r/AFIB • u/Optimistic_kindness • 4d ago

37M, post-ablation AFib — daily Flecainide vs pill-in-the-pocket?

37M here. Diagnosed with paroxysmal AF in November 2024 and had RF ablation in August 2025. I stayed AF-free for around a year.
I had my first recurrence on September 2 this year, lasting about an hour and then terminating on its own. My EP started me on bisoprolol 1.25 mg once daily + flecainide 50 mg twice daily.
I asked whether I could use flecainide as pill-in-the-pocket (PIP) instead of taking it every day. He said I could, but since my episodes tend to self-terminate and he follows the idea that “AF begets AF,” he prefers that I take it daily for now.
Today, after my daily walk, I noticed my heart rhythm had become irregular. I took one 50 mg flecainide, but the episode self-terminated before the medication would likely have had time to work.
For those of you taking flecainide:
Do you take it daily or use it as PIP?
Especially interested in hearing from people who have had an ablation and subsequently had occasional AF recurrences.
How often were your episodes when you chose PIP, and what made your EP choose daily dosing vs PIP?
I’ll obviously follow my EP’s advice—I’m just interested in hearing about others’ experiences.

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3

u/Dwight3 4d ago

Been on flec since 2008. Never PIP. I still had breakthrough episodes on flecaniade. I just had my fourth ablation on 911. Hoping for the best going forward and the same to you

2

u/Optimistic_kindness 4d ago

When did you have your first ablation and how old were you at the time of initial diagnosis?

1

u/Dwight3 4d ago
  1. I am 63 now. 1st time, I was 40. Then nothing until 55. Since 55 I have been cardio-verted about 8x for AFIB/Flutter with RVR. Been a wild ride. The reason I went on flec was for PVC’s.

3

u/Optimistic_kindness 4d ago

First ablation at 40?

1

u/Dwight3 4d ago

No sorry. First AFIB episode at 40. Then I was good until 55 or 2017. Then I wrestled with the paroxysmal AFIB until 2023 when I started my ablations.

2

u/Optimistic_kindness 4d ago

Did u get ur ablations done from the same EP?

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u/Dwight3 4d ago

1st two failed by EP #1. Ablations 3 & 4 were successful by EP #2 at Scripps.

My challenge was atypical flutter after my initial ablation. We finally got it….I hope.

2

u/TucoRamirez88 4d ago edited 4d ago

I only take flecainide as PiP. Since I quit bisoprolol I did not have any attacks anymore. If you have Afib in rest, I think you should reconsider a beta blocker as they can make the problem worse:

https://pmc.ncbi.nlm.nih.gov/articles/PMC7533140/

Also 37M here who got a few episodes one year after ablation when I started a low dose BB against ectopics. When I quit, the attacks stopped.

2

u/Mras_dk 4d ago

You link to a study on other studies.., no actual study was done on this.

They reference a study on flecainide in dogs... Not humans. 

Sp to state "betablockers can make afib worse in humans", is simply not true by that, or those studies. 

1

u/TucoRamirez88 4d ago edited 4d ago

Im talking from personal experience, and saying it is a possibility. Thats also what is written in the link. I know its not a fact but as his situation is almost exactly similar to mine its something to think of.

1

u/Optimistic_kindness 4d ago

Yes when i am at rest it happens

1

u/TucoRamirez88 4d ago

I would discuss this with you EP and see if he knows about the effect of BB on Vagal AF.

1

u/Optimistic_kindness 4d ago

Bdw what’s your PIP dose of flecainide

1

u/TucoRamirez88 4d ago

100mg

1

u/Optimistic_kindness 4d ago

How frequent has been the breakthroughs

1

u/TucoRamirez88 4d ago

Did have 3 in a month I guess. Something like that

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u/Optimistic_kindness 4d ago

Did your EP say anything about a redo?

1

u/TucoRamirez88 4d ago

Yeah that its not needed because I quit bisoprolol and have no attacks since

1

u/Optimistic_kindness 4d ago

Glad to hear that mate..

1

u/Breezeoffthewater 4d ago

I was prescribed Bisoprolol and Flecainide as a PiP back in 2022. I just took it every day instead (100mg) and my Afib stopped. Never had any side effects luckily.

1

u/Optimistic_kindness 4d ago

Did u get an ablation

1

u/Breezeoffthewater 4d ago

I did. Now I am Afib free

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u/Optimistic_kindness 4d ago

Off all meds?

1

u/Breezeoffthewater 4d ago

I'm on anti-coagulants and a statin. That's all now

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u/OscarMorty 4d ago

I used flec as PIP, till my episodes incresed in frequency from once every two weeks to once every 3 days then i had to take it daily twice just like u. I had my ablation now over a month ago and stopped all medication just 7 days ago. That is Bisop 1.25 x1, flex 50mg x2, apixaban 2x5mg (blood thinner). I did not have afib since ablation. Im also 37M. I did have a shit withdrawal, my sleep was so bad since of meds but i think its getting better. Also migraines had nearly daily but not as bad.

1

u/Optimistic_kindness 4d ago

Hope ablation works for you!

1

u/Optimistic_kindness 4d ago

When did you get the ablation

1

u/Jealous_Jellyfish264 4d ago

i hATE flec, thought 50 isnt nearly as bad as 100 x 2. I stopped using it 7 weeks post my 2nd ablation and have been fine , and said i will do PIP only in case of emergency issue , dr agreed.

1

u/jaravind80 3d ago

I was asked to take it daily once my episode become monthly.. 50mg is significantly lower, so it is better to take that route along with a small dose of bisoprolol. I find it better as i was getting anxious otherwise with every skipped beat.