flecainide, afib, and pvc runs - 4 questions

[bill00]

I have had good luck with Flecainide controlling atrial fibrillation for about 4 years. There were occasional episodes, 2 a year or so but they converted in 3-4 hours after taking my next scheduled dose. My dose increased from 50 to 150 mg twice a day over a year or 2. For 2 years I had no episodes but I've had 3 in the last 4 months.
While in the hospital for one of the episodes the day before yesterday, when I'd stand up, I saw ~"PVC run HIGH" on the monitor. I asked about it and was told they were probably "atrifacts"

My echos are normal. Left atrial diameters oldest to most recent 4.0, 3.9, 4.0, 3.3 mm.

1. Could afib be progessing while in sinus rhythm ?
2. Could having a great deal more stress be a cause of this ?
3. Can Flecainide lose it's effectiveness ?
4. Does the explanation of the PVC runs sound likely ?

[LindaTX]

I don't know how old you are but if I were you, I'd at least take a look at the possibility of an ablation.  Flecainide won't work forever.  It had a bad effect on my heart when I had to go on a very high dose AFTER my ablation in Sept of last year.  It caused changes on my ECG and my Dr wanted me off of it as soon as possible.  Fortunately when i went off the high dose last March I haven't been bothered by a-fib since, so the ablation has been successful in the long run.  I had a-fib for 12-14 yrs.  I do get short episodes of atrial tachycardia and have to take a beta-blocker followed 20 min. later by 3 100mg of Flecainide to get back to NSR.  It works for me but I've only had to take the Flec a couple of times.  The BB usually takes care of it. It sounds like you are entering the progressive stage of your a-fib.  I would start exploring my options at this point.

[bill00]

Deltadawn23 and Jerry_NU
Thank you very much for writing back.
Maybe if the stress lets up some, the Flecainide will work as well as it had for the last 2 of my 15 years of life with afib.
The echo where the low left atrial diameter was measured was taken while I was lying on my back, the others weren't, Maybe that's what caused the difference.Thank you for correcting me on the units Jerry_NU.
Still, I hope recent weight loss might have contributed a tiny bit.

[Jerry_NJ]

I add only what I know about left atrium shrinkage.  I had a leaky mitral valve and it let high pressure back-flow into the left atrium, which caused it to stretch, grow in size.  I had MV repaired in late 2007 and the surgeon and my cardiologist said it was possible my left atrium would shrink back as the pressure in that chamber is now normal.  The size hasn't shrunk, but I can say I've had echocardiograms that show it has shrunk. My conclusion, not just from my doctor, is that the echocardiogram is only a rough estimate of chamber size and is operator dependent among other things.

My only adder is unless you can come up with a reason for your atrium to shrink I'd guess it hasn't the 3.3 cm (I think it is measured in centimeters) is in error and the other numbers are collectively the approximate size.

[DeltaDawn23]

These are just my opinions, gathered over the last nine years of having Afib:

1. Afib usually worsens as the heart ages.
2. Stress definitely plays a part in my episodes.  3 out of the first 4 episodes were times of great stress.  The last 2 I was very stressed on my job and suffered from obstructive sleep apnea, which was not being treated appropriately.
3.  I have heard on this message board that all the arrythmics eventually lose effectiveness.  Altho I have also heard of people being on one for 10 years and having no problems.
4. I don't have any knowledge on the pvc runs.

I am interested in the fact that your atrial numbers indicate shrinkage.  My cardio told me that if my sleep apnea is appropriately treated, my atrial enlargement may shrink.  To what do you attribute the shrinkage?

Good luck to you.  Keep us posted on how you're doing.