I have persistent AF, coupled with a naturally low heart rate and more recently I had a number of blackouts which occurred when I was in NSR for a short while after a cardioversion.
I will shortly be fitted with a 72 hour monitor to see if any indications come up to give some reason behind the blackouts.
The blackouts only occurred when I was in NSR and in the last 4 weeks since I have been back in AF there have been none. I therefore do not hold out much hope that the monitor will give me any answers.
My resting heart rate in NSR is in the upper forties to low fifties, whilst my resting heard rate in AF is in the mid seventies and we’ll controlled by 2.5mg Bisoprolol.
The blackouts are the most worrying part of the whole scenario as you just don’t know when one will occur, what you may be doing at the time and what dangers could befall you. My brother some years ago was standing on a ladder about 6 foot off the ground when he had a blackout and spent months recovering from his injuries.
My cardiologist has said that as my AF doesn’t cause me many problems and I live a reasonably normal day to day life that I should consider the option of remaining in AF as opposed to the other route of cardioversions and ablations plus the likelihood of needing a pacemaker (due to my low heart rate), all of which do not guarantee a successful outcome and may not necessarily get to the root cause of my blackouts.
I can understand his logic which took me a bit by surprise. I’m 71 and don’t relish the next few years going from one procedure to another in the hope that AF and the blackouts will be resolved.
I wondered what others out there would think if they were in my place.
Would think the cardiologist would refer you for further medical eval if there could be another reason for the blackouts other than AF. And will prescribe proper medication to prevent.
The heart monitor should provide an accurate assessment of your heart function. If you don't have, you may want to invest in a personal heart monitor like Kardia or Apple Watch which can also provide info for your cardiologist. Monitoring blood pressure is also important.
Thank you for the link to the document. It tends to show that identifying the cause of blackouts is not that easy.
The consultant wants to see the results of the 3 day monitor test which is in about 4 weeks time, will see if that identifies anything although I’m not hopeful.
I have a Kardia and also a Fitbit although I am thinking of changing to an Apple Watch which gets good reviews on this site.
My consultant is also changing the Bisoprolol for Diltizem which suits me as I am not a fan of beta blockers. I currently take a calcium channel blocker for another issue which he will stop as Diltizen is also a calcium channel blocker.
I would wonder if the Bisoprolol could possibly be contributing to your blackouts by lowering both blood pressure and heart rate (since it does both as a beta blocker), so that in NSR especially you really don't have enough of either to oxygenate your brain satisfactorily. What would happen if you didn't take the bisoprolol?
Unfortunately my post was not clear and didn’t explain that when the cardioversion converted me to NSR I had to stop the Bisoprolol as it pulled my heart rate down to 40 and below.
I had the blackouts probably about 2 weeks after stopping the Bisoprolol and perhaps even at a rate of around 50 could have been too low.
Thinking back, I was working in the garden for a couple of hours on what was a very hot day and didn’t drink anything so that could have been the cause of the blackout that followed shortly after I had finished.
I’m sorry to hear about your blackouts, that must be very scary for you, the more so given what happened to your brother. With the caveat that I am not medically qualified in the slightest, as PlanetaryKim has suggested, maybe your body has adjusted to the rate when in AF and so the Bisoprolol is causing your heart rate and blood pressure to go too low when you are suddenly back in NSR and your naturally low heart rate is restored.
As for what to do, it’s really a question of quality of life, isn’t it. If your QoL in persistent AF with the Bisoprolol is good and enables you to do the things you want to do then I suppose one has to ask why you would put yourself through those procedures given, as you say, there’s no guarantee of a successful outcome. Then again, I am a terrible wuss when it comes to medical procedures, so probably not the best person to advise you😀
All the best to you, whatever you decide to do, TC.
The only positive that came out of my brothers fall was that the ambulance medic spotted that my brother had Atrial Flutter which was subsequently resolved by ablation.
You will see in my reply to PlanetaryKim that my original post wasn’t clear in respect to Bisoprolol which has confused matters.
Difficult decision to make as none of us like medical procedures and what my consultant is saying seems logical, it just seems to go against the grain in not trying to resolve the AF.
Have to give it a lot more thought after he has changed my Bisoprolol to Diltizem which he says may be better.
Agree with Planetary Kim. When you revert to NSR your heart rate may drop . I could not take Bisoprolol as even the 1.25mg I was prescribed dropped my resting HR from 70 to mid 40s and although I can't say I blacked out, I was not far off as I was asleep 40 mins after every tablet I took and stopped asleep for 4 or 5 hours!
Could you try a reduced dose of Bisoprolol to see if it still helped enough when in AFib, but may not cause the blackouts in NSR. Alternatively there are other beta blockers.
I tried Atenolol 25mg ( min dose) which did not put me to sleep immediately but still left me very tired. There are several other beta blockers I gave not tried personally.
I can only take Bisoprolol when in AF. If I take Bisoprolol when in NSR my heat rate is down to 40 and below. Unfortunately my original post was a bit confusing.
