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Is it advisable to take Flecainide for AFib?

This Premium Q&A, reviewed and published, features a real conversation between an iCliniq user and a physician.

Patient's Query

Hello doctor,

I am 50 years old and have PAF (paroxysmal atrial fibrillation). My first episode of AFib occurred five years ago, and I converted on my own. It went away for five years, but at the end of the year, I started a keto diet and went into AFib twice, both times converting on my own. I started the keto diet again and went into AFib twice more, again converting on my own. My cardiologist has prescribed 50 mg of Flecainide twice a day. I am also taking 20 mg of Fluoxetine and 400 mg of Trazodone. I am concerned about developing prolonged QT syndrome and am unsure whether Flecainide is really necessary. I worry about the potential effects of Flecainide on my heart, especially since I otherwise have a healthy heart, with a resting heart rate of 60 and a blood pressure of 95/70 mmHg.

Please advise.
Answered by Dr. Ilir Sharka

Education:

Faculty of Medicine

Professional Bio:

Dr. Ilir Sharka is a Cardiologist. He can diagnose and manage heart diseases such as coronary artery disease and heart failure. He can interpret ECG, echocardiography, and stress tests. He can help in hypertension management and lipid control. He can treat arrhythmias and conduction disorders. He also does interventional procedures, including angioplasty and stenting (where applicable). He can help in heart valve disease assessment and management. He can provide preventive cardiology and risk factor modification.

This doctor is not available for online consultations on the platform anymore.

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Hello,

Welcome to icliniq.com.

I have carefully reviewed your medical history and would like to explain that you are correct to be concerned about your current medications. Both Fluoxetine and Flecainide can increase the QTc interval and may predispose you to arrhythmia. I would recommend discontinuing their concurrent use. It may be better to start withdrawing both medications. However, if this is not feasible at the moment, you should discuss with your attending doctor the possibility of continuing the most essential medication, which in your case seems to be Fluoxetine.

Additionally, Trazodone may also exacerbate the pro-arrhythmic effects (increase the QTc interval). In light of this, it would be prudent to stop the keto diet for now, as well as Flecainide. Adjusting the combination of Fluoxetine and Trazodone is recommended to minimize potential adverse effects. You should also check your thyroid hormone levels to ensure they are not contributing to the recent episodes of atrial fibrillation.

Thanks and regards.

Medically reviewed by Dr. K. Shobana
Published At September 1, 2023
Reviewed At November 15, 2024

Education:

Faculty of Medicine

Professional Bio:

Dr. Ilir Sharka is a Cardiologist. He can diagnose and manage heart diseases such as coronary artery disease and heart failure. He can interpret ECG, echocardiography, and stress tests. He can help in hypertension management and lipid control. He can treat arrhythmias and conduction disorders. He also does interventional procedures, including angioplasty and stenting (where applicable). He can help in heart valve disease assessment and management. He can provide preventive cardiology and risk factor modification.

This doctor is not available for online consultations on the platform anymore.

Consult other doctors in the same speciality

Education:

BDS

Professional Bio:

Dr. K. Shobana is a Dental Surgeon specializing in oral health and dental care. She is skilled in preventive dentistry and provides oral hygiene education. She can do restorative treatments such as fillings and crowns. She can handle periodontal problems such as gum diseases and periodontitis. She can do root canal treatment.

This doctor is not available for online consultations on the platform anymore.

Consult other doctors in the same speciality

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Dr. Ilir Sharka
Dr. Ilir Sharka

Cardiology

Education:

Faculty of Medicine

Professional Bio:

Dr. Ilir Sharka is a Cardiologist. He can diagnose and manage heart diseases such as coronary artery disease and heart failure. He can interpret ECG, echocardiography, and stress tests. He can help in hypertension management and lipid control. He can treat arrhythmias and conduction disorders. He also does interventional procedures, including angioplasty and stenting (where applicable). He can help in heart valve disease assessment and management. He can provide preventive cardiology and risk factor modification.

This doctor is not available for online consultations on the platform anymore.

Consult other doctors in the same speciality
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