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Atrial fibrillation, trough electric cardioversion, taken Flecainide, Nebivolol. Safe medicines?

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Cardiologist, Interventional
Practicing since : 1998
Answered : 410 Questions
I am a 51 year old man. My BP is under control, and so is my cholesterol through drugs.

Last month I had my second ever episode of atrial fibrillation the first one was in 2003.

On both occasion I had to go to an emergency room, and was hospitalised. The Afib was very fast, did not respond well to drugs, and was eventually resolved trough electric cardioversion.

My heart works very well otherwise. The holter test did not reveal anything wrong. The cardologist says that we need to try to prevent further episodes, and prescribed 100mg flecainide + 2.5mg nebivolol.

I have never taken drugs for the heart before, and am a bit concerned.

Can I start taking these medications with confidence? Will they give me more trouble than benefits?
Thank you in advance.
Posted Thu, 26 Apr 2012 in Hypertension and Heart Disease
Answered by Dr. Prabhakar C Koregol 2 hours later

You have very valid and genuine concerns. Now your atrial fibrillation (AF) gets classified as Paroxysmal Atrial Fibrillation (PAF). There are few issues that needs to be further probed, they are:

1. Were these only episodes of AF that you had or were there silent episodes and you did not realise.

2. Does your ecg shows any evidence of electrical phenomenon called pre excitation.

3. Your risk of stroke needs to rectified.

First thing is if your episodes have been nearly 8-9years apart you dont have to take medicines on continuous basis as most of the anti-arrythmic drugs like Flecainide do have significant side effect.
Nebivolol is relatively safe.

In my opinion you are eligible to what we describe as pill in the pocket approach, that is you take drug at the begining of your symptoms.

However if your cardiologist is of the opinion that your arrythmia was so complex to treat and that he wants you to take medicine regulary then EPS (Electrophysiological Study and RF Ablation is safe) strategy is alright.

You need to be on blood thinning medicines (Warfarin/Acitrom) to prevent stroke.

Please discuss all these this your cardiologist.

Hope this answers your question.

Dr. Prabhakar.
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