AF Association

How slow can we go?

This is probably a doctor question, but it is Good Friday, so decised it can sit til monday. Just curious, Im just on PIP for my PAF. ( after much disagreement between cardiologist and EP, EP won the PIP debate). As my blood pressure is creeping up a little, they both agreed to put me on low dose metoprolol 12.5 mg twice daily. Ive taken it for a week and my reating heart rate pre metoprolol was 60's, now it is upper 40's. I feel ok, no dizziness, etc. Should I be worried about heart rate at 48?

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you are right Hoski, t'is a question for your doctor......don't think it should go much lower without seeking advice....not easy but you should try 111 if it stays low.

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Thankyou

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I don’t know anything about Metoprolol and am definitely not a doctor.

However I used to take Bisoprolol (which I no longer take) and I did take Flecainide at the same time (I still take Flecainide).

My heart rate was below 50 for years resting and often 45 ish so don’t worry too much.

If you are at all worried you should call 111 and check, you won’t get a black mark.

Pete

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my heart rate with PAF and no meds was usually around low 40s (I was an athlete), no betablocker. Iwouldn't worry bout your rate if you are asymptomtic

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Heart rate too slow can trigger afib too...

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wheres the evidence for that?

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This is all I could find

ncbi.nlm.nih.gov/pmc/articl...

But general consensus is that it would be more of a concern in older people and beta blockers and how symptomatic you feel - as Goldie mentioned.

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not much evidence there imho. if you make statements please back them up with solid data otherwise its’s scare mongering

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I have sss...and when too slow it triggers my af and have ecg print outs to prove that slow heart rates can trigger af

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I too have " mild" sss, they told me 2 yr ago I would eventually need a pacemaker. Guess I will give the powers that be a call just to be safe. Thanks!

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What is 'sss'?

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Sick sinus syndrome...:-)

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I agree with li17. The proof in my eyes would be me, as my heart tends to labour, thus making it bounce all over the place! I have put a number of replies on the forum in general stating the same, unfortunately, nobody has commented/argued one way of the other.

My point is this 1) We tend to have a one fits all medication mentality - that cannot be correct, as an accepted pulse is between 60 to 100 bpm ( that alone states that we are all technically different)! 2) On the aforementioned basis, how can it then be acceptable for (say) two patients, one with a pre illness pulse of (say) 60 bpm and patient two a pre 90bpm, to then (both) be functioning on say a 48bpm? The percentage difference in pulse drop, is massive between the two - and yet others find it acceptable.

Sooner or later your/my lowest pulse will fail us......what is that pulse rate? Unfortunately that is the enigma, compounded by the fact that we are both different, and yet receiving possibly the same treatment.

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Morning Hoski - I take 2 doses of 12.5mg of Metoprolol daily too, this is a quarter of a 50mg tablet. I also take 2 x 100mg of Flecainide at the same time. I wouldn't be happy if my pulse was going as low as yours. Mine when in sinus rhythm is around 62. Do you know what your blood pressure is now? Is that low too?

This is certainly a question for your GP, but if you start to feel odd at all I would call the NHS 111 advice line. In fact with it being Easter I think I'd call that line anyway rather than wait until Tuesday.

Jean

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I am not a doctor but when I first went onto flecainide 50mg twice a day plus 200mg diltazem I was low to mid 50's resting which was low for me (normally 65 ish) and down to 45 to 48 when asleep ( I measured it on my Garmin gps running watch.)

I inquired with my GP who was happy at that rate as she would expect it to be that 5 to 10 lower when asleep rather than resting but if it dropped further to much lower than 45 asleep then to go back to her. I took this for me to mean that to check again if my resting went down to 50 , so then my asleep could be 40 to 42 and this may be an issue.

I never went further as over the next weeks my HR went back to 60 plus, I assume my body adjusted to the drugs??

Looking back now I expect my GP was really concerned with the downward trend rather than the absolute value of the BPM because , as others have pointed out, people have different resting heart rates anyway.

It is probably worth a phone call to your GP just to put your mind at rest anyway, but if the HR continues to go lower definitely take some action.

Cheers

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Thankyou, I have a fit bit and lowest sleeping so far 48, yesterday I was more active and resting came up to 50's. Will keep an eye on it

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After my first cardioversion I was still on 12.5 mg bisoprolol a day. I did question this but I was told to stay on this dose.

My HR was 38 at rest and I was a zombie.

I contacted the rhythm team and was slowly weaned off the bisoprolol to 5mg a day and a HR in the mid 50s

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As ever well meant advice coming from many. Apart from "See your doctor", then I would have thought that a general question of........What was your normal pulse before Afib knocked on your door? would have been more apt.

If say Hoski was one whose pulse was 100bpm, when/why does it become acceptable to say that 48bpm is okay, bearing in mind we are talking about a drop in the pulse rate of over 50%. Such a massive drop is surely going to cause other problems?

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