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Felt Suffocated After Waking Up And Loss Of Breath. Strange Sleep Paralysis. Reaction To Flecainide?

Posted on Fri, 5 Jul 2013

Question: I went to get my 24 hr. holter results today. I have had several of these over the past few years. This one after being on the flecainide for around 2 weeks showed a 1.1 second pause on the holter but no pvc/pac. It was reviewed by an electrophysiologist. They said this is nothing to be concerned with but I am quite concerned. They said that this was not an issue until 3-4 second pauses etc... The problem is that I never had any pauses on my ekgs/holter until the one taken after being on flecainide. Also the other day I woke up feeling as if I was being suffocated or held down. Like I had to fight to wake up and breath. It was a strange sleep paralysis thing. Now though I am concerned that this could have been another pause that caused that to happen. Do you think it's just an anomaly that I should ignore or do you think this could be something more serious like a reaction to the flecainide? I had a stress test after that holter with the pause and it was good. They maxed me out. Also have had and echo and have had numerous EKGs at the office visits including one today.

Highest Regards,

XXXXX

Answered by Dr. Anantharamakrishnan (56 minutes later)

Hi friend,
Welcome to Health Care Magic

- Normal stress test excludes physiological phenomena (reduced blood supply from Coronary Artery Disease) as the cause of the problem...
- Normal ECHOcardiogram excludes major structural abnormality
They are indeed reassuring...

The difficulty in waking up is not likely to be related to this; only a part of sleep apnoea...

     Pause is a well known feature and is an effect of Flecainide. It may be ignored, if the duration is less as is here. Since your arrhythmia is controlled well, you may attempt reducing the dose of Flecainide...
     Flecainide not a simple drug and is not usually the first choice in most cases...Your doctor might have a reason?? There are a few other drugs and you can go for a different one...but every drug has its limitations; this one a bit more...
     Electro-physiologist may offer thermal or radio-frequency ablation in some cases, which may reduce or obviate the need for drugs.../ at times, they might have tested the effectiveness of a few drugs during the procedure and chosen this? / discuss with him...
A decade of the problem generally means it is probably benign?
And an alternative is always possible, if the patient is concerned...

Take care
Wishing speedy recovery
God bless
Good luck

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Anantharamakrishnan (1 hour later)

Hello sir. I was wondering what is generally considered a safe decrease in flecainide for someone on 100mg twice a day. Is it recommended in most cases to decrease by 25mg over four day periods and take the does over 1-2 weeks down to 150mg? Would that be a safe method generally speaking?

Highest Regards,
XXXXX

Answered by Dr. Anantharamakrishnan (1 hour later)

Hi

We can simply reduce the evening dose by 50 mg (to 50 mg here).
Continue the morning dose (100 mg here) as usual
Check in two weeks

ANY ADJUSTMENT OR ALTERATION (any drug for that matter) SHOULD BE UNDER THE SUPERVISION OF YOUR PHYSICIAN

All the best
Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Anantharamakrishnan (18 hours later)

Hello. This is my last concern at the moment. Do you think the 1.1 pause on the previous holter while on flecainide means that I should have another 24-48hr holter monitor done? I see the EP on July 17th.

Highest Regards,
XXXXX

Answered by Dr. Anantharamakrishnan (1 hour later)

Hello

Yes
Another Holter after this interval is preferable (even otherwise too).
Also after any change in medication...

Regards
All the best

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Anantharamakrishnan (1 hour later)

Hello. The EP said I should stay at my current flecainide dose in order to make sure it remains effective. I am seeing the EP for consultation actually on July 15. Do you think I need a holter before that or can I wait until speaking with the EP? The EP that I am seeing is actually the person who reviewed the holter monitor.

Highest Regards,
XXXXX

Answered by Dr. Anantharamakrishnan (3 hours later)

Hi

There is no problem in waiting - until you see him...
The dose is not high; the control is good and the pause is not big...
The dose needs individual titration... it may be possible to reduce the dose in your case, after next Holter, which is necessary, but not urgent...

Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Anantharamakrishnan (11 days later)

Hello sir. I have another important question. When I was younger I always had swollen glands if I just got a little ill. I am not sure that I have an immune system problem now or not. Seems as if my sinuses and tonsils are often affected. The tonsils are always putting out lymphocytes. They do not get infected though because I keep them flushed out. Here is the important point though. I took a corticosteroid for around a week last year or so and my palpitations were abolished for around 1.5-2 weeks during and after that. Do you think any of my symptoms could be related to adrenal insufficiency? Or perhaps something else related? I am trying to determine if I should see an endocrinologist before I see the EP on July 15? You opinion on this would be greatly valued. I have a strong feeling that this may be related to the adrenals or an autoimmune issue causing chronic inflammation. Either way the corticosteroid stopped the palpitations cold.

Highest Regards,
XXXXX

Answered by Dr. Anantharamakrishnan (1 hour later)

Dear XXXXX

- Swelling of glands is often secondary to infection in their area of drainage...
- Only rarely, it is a primary disease of the immune system – if so, it could not have remained silent!
- Repeated inflammation of the tonsil is not often infection and that too there – it simply arrests them there from its area of coverage...
- Everybody gets them, when young!

- Adrenal insufficiency won’t cause this – if anything, excess of it, can!
There are several adrenal hormones and adrenaline (epinephrine) excess is the culprit for rate and pressure.
- Steroids are immuno-suppressive / anti-inflammatory – they don’t do this.
Relief by a drug is no proof of the cause – ‘Post hoc ergo propter hoc’ (meaning "after this, therefore because of this")

- It seems very unlikely to be related to immune or endocrine systems.
That will not be restricted for long to one system like the heart and that too one aspect like the ectopic...

- A second opinion is always welcome – There is no harm in seeing an endocrinologist or immunologist; they can exclude problem in their field, which will be greatly reassuring...

- I strongly believe it is from the heart and the Electro-physiologist is the apt one...
And your specialist is doing a great job...

Regards
Have a great day (– today, tomorrow, everyday...)

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Anantharamakrishnan (15 days later)

Hello. This question pertains to Flecainide. If one is on that medication when is it advisable to discontinue using it. For example if someone is on 100mg twice a day(200mg total) should they be seriously concerned if they have 2-3 runs of fast pvc's that did not happen until 2 month on the drug? Every once in a while before there was a single pvc or two but flecainide was working well until the 2 runs of 3-4 pvc's the other night. I go to see another EP on monday but do not want to play around with flecainide if it's becoming Pro-arrhythmic. In a case like this would one normally lower the dose by 50mg at a time or would one discontinue the drug completely? I will have to go off the flecainide in the near future anyway in order for the EP to be able to have enough Pvc's to map for an ablation. Most likely I will have the ablation done at the Clevelend Clinic with Dr. XXXXXXX Chung. Please advise on the flecainide and what you would do in a similar situation. I of course will consult my cardiologist and EP before making any changes to my medications.

Highest Regards.
XXXXX

Answered by Dr. Anantharamakrishnan (5 hours later)

Dear friend,

     In such a situation, one cannot be certain whether it is an aggravation of the original problem or a side effect of the drug – and the solution will also be exactly opposite!
     The best and safe option is to give the benefit of doubt and consider the drug as the contributing cause. We should reduce the dose (50 mg) and watch – not stop it.
     A single episode need not alarm – even if the drug is not controlling completely, it could prevent more complicated arrhythmia...

Regards

Note: For further queries related to coronary artery disease and prevention, click here.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar