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Suggest Medication For PSVT In An Obese Person
Question: Hi I was diagnosed with PSVT about 8 years ago. Had various test like stress and eco-cardiogram that showed no underline heart disease. I was told to live with them, which I did for a few years. They started to affect my life so my Cardiologist tried several beta and calcium channel blockers that did not work well. He then carefully put me on flecainide 100 MG twice a day. I am aware that this drug can be dangerous but it work great with some but tolerable side effects. Been taking the drug for six years. Recently I had to change Cardiologist and on my first visit after reviewing my history and ekg he highly recommend that I take diltiazem 120 MG a day to protect me from any bad reaction to flecainde. He indicated that flecainde can cause sudden heart events that dilltiazem could minimize. He said I am lucky. I would like to avoid taking any more pills if I can. I did some research and I can not find any facts about this drug combination to prevent sudden heart events, only about high BP. My BP ranges from 135 to 115 depending on the time of day. I take 20 MG daily lovastin and 300 mg allopurnial for gout. Gout and cholesterol are well maintained. Slightly over weight (not obese) 67 male non smoker that exercises. Just wonder if I really need to take diltiazem after 6 years of no problem with flecainiae?
Brief Answer:
I would explain as follows:
Detailed Answer:
Hello,
Welcome and thank you for asking on HCM!
I carefully passed through your medical history and your concern; and my explanation on this issue:
-Flecainide is a very effective antiarrhythmic drug for the treatment and prevention of supraventricular arrhythmias (atrial fibrillation and PSVT).
But during the exertion of its anti-arrhythmic effect, especially when used for atrial fibrillation, it has been shown that when atrial fibrillation is transformed in atrial flutter (because of flecainide effect), it is not associated with slowing of atrio-ventricular node conduction properties. This has led to a fast conduction 1:1 of this supraventricular arrhythmia to the ventricles. As a consequence dangerous ventricular arrhythmia ensues leading to a serious life threatening condition.
This is called the “late pro-arrhythmic effect” of flecainide and usually is not seen at the initial phases of treatment.
That’s why your cardiologist has recommended you to start diltiazem, because by slowing atrio-ventricular conduction velocity, it prevents the above mentioned pro-arrhythmic effects.
In general pro-arrhythmia occurs when flecainide is used for supraventricular arrhythmia conversion and quite rarely for prevention (such as your case). In addition pro-arrhythmia has some predisposing factors such as: ischemic heart disorder, heart failure, widened QRS interval (>120ms), renal disease, low blood potassium levels, etc. .
After reviewing your normal clinical status, I would conclude that the risk of pro-arrhythmia is quite low in your case.
Nevertheless, I would explain that the combination of flecainide and diltiazem is not harmful at all and could add further safety to your arrhythmia treatment.
So, my advice is to follow your cardiologist recommendation and also to discuss with him the possibility of cardiac ablation (a non-pharmacological strategy), which could definitely treat your arrhythmia substrate (by burning pro-arrhythmia focus/pathways), thus definitely avoiding the need for further drugs.
Hope to have been helpful!
Kind regards,
Dr. Iliri
I would explain as follows:
Detailed Answer:
Hello,
Welcome and thank you for asking on HCM!
I carefully passed through your medical history and your concern; and my explanation on this issue:
-Flecainide is a very effective antiarrhythmic drug for the treatment and prevention of supraventricular arrhythmias (atrial fibrillation and PSVT).
But during the exertion of its anti-arrhythmic effect, especially when used for atrial fibrillation, it has been shown that when atrial fibrillation is transformed in atrial flutter (because of flecainide effect), it is not associated with slowing of atrio-ventricular node conduction properties. This has led to a fast conduction 1:1 of this supraventricular arrhythmia to the ventricles. As a consequence dangerous ventricular arrhythmia ensues leading to a serious life threatening condition.
This is called the “late pro-arrhythmic effect” of flecainide and usually is not seen at the initial phases of treatment.
That’s why your cardiologist has recommended you to start diltiazem, because by slowing atrio-ventricular conduction velocity, it prevents the above mentioned pro-arrhythmic effects.
In general pro-arrhythmia occurs when flecainide is used for supraventricular arrhythmia conversion and quite rarely for prevention (such as your case). In addition pro-arrhythmia has some predisposing factors such as: ischemic heart disorder, heart failure, widened QRS interval (>120ms), renal disease, low blood potassium levels, etc. .
After reviewing your normal clinical status, I would conclude that the risk of pro-arrhythmia is quite low in your case.
Nevertheless, I would explain that the combination of flecainide and diltiazem is not harmful at all and could add further safety to your arrhythmia treatment.
So, my advice is to follow your cardiologist recommendation and also to discuss with him the possibility of cardiac ablation (a non-pharmacological strategy), which could definitely treat your arrhythmia substrate (by burning pro-arrhythmia focus/pathways), thus definitely avoiding the need for further drugs.
Hope to have been helpful!
Kind regards,
Dr. Iliri
Note: For further queries related to coronary artery disease and prevention, click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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