When is bradycardia afib?

[Czech_Mate]

I think I am confused about what is wrong with me. I thought I noticed something wrong with my heartbeat in that it didn't seem to be following the normal procedure of going faster when I exercised then slowing down when I rested. My GP checkef it with a simple EKG and immediately saw something wrong, put me on warfarin and referred me to a cardiologist at the local hospital.

The cardiologist fitted a 24 hour halter which showed that my heart was beating rather slowly, especially at night. The main figures it came up with was that around 1100 times during the 24 hours there was more than 2 seconds between beats and the longest gap was 4.89 seconds between beats. OK that's bradycardia isn't it. It had been pointed out to me 6 years ago when I had varicose veins operations in both legs, but I've always been relatively fit with a resting heart rate of about 45 BPM.

The cardiologist sent me immediately for a pacemaker to be fitted. It has just 1 wire and should maintain a minimum heart rate of 60bpm. The warfarin was changed to a more modern anti-collagulant Eliquis 5mg twice daily. OK it means that I don't have to have regular blood checks with that. However I was also given Betaloc ZOK, 25mg each morning, which is the trade name of metaprolol succinas here (Czech Republic). I think this is making me tired so I told the nurse who said OK take just half a tablet is 12.5mg. That's just a couple of days ago and I've not noticed any difference yet. Should I be taking that at all if the problem is a slow heart rate?

And if I have bradycardia does that automatically mean I have afib so should I be on this forum anyway?

Just one more thing, the cardiologist said that 2 of the valves in the heart were leaking a bit, but that's not unusual for someone of my age.

Any suggestions to help my confusion with what's going on ?

[pottypete1]

Bradycardia is not AF and is the description of a slow heart rate generally <50bpm. They are completely separate conditions.

I used to have AF regularly but after a number of ablations rarely get AF but I do have Bradycardia.

You can however have slow AF as well as fast AF. I used to have both together with Atrial Tachycardia which is a very fast heart rate typically over 100bpm often over 120-150bpm. This too can come with AF.

Hope I haven’t confused you.

And yes you are welcome here on this forum.

Pete

[drivinghome in reply to pottypete1]

Can you please tell me what you did and don’t have afib now I have had 4ablations I am 63

[pottypete1 in reply to drivinghome]

Not quite sure what you are asking.

I have had 7 ablations. 1 for Atrial Flutter followed by 5 for Atrial Fibrillation and finally 4 years ago 1 for Atrial Tachycardia. This is somewhat unusual and if you have had 4 is quite a lot too.

Slowly after the last ablation my AF has declined and I only get a couple of episodes a year. My problem now is a slow heart rate and I am told I should have a pacemaker but am resisting at present due to multiple allergy problems I have.

I am 75 years old and it all started just over 30 years ago.

Pete

[drivinghome in reply to pottypete1]

That is too many ablations great courage you have Great though you don’t have afib anymore only sporadically sorry to hear about your bradycardia do you believe maybe the many ablations might have caused this

I was just wondering if you do anything else apart from the ablations such as supplements I live in Greece

Another thing is I don’t know what type of afib I have how can I find out

Yes I could ask my dr but he says I search a lot on the sites

[pottypete1 in reply to drivinghome]

No my left atrial is dilated because of suffering AF for 30 years not the ablations, and the Bradycardia is a consequence of this.

No I don't take supplements my wife does but I am of the view I am taking too many tablets each day anyway.

AF falls into two major categories.

Paroxysmal AF which is where it keeps popping up and then determining either on its own or with help either cardioversion or sometimes medication.

Permanent AF is as the name suggests permanent and often follows on from PAF. I had PAF and Permanent AF is much more difficult to resolve.

Yes you should ask your doctors, if they have given you 4 ablations they should know your case pretty well by now.

Pete

[drivinghome in reply to pottypete1]

Thank you so much wishing you the best

[kkatz in reply to pottypete1]

There is also persistent AFib.Not sure if this a set period of time or when they cannot do any more to rectify it.

[pottypete1 in reply to kkatz]

Yes sorry missed this one but I think that it over complicates the descriptions.

Paroxysmal Atrial Fibrillation:

Regular episodes that last less than 7 days.

Persistent Atrial Fibrillation

Regular episodes that last more than 7 days.

Both are horrible because it plays mind games as a sufferer never knows when it will end.

Pete

[kkatz in reply to pottypete1]

Yes I second that re horrible.I am just hanging on to persistent myself as permanent somehow implies no hope of fixing.

[mjames1]

First, welcome to the forum, afib or not! Maybe someone can point you to a group more oriented toward your issues, or maybe this is the place, not sure.

I've read that beta blockers, like Metoprolol, are often prescribed if you have a pacemaker. It may take awhile to get used to the drug, so lowering the dose and titrating up makes sense. If that doesn't work, at some point you might want to try a different formulation of metoprolol which would be metoprolol tartrate, or perhaps a different beta blocker. Some people just don't do well on beta blockers in general, so you could ask about trying a calcium channel blocker like Diltiazem instead, or another class of drug as long as it will serve the same purpose.

Sounds like your nurse is working with you on the medications and side effects, which is good. Beta blockers definitely make some people tired, especially in the beginning. We all react differently to these drugs, so while we have to be patient and allow our bodies to adjust, we also have to know when to say a particular drug isn't working and when to either change the dose or change the drug itself. It's a process.

Jim

[Gatun in reply to mjames1]

Mjames, Be careful with Diltiazem, took it for a couple years and had bad results, you maybe different by even my cardiologist doesn't prescribe the drug anymore. Best to you.

