AF Association
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AFIB Questions

Hello, I'm new to this community and just diagnosed with AFIB (October 2017). I have two questions and hope that this community can provide some insight for me.

My cardiologist put me on 25mg of Metropolol once per day. Previously, my heart rate was constantly over 130 BPM. Now, my heart rate is usually between 65 -85 BPM. My resting heart rate is 66 BPM.

My question is - Am I still in AFIB? Are the dangers of stroke reduced since my heart BPM have been reduced with the Metropolol?

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Firstly you have Af so you have a stroke risk dependent on what other co morbidities you have (CHADSVASC score) . Anticoagulation should have been discussed and applied if required. Rate and or frequency of events is not relevant to stroke risk. Just being diagnosed with AF is enough.

Secondly Metropolol is not an anti arrhythmic drug as such and will not stop your AF It will slow your heart and possibly make AF less likely or hold the rate down when you are in AF.

I am guessing you have been diagnose with paroxysmal AF which comes and goes rather than permanent which is always there.

AF Association main website has a wealth of fact sheets to help you understand this mongrel condition.

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Thanks Bob. I have an appointment on January 2nd, 2018 with an EP Dr to discuss blood thinners and next steps. My current cardiologist said that even though I have a CHAD score of 2, blood thinners were too risky at this time and recommended that I not take them. Everything that I have read indicates I should be on blood thinners.

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We prefer the term anticogulant as they do not thin blood and that term makes people think that they may bleed more easily. With a Chadsvasc score of 2 then anticoagulation is recommended unless you have a serious bleed risk. Sadly many cardiologists and quite a lot of GPs are still scared of anticoagulants and prefer their patients to be a stroke risk . Strange I know!!!

Hopefully your EP will be more up to date.

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Hi I totally agree that cardios and G Ps are scared of anticoagulants 10 years ago I was diagnosed with AF, only 3 years ago I was actually given all the tests and given a CHAD score of 0-1 of having a stroke and then earlier this year I had 2 strokes 1 month apart , I walked into hospital and 7 days later walked out after having all the tests available holding my Apaxiban ,so I think you are right when you say the specialists are leaving you at risk of a stroke before giving you anticoagulants.

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In addition to slowing the heart rate, Metropolol is a class II anti arrhythmic. Also, according to both EPS I see, the amount of time spent in AF is a factor in stroke risk. It should be considered along with chads-vasc score. Someone with high AF burden should take anticogulation even with a low chads-vasc.

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That is a view. The people I respect may not agree with that assessment. The current thinking is that it is less the AF and more the company it keeps.

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That's interesting, intuitively it seems like common sense. Over here in the UK I think the view is different. As exemplified by the fact that there is a lack of good evidence that successful ablation reduces stroke risk, so we generally stay on ACs. Is your EP's view a reflection of the AHA view?

We think ACs better than aspirin for stroke prevention. Your medics apparently are less sure.

Do the Class 2 anti-dysrhythmics prevent AF or rather just slow AV node conduction?

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Not being a doctor, I don’t know the answer to these questions. From what I’ve read, AC is certainly better than aspirin for preventing ischemic strokes, but worse for hemmoragic strokes and major bleeding. Whether to take AC is a balancing act.

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Also, just to clarify, one of my EPs said that short infrequent episodes, I think those lasting only seconds, wouldn’t warrant AC if a low chads-vasc score.

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The metoprolol is a beta blocker and will lower your heart rate .

You won't be given anticoagulant at this stage because you don't need it yet, you may not have another episode for years

Your cardiologist will monitor you and if you do go in and out of afib and you will certainly know if you are then you will get the appropriate treatment

I Found Metoprolol very good at controlling the rate for a long time

Try not to worry too much there is so much more they can do for afib

Trust your CARDIOLOGIST

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"Trust your CARDIOLOGIST " IMO not always. Mine has known, or should have known, that keeping me on Metaprolol 100mg twice daily could be toxic as well as not needed, especially after letting the AF go unbridled, so feel blessed that you stumbled onto this site and were enlightened.

In my case I'm self medicating as appointment for a new GP not until March and not finding a cardiologist accepting new patients as of yet is delaying that aspect. Who knows? Haven't been in sinus rhythm at all for over 6 years I may end up going back to our Maker with a strong beat.

