Low heart rate ?

[Awilksy35]

Hi all..

Diagnosed with Persistent AF around 9 months ago and was put on medication ( bisoprolol 2.5mg, rivaroxaban 20mg) . I was due to have a cardio version in March, which was unfortunately cancelled due to the Covid 19. Prior to the cardio version I was also prescribed amiodarone 200mg pre and post CV. I spoke to the doctor for advise reference medication as the CV was cancelled and was advised to continue as prescribed.

Last week I suddenly then went into sinus Rythmn ( Apple Watch 5) and have been for almost 2 weeks. However my heart rate has been very low (42) with a resting heart rate of 49, presumably due rhythm and medication.

Anyone had this ?

Thanks Andy

[pottypete1]

Bisoprolol slows the heart rate.

I used to take Bisoprolol but my EP stopped it because I have developed conductivity problems over the years.

My resting heart rate is circa 40 -45bpm. Whilst lower than the rate that most consider normal ie 60 - 100bpm, I am fine albeit I do have some shortness of breath. I can live with it.

Pete

[Paulbounce]

I can only comment from my personal experience.

First thing in the morning I'll be about 53 / 54. As the day goes on I'll be 63 (ish) and sometimes lower - this is at rest. The lowest I hit was 46 first thing in the morning. It's often about 51 - 53.

At night if I eat a big meal I'll knock around at 75 (ish). It does seems to change depending on the time of day.

60 to 100 is considered the 'norm'. However (for me personally) I know what end of the spectrum I'd rather be in.

I'm not medically qualified in anyway at all so you need to check with you doc. 49 would be acceptable to me but as I've said I AM NOT medically qualified - that's only my personal take.

42 is a little low IMO. Chat to your doc about your med's.

Good luck.

Paul

[pottypete1 in reply to Paulbounce]

Although the “norm” is quoted as between 60-100bpm I actually feel rather unwell if my heart rate exceeds 70bpm.

In fact on the vast amount of occasions I have had AF my heart rate rarely exceeded 90bpm and often settling around 80-90bpm. I always felt awful.

We are all so different which is why anyone asking questions of this forum must also talk to their medical professional who is responsible for their care.

Pete

[Paulbounce in reply to pottypete1]

Pete wrote

"Although the “norm” is quoted as between 60-100bpm I actually feel rather unwell if my heart rate exceeds 70bpm"

I can take about 85 -90 before feeling the same.

And

"We are all so different which is why anyone asking questions of this forum must talk to their medical professional who is responsible for their care"

Yep.

Paul

[cuore]

Wow! I find your time-line for persistent AF most fascinating. By my calculation, you were diagnosed in October, placed on Amiodarone ( an anti-arrhythmic drug) in March, and 2 1/2 to 3 months later converted to sinus which you have been in for two week. So my question is would that qualify as a chemical cardioversion? Plus even though you were persistent for eight months, because you converted, does that mean your heart was not remodelled? I know these are questions for an EP, but I am most curious.

I am taking Propafenone, an anti-arrhythmic drug, and it is keeping my heart rate in the forties. When I went off it for 6 days, my heart rate shot up to the sixties.

[Palpman in reply to cuore]

A chemical Cardioversion is when the heart is stopped with a chemical for about 6 seconds. Used for SVT's such as AVNRT or AFlutter.

[cuore in reply to Palpman]

Actually, I have had a chemical cardioversion. It was with Procainamide. I recall it as a slow drip for more than a half hour. I did not have experience with the heart stopping and it was for AF.

I was just wondering if when you are taking Amiodarone and you go back to sinus rhythm whether the fact you are taking the drug that would qualify as a chemical cardiversion.

Thank you for your view of chemical cardioversion. My perception may be entirely wrong. I will do some research on chemial cardioversion. Also, it may have been for SVT.

[Palpman in reply to cuore]

Actually Procainamide is an antiarrhythmic drug used for Ventricular Arrhythmias. It is used in a hospital as an IV.

Amiodarone is an antiarrhythmic tablet used for many types of arrhythmias.

Neither of the 2 are used as a Cardioversion as such.

Adenosine is not an antiarrhythmic drug but a chemical injected into a vein that causes the heart to stop for 6 seconds to hopefully get it back to sinus rhythm.

This is much like an electrical shock to the heart to convert it.

Adenosine and electric shock are used for Cardioversion.

I hope I made it more clear now.

[cuore in reply to Palpman]

Yes, thank you, you have made it very clear. But, that is not what happened to me when I went to emergency for an electrical cardioversion as directed by my Bordeaux EP. I live in Vancouver, Canada. I told the receptionist that I was taking Amiodarone. Without relaying the whole scenario, the emergency doctor twisted my arm to get a chemical cardioversion despite my saying several times that I had been directed to get an electrical cardioversion. To convince me, he even printed out a Procainamide cardioversion article. It didn't work, plus my blood pressure got so low that I almost passed out and I believe they had to hydrate me,plus do the electrical cardioversion after all. It was a very bad experience that made me lose a lot of faith in that hospital since I already had had bad experiences there.

I am in sinus now. I hope I never have to have a chemical cardioversion again. But, if I do I will ask if they will be using Adenosine.

[Jeans1234]

Congratulations on going into NSR xx

[TheProf]

Yes. Amiodorone and fecainide (independently) both slowed my heart rate by 10 down from 53 to 42.

Not a problem for me as it used to 39 when I was exercising.

[Palpman]

Low heartbeats at around 40 odd may increase AFib episodes and cause ectopic beats to feel more pronounced.

Normally HBs in the 30's is total heartblock where no signals from the sinus node get past the AV node to reach the ventricles.

[Janey1955 in reply to Palpman]

My normal heart rate is about 45 as I go about my day and 33 in the night, Both my grown up children have exactly the same. I have no faintness, dizziness or shortness of breath. However, I have developed paroxyl AF and do have a stage one heart block. I think my heart rate is normal for me, but it may have caused the AF. I cant take a lot of these medications because I cant take anything which would reduce the heart rate further.

[Palpman in reply to Janey1955]

If the sinus node pulse gets stuck at the AV node and cannot continue to the ventricles then the heart has a plan B

When this happens it is a complete heartblock and the emergency AV node pulse will take over. This is a smart backup to prevent sudden cardiac arrest.