost of inquiries from people age 20 to 50 years old about PVCs,none from 65 years old.I do not recall feeling them as a child and in fact they became noticed 6 years ago then went away.Came back for 7 months went away then 3 years ago came back fairly strong hence the lifestyle changes.Thank you

Expert:  Doctor G. replied 8 years ago.
Thanks you for the additional information.
Let's start off by discussing PVC's. PVC's themselves are not dangerous per se. In fact the majority of the population has them. It also doesn't really matter if you have many PVC's as long as they are not symptomatic and are unifocal. Where you start running into issues is when they are multifocal or have runs of them or have underlying heart issues such as heart disease or cardiomyopathy or having PVC's with symptoms. The easiest to treat in terms of PVC's is when a person falls into two categories. First, when they PVC's and are unifocal, no runs, no symptoms, no heart disease. At this point you do nothing except monitor. The next is when a person has PVC's and may have heart issues or they are multifocal or they are symptomatic or have multiple runs or have a family history of sudden cardiac death. At this point you treat with various medications and even an implantable cardiac defibrillator (ICD).
Your situation has no real hard-and-fast rule.
You have PVC's, 1 run, Normal ejection fraction (EF), no heart disease (Left ventricular hypertrophy-LVH- is a common thing and is usually caused by hypertension, not really considered to be structural heart disease per se).
So does one do with someone who is not a textbook case? Well, flecainide is the drug of choice for someone in your shoes. It is used in people who may have issues with PVC's but otherwise have no cardiac disease. It is true that this medication can act as a "Proarrhythmc" meaning it can actually cause an arrhythmia but this happens with people who are taking high doses or have undetected conduction issues (such as hidden pathway), or have poor ventricular function (ie, low EF).
The drug is a relatively good one as it does really work and does not have significant side effects (such as stomach issues and the lot). The bad news is that it has a relatively tight safety index. This means that the drug has to be kept within a certain range because you can become toxic if the levels are not monitored. This is done with blood work. This doesn't last forever just until the drug is stabilized.
This is why the cardiologist is deciding that this may be the best route for you.
I would have liked to seen you go to the electrophysiologist for this and possibly get an electrophysiology study done to see where this arrhythmia is coming from or even how easy is it to trigger.

I now this is a complicated topic, so feel free to dissect and ask questions.


Have a blessed Wednesday.
I hope I’ve been able to shed a little light on this for you.
If you have further questions on this topic, please feel free to ask.


You should always consult with your physician for the proper diagnosis and treatment.
The above was for educational purposes only and does not confer a doctor-patient privilege or relationship.
Doctor G. and 3 other Health Specialists are ready to help you
Customer: replied 8 years ago.
Thank you,it was the cardio eletrophysiologist who prescribed the flecainide.I can feel every PVC or PAC, they can become uncomfortable and enough of them an hour is hard to get past. A full day of them can cause swelling in ankles though I stand all day also. I would have hoped to find a trigger or two to avoid to keep them away. From the report: heart rates from 44 to 154(running) 168 supraventricular ectopics w 36 couplets no runs 1280 ventricular ectopics 33 couplets 1 triplet 1 4 beat tachycardia 130beats/min 17 hours and 56 min out of 24 I wore the monitor. bigeminal at times.I guess the other 7 hours were not needed? they missed another 600 ectopics.an odd note (to me) the tachycardia was at 5:41 am (130 beats/min) the low of 44 b/m at 5:44 am all of which woke me up from action style dreams
Expert:  Doctor G. replied 8 years ago.
I'm glad to see your being treated by the electro doc. Since you are symptomatic, this is the right approach. It's very difficult to find a trigger point. The reason is because most of the time there is none to speak of. The 7 hours probably didn't have anything important to speak of, such as more APC's or even JPC's. In the morning we release catecholamines which increase the heart rate and then it decreases. That's not that uncommon. The botXXXXX XXXXXne is I think your doctor is on the right track and using the proper approach.

Have a blessed Wednesday.
I hope I’ve been able to shed a little light on this for you.
If you have further questions on this topic, please feel free to ask.


You should always consult with your physician for the proper diagnosis and treatment.
The above was for educational purposes only and does not confer a doctor-patient privilege or relationship.