I know exactly what you mean about beta blockers and sleep, I try not to sit down for too long in the morning as I would only fall asleep, the trouble is when I watch tv at night I miss parts of most of the programmes as I dose off.
My consultant is going to take me off beta blockers as I have a bit of a problem with my Asthma, he’s going to change it to Diltiazem which suits me as I don’t normally have a problem with a calcium channel blocker.
In the past I've passed out, usually to a low resting heart rate from running. An EP told me that his colleagues would have fitted me with a pacemaker. That he said, would mean that I would pass out with a better heart rate.
Would have thought that a faster resting heart rate would have helped to provide more blood and therefore oxygen to the brain, so don’t quite understand his comment.
I think that he meant my low heart rate might have been limiting lung perfusion , so my SpO2 would have been lower. After that I was told that it was not sleep apnoea and, I didn't pass out on a tilt table test despite two sprays of nitroglycerin under my tongue. I think the diagnosis was vasovagal syncopy with unknown cause. When I'm in hospital overnight and on a monitor, the audible alarm keeps going off due to either low respiration rate, or low heart rate as I drop off to sleep. Eventually a nurse will get fed up and permanently switch off the alarm: LOL, I don't know if it's monitored at the night staff station.
Everyday is a school day on this site, so much useful information provided.
That’s disappointing that they could not establish a cause for you passing out.
Hopefully the alarm is visually if not audibly monitored at the night staff station, otherwise one day they might have some tricky explanations to give.
Try this for coming up with a tricky explanation. Admitted with a non-productive cough and lung sounds; a young doctor diagnosed community aquired pneumonia (I was 70) and discharged me after an overnight stay. I'd read American medical reports and believe I have pulmonary toxicity caused by dronedarone. Things don't improve and I'm readmitted for a fortnight in a geriatric ward! A team of young doctors go through the diagnostic book, but fail to note that a powerful antibiotic had no effect, so it was unlikely to be pneumonia. A young doctor discharges me with no medication and no follow up. I worsen and an on the ball nurse at the local Health Centre made sure that I was waylaid by my GP. My SpO2 is 76% and he sends me straight to the specialist lung centre. My x-rays have been scanned by the professor who leads the lung centre. I ask a doctor, do I have pulmonary toxicity? Yes, she replies. That night I'm a hairs breadth from going critical, and I'm put on 25 litres / minute of oxygen; they work through the night in the ward.
If I had stayed at home, I would have died that night. No doubt the doctor who discharged me the second time, had some explaining to do.
I would have made a formal complaint to the hospital about both the doctors who discharged you otherwise such incidents and the potential consequences are soon forgotten.
Both need to understand the seriousness of their actions or lack of and to learn from what happened.
As you said they are both young doctors and therefore still have a long way to go with their practical learning and treatment of people. Hopefully this has been a good lesson.
Glad the nurse at the Health Centre was on the ball.
I don’t think you have been well served by your doctors and in your position and your brother’s, I would want to know why syncope (blackouts) occur. The Arrythmia Alliance (same organisation which sponsors this forum and runs the Atrial Fibriallation Association) have a sister organisation called STARS. I would suggest that you contact them and read up on all of the possibilities and then return asking for a referral.
My brother was very poorly served by the nhs which was in the middle of the epidemic. It was the ambulance medic who spotted my brother had Atrial flutter which he subsequently had sorted by ablation.
The cardiologist I was referring too was private, he wants to meet again once I’ve had the monitor fitted and also to review changes to my medication, I’ll be raising the issue of the blackouts again with him then.
Whilst I am in 2 minds about the way forward in respect to AF, I still want to get to the bottom of my blackout problem. The trouble is they only occurred whilst I was in NSR and haven’t occurred to date when I am in AF so available data/information is lacking.
Thank you for the pointer to STARS, I will follow that up.
Hello Denboy70, over the past couple of years I have developed Afib and had a cardioversion and two ablations which were unsuccessful. I also passed out on the golf course and felt ill. Also passed out again which was quite different rom the first one, and only lasted a few seconds.I had an excellent Cardiologist in Bristol who after talking me through various options recommended a pacemaker with an AV node ablation, best thing I ever did. Back playing golf three times per week too with no ill effects.
I am 77 so plenty of time for you, taking no drugs for AF only a blood thinner to help reduce the possibility of a stroke.
The second time you passed out which lasted just a few seconds is the classic faint/blackout and is sometimes preceded by a feeling of dizziness.
My first 2 episodes only covered the feeling dizziness stage, my next 2 episodes I regained consciousness as I hit the floor so out for say a second and then back to normal, then 4 weeks recovering from the bruises and soreness.
Pardon my ignorance but you said your ablations were unsuccessful so I assume you were in AF. A node ablation is I think where you become entirely dependent on the pacemaker ?, does that then mean you are thereafter in NSR.
