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Treatments for Afib: Flecainide

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Flecainide is a medication used in treatment of AFib. Although it is very effective, people tend to be wary of it because of negative publicity in recent years. In this video, i demystify Flecainide. Id be so grateful if you would please consider sharing and subscribing

My name is sanjay gupta i’m a consultant cardiologist in new york thank you very much for watching my channel i wanted to do a new series of videos looking at medications that we use and in particular going through the medications explaining why we use those medications what the benefits are and what the risks are and in particular i wanted to start off by doing

This for people who have atrial fibrillation and talked about medications that we use in atrial fibrillation okay so today i wanted to start off by talking about a medication called flake and i’d like an id is an anti destroyed m’q what that means is it tries it’s a medication which can be used to preserve heart rhythm or if the patient is in an abnormal heart

Rhythm it can convert them back into a normal rhythm so in atrial fibrillation the heart beats irregularly like an ied will a try and stop you from going from a normal regular rhythm to an irregular rhythm but if you are in an irregular rhythm flecainide can help bring you back into a normal rhythm okay so that is the role of flaca might flick a night can be given

In three ways the first way which is quite handy is as a pill in the pocket so this is ideal for those people who get in frequent paroxysms of atrial fibrillation so they’re they’re fine then once every month or once every six months or once every year they’ll get an episode of atrial fibrillation and in that setting flecainide can be used as a pill in the pocket

It can be given in a dose between a hundred to four hundred milligrams a day and you basically take this dose and it can be very effective and in fact if the atrial fibrillation has been going on for less than 24 hours then there’s some good research studies which have shown that a pillar of flecainide can terminate that episode of atrial fibrillation in about 68%

Of time 68% of times and it does say within around about an average of 110 minutes so it’s really useful it with that regard as a pill in the pocket the second way in which black an id can be used as it can be given on a daily basis so if you had atrial fibrillation and you had one episode every month then you could use it as a pill in the pocket but if you were

Getting episodes every day and then it’s a bit of a pain to have the episode and then take a pill rather than that you’d rather not have the episode to start off with so by taking flak a night every day that a dose of 50 to 100 milligrams daily you can significantly reduce the number of paroxysms of atrial fibrillation that happened and when you do go into atrial

Fibrillation you may not remain in atrial fibrillation for as long so it can be given in that way there’s the third way in which flack a knife can be given and that is it can be given intravenously so if you have an atrial fibrillation attack so you’re sitting at home you go into atrial fibrillation your heart is make it’s going really fast you don’t like it you

Go into a knee and they can give you an intravenous infusion of flack a night and that can be very effective and in some research studies that has been shown to be you know to try and get 65 to 90 percent of patients out of atrial fibrillation within a six hour period so it’s a very useful drug let’s talk about some of the other important considerations with a

Medication like this okay you have to be aware of two main things with flaca night the first is this flakka night can be probe a ritmo genic what i mean by that is it can cause heart rhythm disturbances of its own accord as a side effect there was a very interesting study that was done which was called the cost study cas t and in this study what happened was they

Took a bunch of people who’d had a heart attack and who had irritability of their heart as manifest with heart rhythm disturbances and they gave these people flak a night and unfortunately what they found was the mortality was increased in the group that took the flaca bite and therefore fleck and i’ve got a really nasty reputation because people thought oh it’s

Pro arithmetic it can cause heart rhythm disturbances it’s a dangerous drug actually when people started looking at the research what they started realizing is that perhaps the increase in mortality in that study was confined to those people who’d had damage to their heart so if you have a structurally normal heart then flecainide is actually considered a relatively

Safe drug and should not cause any of those problems so it is not so doctors don’t want to prescribe it without being confident that the patient has a structurally normal heart and they do say by doing an echocardiogram say it hardly looks structurally normal and that’s incredibly reassuring and then sometimes what doctors like to do is they like to study the heart

Artery supplying the heart to make sure there are no narrowings because if there was a narrowing that could cause the heart to malfunction and then if you’re taking the flaking eyes that could make it more irritable etc so generally what doctors would like to do before they prescribe flecainide safely is to do an echocardiogram and maybe some kind of a tiller

Test which delineates the heart arteries that could include a ct coronary angiogram of cardiac ct scan or an invasive angiogram where they stick some dye into the arteries and look at it on an x-ray invasively and if those are okay then flecainide is a safe drug and can be a very helpful drug to try and reduce episodes of af one other thing you should know about

Flecainide is that flick knife can sometimes convert people who are in atrial fibrillation into something called atrial flutter where the atria are not actually fibrillating they’re beating a bit slower but they can beat us fast as 300 beats per minute the problem with that is that’s because of the tonight what can happen is sometimes that atrial flutter can be

Transmitted down to the ventricle and there ha the ventricular rate can go very very fast and that can be considered potentially quite harmful so most doctors prefer to give flak a night with something else with another medication which slows the conduction down through through the atrioventricular node and thereby prevent the possibility of the heart game very

Fast actually we see this kind of thing only in about 3.5 to 5% of patients but still just to cover it doctors will often ask the patient to take a small dose of a beta blocker or a calcium blocker in addition to the flack a night to prevent the eventualities of the seleka night converting the atrial fibrillation to atrial flutter and then to reduce the likelihood

Of this conduction through the atrioventricular node to the ventricles the beta blocker slows conduction down through the av node and thereby reduces the likelihood of this happening other than that flex night seems to be very well tolerated side effects tend to be confined to less than 20% of patients that take it these include headache difficulty focusing or

Blurred vision and sometimes nausea having said that you know those side effects shouldn’t deter you from trying to like a night if you have a structurally normal heart particularly if your atrial fibrillation is very troublesome so i hope you found this useful and i would love to know i would love to hear from you to hear what you think of this video if you get

A chance i’d be so grateful if you’d consider subscribing to my channel on youtube which is your cardiology and i have a what’s up broadcast group which and my number is oh seven nine five one three one zero zero zero eight thank you so much all the best take care bye

Transcribed from video
Treatments for Afib: Flecainide By York CardiologyliveBroadcastDetails{isLiveNowfalsestartTimestamp2019-02-09T064302+0000endTimestamp2019-02-09T065318+0000}