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I have a history of tachycardia that would take off

sometimes for 30 minutes to...
I have a history of tachycardia that would take off sometimes for 30 minutes to 5 hours. My ekg’s always showed tachycardia in normal sinus rhythm. Except for one that said borderline atrial tachycardia. I’m slowly getting off acebutolol. My recovery time was horrible.I had an ablation for avnrt last March (it was exploratory really Bc they didn’t know where it came from). Afterward my heart Rate was still high. It shot up to 130 when I’d barely move in bed right after the ablation. So my EP changed me from diltiazem to acebutolol 200 mg twice a day. I had been pretty tired on it for about 9 months. The EP I went to did not seem to care to manage my Meds. I went through a lot of “episodes” from trying to get off Meds without really tapering off more than taking it every other day and then stopping. It was horrible. I still slowly getting off it.I went to another EP and he wants me on flecanide. He said my tracings never warranted an ablation and if I had one I’d need to be awake for it. He said, “Great if he found something to ablate, but that (anvrt) wasn’t what was causing your problem.” My ekg always showed tachycardia with normal sinus rhythm. Once it showed probable atrial. He has all my records.He said flecanide is very safe for my problem and I should try it. He said I could start it while on acebutolol. Does flecanide lower your heart rate as well? Would it counter act my hypertensive and variable heart rate when getting off of acebutolol? Is flecanide difficult to get off of it it does not work? I’m tired of episodes and some side effects. I just want a time of peace and no worry. What are your thoughts on the My heart rate is a little high first thing in the morning. Every once in a while with variances, but mainly normal. What questions should I ask and what is your opinion? Thank you
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Answered in 24 minutes by:
2/18/2018
Dr. D. Love
Dr. D. Love, Doctor
Category: Medical
Satisfied Customers: 19,643
Experience: Family Physician for 10 years; Hospital Medical Director for 10 years.
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There are several questions here. Let me make some general comments and then address specific question in turn.

It sounds from the comments of the various doctors that this is more than simply a sinus tachycardia, regardless of what the EKGs say. It does not make sense to even try an ablation for a sinus tachycardia. And if they say that they are performing an ablation for AVNRT, that would not alter a sinus tachycardia. Of course, they could be seeing something on an EP study that is not apparent on the EKG, but without seeing the formal report, it is difficult to know what was seen.

To the extent that they are seeing something beyond a sinus tachycardia, then the use of flecainide would make more sense. It is more often used for abnormal atrial and ventricular arrhythmias, rather than a sinus tachycardia.

Does flecanide lower your heart rate as well? Yes. It does not directly lower the heart rate in the same way that a beta-blocker does. It also can have a mild effect on slowing the normal resting heart rate, but it is not as significant an effect as a beta-blocker. But the flecainide clearly slows abnormal heart rhythms that cause tachycardia, including atrial tachycardia, supraventricular tachycardia, and atrial fibrillation.

Would it counter act my hypertensive and variable heart rate when getting off of acebutolol? Yes, it may, although there is no heart rhythm medicine that works in everyone. So, it cannot be said that it definitely will work, but it is a reasonable option in this situation.

Is flecanide difficult to get off of it it does not work? It is not difficult to get off of if it does not work. The primary issue when stopping the medicine is a worsening of the underlying condition. This is more of an issue when it is helping but is also causing side effects and stopping the medicine is being considered because of the side effects. if the flecainide simply does not work, there is still an issue of finding something that will work, but stopping the flecainide is typically not an issue in that situation.

The primary question to ask is to get a better understanding of what was seen and what is being treated.

If I can provide any clarification, please let me know.

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Customer reply replied 4 months ago
Thanks for taking the time to answer.I’ve been getting mixed guidance. One Dr thinks I’ll be fine off meds, and two others from the same group want to try flecainide. My Cardiologist thought an ablation would be better than Meds if it worked. His EP said it’s better than the side effects of medication.I’m 37. With flecainide I have to have my liver checked every 6 months. What’s your opinion on it it’s a safe drug and should I be concerned about liver damage if I’m in it most of my life?Are there any other options or meds I should ask my EP about?My 1st EP only stated avnrt from the ablation and mapping in surgery. I’m not sure I can believe him. Idk.
Customer reply replied 4 months ago
I’d be starting on 50 mg flecainide.

I am sorry for the delay, but I had to step away from the computer for dinner.

As for safety, the flecainide is generally well tolerated. Any drug has the potential for side effects, but the risk for serious side effects is quite low at the lower doses that are used for atrial arrhythmias. Although the article that you attached to the other question addressed atrial fibrillation, the portion of that article of how well the flecainide is tolerated would still apply in your situation, and that article has extensive discussion that the flecainide is generally very well tolerated.

There are other similar anti-arrhythmic drugs, such as propafenone or procainamide, but all anti-arrhythmic drugs have the potential for4 side effects, and among these drugs, the flecainide is considered the preferable drug. It is true that beta-blockers are generally better tolerated than these anti-arrhythmic drugs, but you have already been tried on acebutolol

The 50 mg strength is the appropriate starting dose for atrial arrhythmias.

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Customer reply replied 4 months ago
No problem with the delay. You have answered this more thoroughly than when I tried to ask it before.My only problem with acebutolol 200 mg was that I was foggy and exhausted on it. Now that I’m tapering I have more of my mind and energy. Would you ask about changing to a beta blocker like metoprolol instead of flecainide? It’s a tab instead of a capsule so you can divide it better for lower dosing. I don’t like taking meds, but know I need something. I also had major withdrawals the first time trying to get off the beta blocker.

If the acebutolol worked but is being stopped solely because of side effects, then it would be reasonable to consider a different beta-blocker, such as metoprolol. One of the other advantages of metoprolol is that it is available as a sustained release form, so maintains a steadier level in the blood stream, and that would be more of an advantage if the side effects to acebutolol were more prominent when the drug is peaking in your system.

Dr. D. Love
Dr. D. Love, Doctor
Category: Medical
Satisfied Customers: 19,643
Experience: Family Physician for 10 years; Hospital Medical Director for 10 years.
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Customer reply replied 4 months ago
Thank you for your insight. Have a great night. You answered well.
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