Irregular heartbeat after AF episode

[Twitchen]

Last night my OH had his second AF episode, first one was about 22months ago for which he was hospitalised. Since then he has been on Bisoprolol 1,25mg once daily and Apixaban 5mg twice daily. He was told if he had another episode to take “pill in pocket” once, which is a 5mg dose of Bisoprolol. This did bring the heart rate down, but it is still very irregular and has gone up again to nearly 100bpm. Due to taking the 5mg pill, he didn’t take his usual 1,25mg pill. Just wondering how long it will take for this to stabilise, is prolonged irregular heartbeat usual after AF?

[mjames1]

Hard to be sure without an ecg, but definitely sounds like he's still in afib, just at a slower rate.

Many times you will naturally convert within 3-4 days, but if much longer than that, I would suggest you ask your doctor or go the A&E for a cardioversion. Since he's already on a thinner, they can do that right away.

Moving forward, you might also want to ask for a different kind of Pill in Pocket that is an anti-arrhythmic like Flecainide. Unlike bisoprolol which is primarily for rate control, Flecainide is designed to convert you back into normal rhythm and often works within an hour or two. Sometimes it's given daily, but since his episodes are so far apart, makes more sense just to take it as a Pill in Pocket.

Jim

[Twitchen in reply to mjames1]

Thanks for replying. Yes definitely Afib, heart racing last night and today blood pressure monitor showing irregular heartbeat symbol every time.

[mjames1 in reply to Twitchen]

If you're having trouble keeping your rate under control at home, either ask your doctor if you can increase the dose of bisoprolol or go the A&E. No reason to stay at a high heart rate for prolonged periods of time.

Jim

[Ppiman]

I find that bisoprolol takes about 1-2 hours to work fully but then works well for about a day or more. I take it only on an as need basis and am grateful for it. I rarely get AF but often get mild tachycardia and a really bumpy heart from ectopic beats or similar. The bisoprolol doesn't entirely take away the bumps, but it is helpful. I have read, in fact, that a very slow heart is more likely to have these ectopic beats ("PVCs" or PACs") than one beating normally, so, I suppose the bisoprolol might actually encourage these.

I've been told that I can increase my bisoprolol dose safely as needed, by the way, so maybe your husband might check to see if this is the case with him. It seems it is a very safe tablet to take.

If you haven't already, from my own experience, I could recommend getting a Kardia device, a small portable ECG gadget that would work with an app on your husband's phone. The company offer a paid-for "advanced determinations" service for their 6L model that picks up a wider range of arrhythmias than, say, an Apple Watch can do, and you can also send of one ECG a month for their experts to review and comment upon. I pay, I think, £5-95/moth for this service. but haven't sent any ECGs off yet as my GP or cardiologist are more than happy to review these.

Steve

[Karendeena]

Hi Twitchen, my af episodes last around 36 yo 48 hours, awful and leaves me exhausted, fortunately (at he moment) I usually revert back to NSR myself, not sure how long that will last though!

[FancyPants54]

In the UK 100 beats per minute is still in the "normal" band, so don't worry too much. My heart rate is high all the time and often over 100 but I don't notice it. I am in permanent Afib. And as I tell anyone who listens, it's so much better than the Afib that came on out of the blue for 3 days or less and knocked me for six. I mostly don't notice this at all now.

[irene75359]

Bisoprolol is very effective for slowing my heart down but does nothing (for me) to restore NSR. Flecainide works in 1-2 hours, I use it as a PiP.

[Twitchen]

Thanks for all the helpful replies. This morning heart rate and blood pressure are quite low, but he has had one reading without the irregular heartbeat symbol showing, so perhaps it is correcting itself. He did increase his usual dosage of Bisoprolol today by taking two 1.25mg, so hopefully tomorrow he can go back onto just the one 1.25mg. Trouble with taking too much Bisoprolol is that it wipes him out completely. He was never offered Flecainide, but if the irregular beats stop, I suppose it is not needed.

[JOY2THEWORLD49]

HiAF is a irregular heart beat.

I was in rapid, persistent heart beat.

When put on ccb Calcium Channel Blockers last December.

He must control his AF. 100 is normal. I got mine down to 93 day from 186! average.

At night 48 avge.

cheers JOY

[Twitchen]

Thank you all. This afternoon it appears to have stabilised as the irregular heartbeat symbol is no longer showing. He is feeling very tired though as blood pressure is low at circa 80/58, but once the higher dose of beta blocker wears off and he gets back to usual dose, hopefully he will feel better. These episodes certainly do knock you for six though.