My name is Sanjay Gupta, I'm a consultant cardiologist in New York. Thank you very much for watching my channel. I wanted to do a new series of videos looking at medications that we use and in particular going through the medications explaining why we use those medications, what the benefits are and what the risks are. And in particular I wanted to start off by doing this for people who have atrial fibrillation and talk about medications that we use in atrial fibrillation. So today I wanted to start off by talking about a medication called Flecanide. Flecanide is an anti-discrydmic. What that means is it tries its medication which can be used to preserve heart rhythm. Or if the patient isn't an abnormal heart rhythm it can convert them back into a normal rhythm. So in atrial fibrillation the heart beats it regularly. Flecanide will try and stop you from going from a normal regular rhythm to an irregular rhythm. But if you are in an irregular rhythm Flecanide can help bring you back into a normal rhythm. So that is the role of Flecanide. Flecanide can be given in three ways. The first way which is quite handy is as a pill in the pocket. So this is ideal for those people who get infrequent paroxysms of atrial fibrillation. So they are fine. Then once every month or once every six months or once every year they'll get an episode of atrial fibrillation. And in that setting Flecanide can be used as a pill in the pocket. It can be given in a dose between 100 to 400 milligrams a day. And you basically take this dose and it can be very effective. And in fact if the atrial fibrillation has been going on for less than 24 hours, then there's some good research studies which have shown that a pill of flecanide can terminate that episode of atrial fibrillation. In about 68% of time, 68% of times. And it does so within around about an average of 110 minutes. So it's really useful with that regard as a pill in the pocket. The second way in which Flecanide can be used is it can be given on a daily basis. So if you had atrial fibrillation and you had one episode every month, then you could use it as a pill in the pocket. But if you were getting episodes every day, then it's a bit of a pain to have the episode and then take a pill rather than that you'd rather not have the episode to start off with. So by taking Flecanide every day at a dose of 50 to 100 milligrams daily, you can significantly reduce the number of paraccessions of atrial fibrillation that happen. And when you do go into atrial fibrillation, you may not remain in atrial fibrillation for as long. So it can be given in that way. There's a third way in which flecanide can be given and that is it can be given intravenously. So if you have an atrial fibrillation attack, so you're sitting at home, you go into atrial fibrillation, your heart is going really fast, you don't like it, you go into A&E, and they can give you an intravenous infusion of flecanide. And that can be very effective in some research studies that have been shown to be, you know, to try and get 65 to 90% of patients out of atrial fibrillation within a six hour period. So it's a very useful drug. Let's talk about some of the other important considerations with a medication like this. Okay, you have to be aware of two main things with flecanide. The first is this. Flecanide can be pro-aridmogenic. What I mean by that is it can cause heart rhythm disturbances of its own accord as a side effect. There was a very interesting study that was done which was called the CAST study, CAST. And in this study what happened was they took a bunch of people who'd had a heart attack and who had irritability of their heart as manifest with heart rhythm disturbances. And they gave these people flecanide. And unfortunately what they found was that the mortality was increased in the group that took the flecanide. And therefore flecanide got a really nasty reputation because people thought, oh, its pro-aridmogenic, it can cause heart rhythm disturbances, it's a dangerous drug. Actually when people started looking at the research what they started realising is that perhaps the increase in mortality in that study was confined to those people who'd had damage to their heart. So if you have a structurally normal heart then flecanide is actually considered a relatively safe drug and should not cause any of those problems. So doctors don't want to prescribe it without being confident that the patient has a structurally normal heart. And they do so by doing an echocardiogram. So the heart looks structurally normal then that's incredibly reassuring. And then sometimes what doctors like to do is they like to study the heart archery, supplying the heart to make sure there are no narrowings because if there was a narrowing that could cause the heart to malfunction. And then if you're taking the flecanide that could make it more irritable, etc. So generally what doctors would like to do before they prescribe flecanide safely is to do an echocardiogram and maybe some kind of test which delineates the heart archery. That could include a CT coronary angiogram, a cardiac CT scan or an invasive angiogram where they stick some dye into the archery and look at it on an x-ray, invasively. And if those are okay then flecanide is a safe drug and can be a very helpful drug to try and reduce episodes of A.F. One other thing you should know about flecanide is that flecanide can sometimes convert people who are in atrial fibrillation into something called atrial flutter where the atria are not actually fibrillating, they're beating a bit slower but they can beat us fast as 300 beats per minute. The problem with that is that because of the flecanide what can happen is sometimes that atrial flutter can be transmitted down to the ventricle and the ventricular rate can go very, very fast and that can be considered potentially quite harmful. So most doctors prefer to give flecanide with something else with another medication which slows the conduction down through the atrial ventricular note and thereby prevent the possibility of the heart going very fast. Actually we see this kind of thing only in about 3.5 to 5% of patients but still just to cover it doctors will often ask the patient to take a small dose of a beta blocker or a calcium blocker in addition to the flecanide to prevent the eventuality of this flecanide converting the atrial fibrillation to atrial flutter and then to reduce the likelihood of this conduction through the atrial ventricular note to the ventricles. The beta blocker slows conduction down through the atrial ventricular note and thereby reduces the likelihood of this happening. Other than that flecanide seems to be very well tolerated, side effects tend to be confined to less than 20% of patients that take it. These include headache, difficulty focusing or blurred vision and sometimes nausea. Having said that, you know, those side effects shouldn't deter you from trying the flecanide if you have a structure in normal heart particularly if your atrial fibrillation is very troublesome. So I hope you found this useful and I would love to know, I would love to hear from you to hear what you think of this video. If you get a chance I'd be so grateful if you'd consider subscribing to my channel on YouTube which is your cardiology and I have a WhatsApp broadcast group which and my number is 07. 07. 07. 05. 1. 3. 1. 0. 0. 0. 0. 8. Thank you so much all the best. Take care. Bye.