Is it advisable to take Flecainide for AFib?

Question

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.

Answer 1

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.