What’s worse. Bradycardia or AF?

[NJ47]

These timings are rough so please bear with me. About 3 weeks ago I started Amiodarone.

One week later I'm back in Sinus after almost nine months of being in persistent AF.

I ended up in hospital twice as I felt really ill; fatigued, light headed, slightly sick etc. My heart rate was between 46 & 51bpm and we were finding that nothing would up it. I figured that if I could get back to 60bpm which has always been my resting HR unless in AF, I'd be ok.

The hospital put me on 6 Sando- effervescent tablets to get my sodium levels up.

A few days later I was back in, following waking with very heavy sweats.

I then reverted back to AF before getting my HR right. That was about four days ago.

I've now, within the last hour gone back to Sinus, but my HR has not improved. 51bpm.

I think the amiodarone is slowing my HR and we think, although early stages, that I nay how be having thyroid problems which also slows the heart.

So, what can I do to up my HR now I'm back in Sinus? Don't really want a repeat if the last week or so.

I'd be very grateful for your thoughts/idea’s.

Thank all,

NJ

[Hidden]

Im a retired RN and I cannot think of anything to get your heart rate up, other than stimulants, which wont help the A Fib. Slower heart rate can also be caused by sick sinus syndrome. If your heart rate drops in the 40’s, they might talk to you about a pacemaker. Mine stays around 55. Ive been told if my a fib got crazy and I needed bigger med doses I might have to have a pacemaker to keep my heart rate up.

[CDreamer]

The only thing that really works = Pacemaker. After years of fast AF I suddenly developed short bursts of bradycardia with HR in low 40’s and occasionally 35 which would put me into AF. Pacemaker sorted it. Same thing happened to my husband. In my case - it has also drastically helped the AF episodes and I am no longer that symptomatic.

[NJ47 in reply to CDreamer]

This is where learning from the experience of others is SO helpful. Thanks. I guess pacemaker may be an option.

Thanks again

NJ

[Hidden]

Every time I had a cardioversion either by meds or shock I was warned that my HR might come back slow and possibly require a pacemaker.

I was also on Amiodorone for several months and it damaged my thyroid.

[NJ47 in reply to Hidden]

Did your thyroid revert to normal after you came off Ameodarone?

[Hidden in reply to NJ47]

Took about 12 months , but yes, eventually

[NJ47 in reply to Hidden]

Good news. I think it's affecting mine, albeit slightly. If you don't mind me asking, how often did you get your thyroid checked? I understand the medical recommendation us every six months. I'm thinking of checking it again in the next two.

[Hidden in reply to NJ47]

It was discovered because I was feeling so awful and had other issues from being on amiodarone. Following the thyroid damage i was tested every 3 months .

Thyroid function was shown to be improved at every test but took 12 months to be back in the normal range

[NJ47 in reply to Hidden]

Thanks Mikee. At least it got back to normal. Watching everything very closely. Thanks again

[CDreamer]

PS - I think the bradycardia is more serious but the tachycardia more uncomfortable.

[NJ47 in reply to CDreamer]

That makes sense CDreamer

[Cliff_G]

NJ, after going on to Amiodarone, my AF converted in 3 weeks (it was a post-op AF; I also have a 20 year history of AF, ablated successfully in 2002). My resting HR is now 47. This is in combination with beta-blocker (bisoprolol). My GP and Cardiologist are not concerned about the low HR and there has been no talk of a pacemaker. Everyone will be slightly different.

If you are on a beta blocker as well, then when starting Amiodarone, my Cardio said reduce the beta blocker as Amiodarone has a beta blockade effect.

Thyroid problems should be checked out but they will be apparent from any blood tests you've had, and I'm sure if you've been admitted then you will have had many such tests. It's normally too early after only a few weeks to worry about thyroid effects of Amiodarone - IF they happen due to the amiodarone it generally takes a long time (1 year/years, I think), but clearly some react earlier (Mikee above). However, I would be pretty sure 3 weeks is not long enough. You should also have had your thyroid levels tested due to your AF; it's a standard item to check (hypo or hyperthyroid).

Suggest you discuss with your doc.

One other thing, it can take a little while (weeks) to settled in to a new combination of meds, so hang in there, but still discuss with your doc.

Best of luck

[NJ47 in reply to Cliff_G]

Thank you so much, Cliff. At 47bpm I feel like death warmed up. Literally climbing the stairs would feel like Everest and I was both totally fatigued and breathless. How does that compare to you?

Can you tell a difference between 47bpm and 55?

This is an ever learning experience.

[Cliff_G in reply to NJ47]

For me the slow rate is not the problem, and I wonder with you whether the slow rate is not the cause but a symptom of what's going on. For example, with me, I was on Metoprolol and felt awful pretty much all the time, heavy legs, dizzy on standing, unable to do any exercise, climbing the stairs at home was a struggle, breathless, etc. Then for supply reasons I was changed to bisoprolol and it was a huge change, yet my heart rate was very low both before and after the change. I still get the dizziness on standing if I am not careful, and sometimes the first bit of walking or stair climbing is difficult, but once I have got going I am fine and know it is just a question of getting some fitness back. And this is on amiodarone and bisoprolol (amongst others). There's definitely an aspect of "getting the blood moving" with me, which actually is just that and getting more oxygen to my muscles. When we're ill we do a lot of sitting and lying around and part of the problem is re-training the body for movement again. Certainly true for me.

I would talk to my GP initially. Explain how you're feeling and ask that the various possibilities (amiodarone, beta blockers?, some undetected rhythm issue, thyroid, some other drug you're on, etc.) are discussed to see if you can together find the cause and a solution. If necessary, the GP can initially write to the relevant Consultant to save a wait to see them. Good luck

[NJ47 in reply to Cliff_G]

Thanks. Well, I'm seeing my EP on Tuesday and I can correspond with his secretary via email. If necessary, he then calls me, so in effect, (maybe a but naughty here), but I've bypassed my GP.

Thanks again for your reply.

NJ

[CDreamer]

Re - thyroid & Amiodarone - My husband started on it in February after a failed cardioversion (well NSR lasted 8 seconds) he was in persistent AF. It took about 3 months but he is now back to NSR. He is having his thyroid functions monitored monthly.

[NJ47 in reply to CDreamer]

Great. Thanks CDreamer. This us what I LOVE about this forum.

[BobJ52]

Hi NJ47,

I am a pharmacist and when I saw the cardiologist for my AF he gave me the choice of meds. None of them are great but I thought a Flecanide preferable to Amiodarone for me.

I stated out on 50mg Flecainide twice a day and 7.5mg of Bisoprolol. I had been put on that dose of bisoprolol in A&E from 6 visits over 7 weeks due to very fast a PAF events of HR over 230 for several hours making me feel very unwell.

Over time have adjusted meds so now on 1.25 mg Bisoprolol and 100mg Flec twice daily because I was very bradycardia with HR around 40 resting. Resting rate now in low 50’s very occasionally high 40’s but I can live with that...LOL I hope...

Feeling much better but still having rare tachycardia events about once a month. Better than two or three time a day before meds. Not suitable for everyone , especially if you have any signs of heart failure history. I think it’s worth discussing with your Cardiologist though.

Good luck with finding a drug combination that suits you.

Bob