Hi DenBoy70, the second faint was whilst I was driving on the M5. I was taking our daughter to Bristol and just fainted, my daughter managed to grab the steering wheel and get us to the hard shoulder. very lucky for both of us and other drivers who may have been involved. After discussion with the DVLA and my Cardiologist it was no driving for 6 months, a real pain but necessary.As for the question of NSR or AF, the pacemaker with AV node ablation does mean the pacemaker is your very, very best friend. Mine is currently set at HR min 70 with 120 HR max. Yes you can still be in AF but feel no symptoms.
I suppose making the decision on the pacemaker was strange, as in my world items can fail or have problems, was told pacemakers do not go wrong.
My Cardiologist had been brilliant so after full discussion I went ahead. As said previously best decision as am back to near normal life style.
Low and behold tested positive for COVID this Wednesday, ah well can't win them all
Your experience on the M5 is my worse possible nightmare, thank goodness your daughter was there to help.
I asked my cardiologist about having a pacemaker and he advised against it saying pacemakers can go wrong, so confusing as every cardiologist has a different opinion.
Thank you for your help, I hope your recovery from Covid is quick.
Seems you need to stop the BB or have a pacemaker inserted.I have on 2 occasions stopped my BB on my own accord due to pulse dropping too low. My GP later agreed and put me on a channel blocker.
I’m glad to say (although I forgot to put it in my post) that my consultant has decided to stop my Bisoprolol and change it to Diltiazem, a calcium channel blocker.
My lowest rate on Bisoprolol was one night when it went down to 37.
Hi DenBoy70,I was recently in hospital after having a number of episodes of fainting. I am in persistent AF and assumed that they would do a CardioVersion. However the Cardiologist strongly recommended that I use the information on stopfainting.com to help me cope with these episodes. The site is written by the clinical team at Imperial so is authentic, it certainly helped me.
I hope you have recovered after your fainting episodes, it can be very scary and makes you keep wondering when the next one will occur.
Thank you for the link, I’ll have a look at the information they have available.
I did actually e-mail them a couple of weeks ago to understand how to get a referral to them as they are supposed to be top of their field.
They were very helpful and said in general patients came via their doctor by electronic referral although the waiting list (depending on clinical urgency) was quite long.
Do you consider the Bisoprolol a possible contributing factor to your low heart rate? Is your doctor suggesting you accept your AF at 70s BPM as the permanent AF? And is that without rate control?
Am I correct in understanding you were dealing with bradycardia before your AF diagnosis?
Thanks. I wanted to understand a bit more your situation before commenting further.
My resting heart rate for the past few years has always been in the upper forties to low fifties, before that I never used to check what my heart rate was.
These rates have previously never caused me a problem even though they are termed bradycardia. I have previously asked my doctor and also when I used to have a check up in the hospital if they were a problem and the answer always came back “if they are not causing you a problem then there is nothing to worry about”.
AF for me started on the 30th November 2021 and was persistent from the start. I was put on 2.5mg of Bisoprolol which keeps my resting heart rate in the mid 70’s.
After a successful cardioversion in February of this year my cardiologist reduced my Bisoprolol to 1.25mg with the instruction that if I slipped back into AF then I should increase the dose back to 2.5mg.
However 1.25mg of Bisoprolol proved to be too much when my heart was in NSR and I had to stop taking it completely as it was pulling my heart rate below 40.
When I had my blackouts over a 6 day period I was in NSR as I used to check using my Kardia device. I went to A&E immediately after my last blackout as instructed by my doctor.
I think it was the stress and mayhem of being in an absolutely packed A&E for 9 hours that caused me to go back into AF. When I arrived at A&E I was number 15 in the queue just to get into the A&E department.
So since the 23rd March 22 I have been in persistent AF, taking 2.5mg of Bisoprolol and a fairly consistent resting heart rate of mid 70’s.
It was an EP I last saw (not a cardiologist as my original post) and when we discussed the problems of the medication I am currently on, there weren’t too many.
He has suggested a change from Bisoprolol to Diltizem as I was having a slight problem with my asthma even though Bisoprolol is cardio selective and shouldn’t be a problem at a low dose.
Sorry for the long response but my initial post was not as clear as it should have been and may have mislead some of those who have kindly taken the time to respond back.
My cardiologist gets concerned that my sleep rate dips to the upper 40s at times. Also that the intervals can go as high as 6 seconds. He raised the issue of fainting during day hours based on the beat intervals. So time between beats can be, apparently, a cause for fainting. I've never experienced that, but the doc raised that concern. You may wish to look at that.
I concur with others that, given your propensity to low cardiac rate, it might be a contra indication for beta blockers in your case. And I gather your physician is addressing that. My heart rate tends in the lower range and I'm on atenolol, both for HBP and AF rate control, but at minimal dosage, which I tolerate well.
Lastly, since your quality of life is good, the label "persistent AF" shouldn't be an issue. In the end, it's a label, not any worse than proximal, and one in truth most of us progress to as we age with AF.
I'm 68. Got the new label 2 years ago. The label was the only thing new, my QofA hadn't changed an iota.
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Is it a choice? Pacemaker v Implanted defibrillator?
Persistent/ permanent AF episode and exercise 
Search for guidance on the choice to Ablate Ectopic beats.