[mjames1 in reply to Gatun]

Yes, Diltiazem can be contraindicated depending on your medical history. For me, works well with fewer side effects than beta blockers. Also, you can come off it without having to carefully wean like with beta blockers.

Jim

[JOY2THEWORLD49 in reply to Gatun]

HiI take Diltiazem 120mg 180mg too much. I dropped 100 hbpm in 2 hours.

I also stayed on some Bisoprolol separated and have it at night dose 2.5.

If one has a 4.5 second pause that is an irregular heart beat for sure.

Diltiazem got my rapid, persistent Af heart conytrolled the best thing ever.

Balanced and Controlled. BP 123/72. with 77 heart beat.

cheers JOY 73 NZ

[BobD Volunteer]

AF is not slow heart rate. AF is totally chaotic heart rate with little or no regular beats just all over the place in other words. Strange that if you have a slow heart rate (bradycardia) and a pacemaker that you have been put on a beta blocker which will slow your heart even more. I really don't understand that!

[pottypete1 in reply to BobD]

Yes very strange.

My EP was adamant that I must not take Bisoprolol because of my Bradycardia and conductivity problem.

Pete

[jeanjeannie50 in reply to BobD]

I too think it's strange to take something to slow your heart rate when you have bradycardia.

Jean

[bantam12 in reply to jeanjeannie50]

I have a pacemaker for bradycardia and take Bisoprolol.

[jeanjeannie50 in reply to bantam12]

CD has explained the reason for taking beta blockers below. So I understand now.

[CDreamer in reply to BobD]

It’s quite common with Sick Sinus Syndrome - they give you the PM so they can then give you the beta blockers if you have fast AF/AFL/ SSS-Tachy/Brady - ie: flips from slow to fast with pauses.

[kkatz in reply to BobD]

Bob my a fib fits in well.Described as irregularly irregular.

[Czech_Mate]

Thanks for the helpful comments. It's taking time to fully understand my situation. Maybe there is something I 've missed out.The positive is that the pacemaker has settled in OK and I can do most things around the garden (including cutting the grass) and cycle (my favourite exercise) without problems to my arm or chest. I see the cardio for a check up on 7th July so I 'll raise my concerns then.

Dave

[mjames1 in reply to Czech_Mate]

While it may seem counter intuitive to take a heart lowering medication like a beta blocker with bradycardia, since you have a pacemaker, you no longer technically have bradycardia, since your heart rate is controlled. From what I've read, the beta blocker is sometimes used to help with heart remodeling after a pacemaker is implanted. But a really good question to ask your cardio.

Jim

[CDreamer in reply to mjames1]

See my reply to Bob.

[mjames1 in reply to CDreamer]

There you go. Unclear if he has sick sinus syndrome, however, yes, another reason for using beta blockers with a pacemaker.

Jim

[Ppiman]

Your pacemaker was fitted to keep the heart rate up and to stop it pausing; this happens whatever the dose of betablocker, so you are quite safe now and can stop worrying.

What you have is quite a common thing so far as I know, i.e. a need for both beta-blockade and a low heart rate. The pauses you have sound like some kind of heart block, which is quite a common disturbance in the conduction between the upper chamber (where the heartbeat initiates) and the lower chamber (which responds to the upper chamber's signal). With these things, I have a left side block, most have a right side block and you have some form of complete block. The word "block" sounds far worse than it is, though, as the heart is a wonderful organ with many compensatory mechanisms. Still, the pacemaker is given these days just to be sure the bottom of the heart does keep pumping regularly.

Steve

[Gatun]

I had bradycardia all my life with average beat in low 50s until 2016, now I have a mild Afib with average heart rate of 80 (I'm 73 now). Just before going into the MRI tube in 2016 my heart rate dropped into the 20s but the MIR results showed a strong heart and nothing wrong otherwise. Fortunately for me my cardiologist at the time believed less is more so no pacemaker, I am so happy with his decision. I wish we didn't move just to keep him as my MD.The heart is not something to fool around with and we're all different, I could die tomorrow and if I do I hope with a smile on me face. Very best to you.

[JOY2THEWORLD49]

Hi

45 resting at night is Ok but 45 resting during the day is too low - HOW DO YOU FEEL. I'd be too lightheaded to drive or operate machinery.

At 66 years with leaky valves souns awful.

Metoprolol was terrible for me tired, energy loss, pauses during the night of 2 seconds.

That's why you are on anticoagulants. With irregular heart beats your blood pools and there is a strong risk of a stroke.

I had one in Sept 2019 but mine was due to A.F due to thyroid cancer. Feb 2020 all removed but heart did not return to normality.

On Metroprolol avge beats day 186hbpm. Changed to Bisoprolol 156hbpm.

In December I was advised to go to this private cardiac specialist. He was interested listened to my history from stroke date and put me on Diltriazem a CCB a calcium channel blocker. 180mg to much so this was reduced to 120mg a.m and Bisoprolol 2.5mg p.m.

I am now balanced and controlled but I am rapid and persistent with AF.

With a slow heart the anti-coagulant is most important.

Drs cant give some drugs and I found them just upping the dosage.

With CCB my heart monitor showed NO PAUSES.

It takes time and patience to get a balance.

Yes you can have AF with a slow heart or rapid heart rates.

Sure you will do well on this forum there will be others with your condition.

I am 73 years in NZ and do not a suggestion of a leaky heart!

cheri JOY