Again, everyone do have a pleasant celebration of Our Lord's birth.

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Happy Christmas to you too Xanadu. Will you be with family?

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Yes, my wife and I are blessed with eldest son and two daughters in this area located in Illinois just east of the Mississippi river. As I can't yet negotiate steps hopping on one leg we'll all have Christmas eve here. Thank you for asking and do have a blessed HOLYday.

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Would that be Springfield then? Not that I have been there.

We always thought that was where Homer lived with Marge, but it turns out not to be apparently.

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No, we are in Alton, Illinois on the river at the bend just above St Louis, Missouri. Sorry but I do have to go right now as famly arriving very soon.

May God Bless you

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Thanks everyone for the reply's. I had never heard of AFIB until my bother in law had a stroke and as result is in hospice. After quizzing his wife about AFIB, I found out that he had AFIB for about 15 years (untreated) and had been having mini strokes for about 5 years. He did go to the ER on his 1st mini stroke years ago but refused to ever go again. He was always a strange person and I guess he figured if he ignored it, it would go away.

I saw the AliveCor commercial and bought one in October 2017. Luckily it worked and I started this new chapter in my life.

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Hi

I have had AF since 2011 and am on 25mg of Meto too, twice a day. The consultant said once a day would not control my AF for 24 hours. It seems to work well and keep my rate under control.

I did not take an anti coag, until, during an episode, i got a blood clot in my right arm...extremely scary, esp as the hospital sent me home saying they thought it was an RSI.......I am very lucky that is the way it went!!

I now take Warfarin and will be on it for life.

Have lots of questions ready......good to take someone with you as it can be a lot to take in

Good Luck!

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Hi James, does the GA indicate you are in Georgia?

You had two questions.

To the first, I imagine your Kardia should help you and your GP determine that. Your slower heart rate may indicate sinus rhythm, or simply the effect of the Metoprolol on the ventricular rate, independent of AF.

Stroke due to AF is associated with clot in the left atrium. This is due to pooling of blood in the atrium which is not beating in synchrony with the ventricle. At least I think that's the case.

Do you care to share why your cardio thinks AC are contra-indicated for you?

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Yes I am in Georgia. I'm going to Emory Hospital on 1-2-17 for an EP visit to discuss further options. My cardio doctor said that the risk of taking the AC increased my risk of brain bleeds and other bleeds. With a CHAD score of 2 the risks kind of cancelled each other out or something like that. It is very confusing to me that is why am getting a 2nd opinion at Emory. The cardio doctor did say that I had no pooling in the left atrium and that it was slightly enlarged.

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If you want to post some Kardia strips here, showing your previous abnormal traces and another showing your present rhythm, there are members here who may be able to tell you if they show AF.

Apparently you have to start a new thread to do that.

Priority seems to be establishing whether you have paroxysmal or persistent atrial. fibrillation, and then asking why you are not on anticoagulants.

What are the stroke risk factors that give you a score of 2. May I ask how old you are?

I think your EP appt is 2nd January. In the UK, the date you gave would be February 1st, which would not be soon enough.

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Thanks Badger. My appointment is January 2nd. I am 55 years old, Diabetic (using metformin), and have high blood pressure. Both my Blood sugar and blood pressure are well controlled. I am also overweight and have been most of my adult life. My Kardi consistently shows AFIB and it has not been normal since I purchased it in October 2017. Interestingly, I also purchased a Fitbit Charge 2 and it will only give me basic details of sleep because it says that it could not get a consistent heart rate while I slept. I will try to figure out how to attach a Kardi reading. Thanks for all the information.

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Fitbits don't work effectively when we are in AF, but a kardia is basically reliable as it is designed to identify AF.

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Hi James

It might be worth looking up obstructive sleep apnoea if your doctors have not already covered that..

A screen shot posted in a new thread might help with the rhythm strips.

Always hard to make suggestions out of context but I am as a non medic puzzled why your cardio has ruled out ACs. I have hypertension and also take Warfarin. If blood pressure is well controlled, then I understand an AC is not contraindicated because of hypertension per se.

Take it quietly until you have seen your EP.

Best wishes from the UK.

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Thanks.

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