I was diagnosed with paroxysmal AF earlier this year and would welcome comments re. a new observation in my hand-held ECG outputs showing double beats occasionally. Note that it can take 3 months for a cardio chat so I thought getting input from this excellent forum would be a good first step.
Background. Aged 67 and am very active with BMI of 23 with thankfully no comorbidities. Echocardiogram was fine. Don’t smoke and gave up the booze once diagnosed. Normally my BP is 95/60 with resting pulse rate of 50 to 60. Initially AF occurred every 3 days or so and lasted from a few mins to 15 hrs. I use relaxation and entrainment techniques to restore NSR.
I was prescribed a low dose rate of Bisoprolol as an anti-arrhythmic to reduce effects of adrenalin surges as my triggers are predominantly stress induced. From my insistence (as low pulse rate) I started off at 1.25mg/day in Aug and increased this dosage last month to 2.5mg/day. Pulse reduced to 45-55 and BP has remained pretty constant throughout, and no adverse effects such as dizziness etc.
This medication has reduced frequency of episodes to just the one in the last month which is great. However, I’ve spotted recently I am occasionally some double beats. See attached chart showing double beats for most of the 30 sec output. They do seem to be pretty regular at my normal sinus rate so don’t think I’m in AF which has beats all over the place. Fortunately, they seem to clear within a few mins once I’m up and about but they are annoying when I get them at 3 am.
I’m assuming these double beats are ectopics? Are they cause for concern?
Any idea what is triggering them? I wasn’t aware of them before starting the Bisoprolol, so maybe it’s the culprit? I found that stopping my daily Mg Taurate helped reduce night time double beats, but am still having some during the day. (note I used to take one Mg pill first thing in morning and one at night with evening meal)
Secondary question…When I talk to the cardiologist next what should I say if he wants me to increase Bisoprolol dosage (3.75 or 5)? Increasing dosage from 1.25mg to 2.5mg didn’t really change my BP or pulse. If I have to then I’m keen to try as otherwise I guess it’s an ablation?
Thanks!!!
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Vince1001
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Really appreciate the comments Palpman- you are very knowledgeable on this topic. I've read up a bit and watched some videos on this topic now and mainly agree with your diagnosis. It's not quite "normal/ normal/ drop" as some references indicate, but I agree it needs to be reviewed. Strange that I had two ECG's earlier in the year, one while in AFib and one while in NSR and none of this was picked up. Justification though for people having their own handheld ECGs!
I have had the same for several days off and after a run of AF episodes. I believe (helped by a site called Life in the Fast Lane) that those are ectopics in couplets. One cause is the use of a beta blocker which I don’t take though. Unfortunately I didn’t get a diagnosis as they occurred over the weekend and I didn’t feel ill enough to go to A&E.
Forgot to say that there are several other meds that can be tried before an ablation - a beta blocker is the most basic and is not strictly speaking an anti arrhythmic but used to lower rate and response to Adrenalin. However there is a case for having an ablation early before AF is too well established. I also noticed the ectopic rhythm came on when I was still and changed to NSR when I moved about.
Looks to me like bigeminy. No, I didn't just make that up. Bi meaning twice, geminy, from the gemini greek for twins. There is such a thing as trigeminy.
I've been having this off and on all year. I've mentioned it to the arrhythmia nurse when I went for my pre-op (twice). She just noted it and said nothing. My ablation is now cancelled for the second time, with the rise in the covid19 infection rate.
My bigeminy kicks in mainly when I've allowed myself to get too hungry before a meal, and starts when I eat. Sometimes it starts before I eat. I've found the only remedy so far is a long period of relaxation after it starts, and it will go away. On some occasions it has led into full blown AF, but probably only when I was due another bout anyway.
Had my pre- assessment yesterday for an Op I've having early Dec (Covid permitting). Showed her my handheld ECG output and she confirmed it is bigeminy - as she herself has this problem! Said that she just tends to ignore her own condition, as the more she worries - the worse it gets.
She says it won't be a problem for the Op, but it's good for them to know beforehand. Also gave her some random BP/pulse measurements over the last month which she appreciated.
Had my ECG checked during the check up and my heart behaved itself with NSR evident, and no sign of Afib or bigeminy. Still aiming to see the doctor soon to arrange a private appointment with an EP specialist if I can.
