How high is too high for HR - Atrial Fibrillati...

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How high is too high for HR

Ialla profile image
12 Replies

I am new to the AF world, & have been taking Pradaxa for about two weeks with no awful side effects so far.  I have taken Verapamil for many years for PVCs (which maybe was actually AF).  About a month ago I had palpitations lasting about 20 hours.  My GP did an ECG & diagnosed AF & sent me to an EP.  She also doubled my Veraprimil dose.  My EP said I could go back to my previous dose as long as my HR was under control.  For the most part it is, (65 - 75) but I the evening, about 22 hours after taking my Veraprimil my HR goes to 85 - 110.  I'd like to stay on the lower does, but I'm not sure that's smart.  One issue in taking two doses a day is that the veraprimil must be taken at least two hours after the Pradaxa which makes for a scheduling nightmare.

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Ialla profile image
Ialla
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12 Replies
Perrylees profile image
Perrylees

When in AF my  EP was always pretty  happy if my HR was 100 or thereabouts.  I think the consensus is that anything between 60-100 is fine.  110 isn't a great deal more and if this is only temporary maybe not too much to worry about?  The key thing is how you are feeling really .....

Ruth 

BobD profile image
BobDVolunteer in reply toPerrylees

I think your last sentence is the crux of it. If you feel faint, have any chest pain or are otherwise ill then worry and get medical help otherwise try to get on with life. 100 bpm is not considered fast in many quarters

PeterWh profile image
PeterWh

I was told that the ideal is to be close to your rate pre AF as possible. However for many that data does not reliably exist. In my case I knew it was typically in 60s but no evidence to back this up.   After my ablation when I was in sinus my HR was in low 60s so that influenced EP to aim for 80 but that is an arbitrary figure. At the moment I am closer to 90 because bisoprol has been reduced due to low BP.

I suggest that you try and fine tune it a bit so that it coincides with bedtime when HR drops naturally. 

Ialla profile image
Ialla

Very helpful comments - thanks.  My pre AF HR was typically in the 70s, although I'm not sure about my HR in early evening.  I'm so much more aware now.

Mike11 profile image
Mike11

Verapamil should be taken twice a day no matter what the dose as even the slow release version wears off in under a day.   Is there an alternative anti-coagulant you could take that isn't so time-constrained ?

Ialla profile image
Ialla in reply toMike11

I could take warfarin, which I would like to avoid, or one of the other NOACs, but as of now Pradaxa is the only one with a reversal agent.  My EP says the others, which are less time constrained will have reversal agents perhaps by the end of summer.  I took two doses of Verapamil  yesterday, & did not have the evening increase of heart rate.  I take the time release version, & just assumed the effects would last 24 hours.  Wrong assumption!

Mike11 profile image
Mike11 in reply toIalla

Yes I found the same with Verapamil.  The original prescription said to take two tablets once a day but it definitely wore off so I split it into 8am and 8pm which fixed the problem for three years.

I do wonder if people worry about reversal agents a bit too much.  Warfarin has one but on going to hospital once with a badly bleeding tongue they didn't use one to stop it, just the alginate pads (which they ran out of :-)

Ialla profile image
Ialla in reply toMike11

I could also change to a beta blocker, but I have taken Verapamil at a much lower dose for many years to prevent migraine, & more recently for high blood pressure.  I tolerate it well.

Mike11 profile image
Mike11 in reply toIalla

By the sound of it I'd stick with Verapamil if you can.  It does lose effectiveness over time but I actually found it better than beta-blockers whilst it worked.

Ialla profile image
Ialla in reply toMike11

Your responses have been very helpful

Ialla profile image
Ialla

When ones heart rate is high, I think the brain says "panic" 

Ialla profile image
Ialla

What a terrible experience!  I can't tell if you are a man or a woman, but in my experience as a woman, we are somewhat more likely to be labled as panicking, although I'm sure men have experienced this as well.  Here in the US I have seen positive changes over the last several years in terms of my experiences with younger docs.  There are many issues with our health care system, but there seem to be some positives in how physicians are trained.  

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