There is more than one approach to atrial fibrillation
would be ablation. Should I get another opinion? -- P.D.
ANSWER: Atrial fibrillation is a common problem in older adults. It’s a chaotic rhythm disturbance, and problems can arise from both too fast a heartbeat and from the possibility of clots. People with AFib often are treated with medication to reduce stroke risk (warfarin or a new medicine like Xarelto is most common, but a few people need only aspirin), and the atrial fibrillation itself is treated in one of two ways: rate control or rhythm control.
In rate control, a medicine is used to slow the heart rate. Beta blockers such as metoprolol are a common treatment, as is a calcium channel blocker like verapamil. (Digoxin, a preparation of the foxglove leaf, is REALLY old-school treatment.) In rate control, people stay in AFib but the heart rate is kept at a safe level.
Flecainide, on the other hand, is used for rhythm control, to try to keep people out of the AFib entirely. Your cardiologist has chosen rhythm control for you, and it sounds like you have had at least two episodes where you went back into AFib (probably with a fast heart rate) -- which means that it’s not working so far, and that’s why he may be adjusting the dose. Some cardiologists do prescribe flecainide to allow patients to self-convert if they go into AFib: It’s controversial, and other cardiologists prefer their patients to be in a monitored setting before getting flecainide. Some cardiologists will try a different rhythm agent (such as sotalol or amiodarone).
Ablation is a possibility as well, but it doesn’t work for everybody. Anticoagulation remains necessary for most people with atrial fibrillation, but can be discontinued if rhythm control is proven successful.