Hi Vince 😊 I had a similar but not quite the same printout on my Kardia and I become breathless when I get this rhythm pattern so I sent the recording to Kardia for clinical review. I am not sufficiently knowledgeable about ECGs to tell you yours is the same .
The result came back as ...
MULTIPLE ATRIAL ECTOPICS
You have multiple extra beats originating from the upper part of the heart.
ATRIAL COUPLETS
Your atrial extra beats occur in pairs.
Significant ECG abnormality
observed. Forward this report
to your physician for his/her
advice unless the abnormality
is already known and been
assessed/treated.
...My EP was told about it but seemed unconcerned..
I suggest you Google ATRIAL COUPLETS in 'images 'to look for similarities...😊
Re your second question, discuss with your cardio why Flecainide has been overlooked; it is a powerful drug but relatively old tried and tested & reputedly risk free at your age with no accompanying comorbidities. I started on 100mgs/day which didn't stop my AF, so I suggested we try a medium dose of 200mgs/day before taking up the offer of an ablation. Result AF virtually stopped for 6 years and counting, ablation postponed saving the NHS £15K! Most cardios prescribe this drug with a BB but my cardio insisted the latter would make me feel unwell due to my lowish pulse/BP being roughly the same as yours. If you can, consider a private appointment to reduce anxiety/stress. All the best.
Many thanks secondtry. Really good news re. your success of the Flecainide. I agree with getting a private appointment as I can't handle a 3 month delay in seeing a cardio.
I am also 67, active, with no other health issues. I have had this same couplet pattern for about 20 years. I have it at rest mostly and certainly in the wee hours of the night. I have bradycardia, a very slow heart. My resting heart rate is in the 40’s. My pattern becomes normal under exertion.
I also have PAF and PAFlutter, but cannot take a beta blocker because heart rate already low, and a BB would only make that worse I am told.
My EP has never seemed particularly concerned about this pattern, because I don’t have symptoms with them. However, I have been told that an unusually slow heart rate can beget a fast arrhythmia, or any arrhythmia, and my AF episodes always started in middle of night while sleeping. (I’ve had 2 ablations, so far successful for PAF, but they couldn’t fix the flutter, so am now on Tikosyn.)
It might be a problem if your Bisoprolol was increased, as it sounds like your heart rate has already been lowered. I hope your cardiologist can give you explanation of the cause of this pattern. I would love to know what you learn!
Thanks for sharing that info, Violet. It's my gut feeling not to increase the dosage too much ...though I'm aware the next step otherwise might be ablation. I'm trying to see the doctor/ cardio asap but recognise that I may need to go private. Will keep you posted
You are correct Paplman. Just checked my diary and found that I have had these double beats at least 5 times in the last month, and each time this was first thing in the morning. They clear once I'm up and about.
Note that before using Bisoprolol I recorded my pulse at night before using my oxyimeter, I I recall it went down to 35 bpm, though can't remember getting any double beats. I made this clear to the cardiologist ( a local prof) when he prescribed the medication and his response was "that pulse is normal at night". Obviously I now need to check what rate it goes down to now...and then have a chat with the cardiologist.
I am beating this drum to death, but hope it helps someone as it has me: Liquid COQ10 (I use Qunol, often on sale at Costco) has ironed out my irregular beats like nothing else! After two ablations, the first following 10 months of full-time afib, I started getting occasional runs and ectopics, so started taking 30 mg every single day, and by golly if it didn't back right off. I still get occasional nighttime flutters that wake me, but nothing like it had been doing, off and on all day. I'm on no other medication except Eliquis right now.
Seems to accord well with my own singular experience of A&E when I first started with AF three years ago. I'd recorded 280bpm on an ECG with the paramedics, while I was still at home thinking I was about to die. A&E stuck me on a trolley (there were no beds available) in a cubicle and left me there for hours, with a nurse checking me over at half hour intervals. Eventually, at about four in the morning, a doctor came and told me it was AF (I'd already had all that explained to me by the ambulance people). He gave me an aspirin. I was discharged at 10am with assurance that I would be referred to their cardiac unit. That never happened. Two days later I bought the Kardia. I had to arrange my own referral weeks later through my GP. The cardiac unit were also useless, and I went back to my GP asking for referral to an EP.
I've never been back to A&E, no matter how bad its got.
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