AF and Tired

[mjm1971]

Hi all

So when I’m in AF it lasts for 5 days and then I’m NSR for 1-3 days and then back in AF

When I’m AF my BPM goes from 85 to 125

When it’s averaged out it’s about 95bpm

I’m on 200mg Flec per day

5mg of Bisoporol per day

So now the question .

Should I ? Or is it normal to still get Tired / lethargic spells while in AF even with a relatively low BPM average and the drugs I’m on .

Why would I still get these spells with a relatively low BPm for AF ?

Some days I could easy have a nap in the afternoon ??

Thanks for all the replies in advance

Thanks

Matt

[Hidden]

The usual caveat, I’m not medically trained but it’s often said that it’s difficult to distinguish the difference between the symptoms of AF and the side effects of some AF drugs, particularly Bisoprolol. From my experience, in the days when I was taking a daily maintenance dose of 2 x 50mg Flecainide it did not seem to present any additional side effects but of course, we are all different. The only advice I can offer is that you discuss the possibility of an alternative beta blocker, maybe Nebivolol or a calcium channel blocker such as Diltiazem.

Perhaps now is the time to consider ablation therapy or if your feeling flush, one of the MiniMaze options……..

[mjm1971 in reply to Hidden]

Hi Flapjack

It’s was more that if AF and drugs can make you feel like this or does everyone in AF always feel ok once drugs are sorted .

I had an ablation in March , clearly failed lol try again

[Hidden in reply to mjm1971]

I just took a peek at your history Matt, (the old memory isn’t so effective as it used to be) and I see you had a Cryoablation probably about 4 months ago so in truth, you are still within the blanking period therefore it’s really too soon to say it’s failed unless it’s what you have been told by your EP. Normally, it’s usual to have a review within 6 months of having the procedure so if this has happened and you have been prescribed Flecainide and Bisoprolol at the doses you describe since the ablation then I guess it’s likely that your EP is aware that one or more of your pulmonary veins were unable to be treated or that rogue impulses are firing off elsewhere in your ticker. This would not be unusual, but the EP would normally offer a second RF (heat) ablation to hopefully treat the missed beats. Of course, there may be other factors involved, but bearing in mind how recently you had the Cryoablation, it would be surprising if the EP hasn’t spoken about the available options.

Apologies if you are aware of all this but I just thought it was worth mentioning……

[mjm1971 in reply to Hidden]

Hi Flapjack

Yes I’ve had the review and they have put me on a 7 day holter and offered the 2nd a Ablation which I’ve accepted . They are currently reviewing meds

[CDreamer]

It’s hard to know if it’s the drugs or the AF but my guess would be the AF episodes on their own would be tiring. We tend to vastly underestimate how much rest we need when we have frequent AF episodes, no matter what the HR, so why not nap in the afternoon? A nap can work wonders.

I had a long period with similar intensity and frequency and episodes would wipe me out. Nap in the afternoon………..my ‘naps’ could last 12-18 hours but I also had other conditions. I wasn’t taking any heart drugs.

I would question why you are still continuing to take Flecainide if you are getting such frequent episodes?

Best wishes

[mjm1971 in reply to CDreamer]

Hi CD

They have just done another 7 day Holter and are reviewing the next stage for me .

I’m at St Barts so I’m in good hands despite the 1st ablation failing

[CDreamer in reply to mjm1971]

That sounds excellent, in good hands there. Good luck.

[Cat04]

As CDreamer says - AF is exhausting whatever the bpm. I had a nap this morning & another this afternoon!

[Physalis in reply to Cat04]

AF is not always exhausting. I could go for 24 hours or more at an average of 140 but pottering around at home, I didn't really notice it. In fact it started quite a long time ago, was diagnosed in 2013 but I ignored it until 2019. It was only when I realised that I was in AF for at least a third of the week that I took it seriously.

It was the bisoprolol that made me feel tired.

[Cat04 in reply to Physalis]

Yes, it is one of the differences between symptomatic and asymptomatic AF

[jeanjeannie50]

You poor thing Matt, I can easily understand how that makes you feel tired. You've no chance to recuperate from the AF as it's back so quickly.

Are you under an EP (Electrophysiologist who specialises in heart arrhythmias) and is there a plan to help you? It doesn't sound as though your medication is doing a lot.

Jean

[mjm1971 in reply to jeanjeannie50]

Hi Jeane

Thanks

Yes they are looking and planning other solutions

I just didn’t know if I was exaggerating or overreacting on the tired issue

BPm average 95 when in Af I just assumed I should feel normal with the heart rate at an ok bpm etc .

[jeanjeannie50 in reply to mjm1971]

You're not over reacting at all Matt. I don't think you're right to go by average rates with the heart. A heart rate of 125 will leave you feeling drained, depending on how long it goes on for. If it's for days then when you go back into normal rhythm, you'll still feel drained for a day or two. You are not having enough time between yourAF attacks to get your energy levels back.

Jean

[Paulbounce]

125 bpm is to high Matt - certainly at rest. I'm not a medic but that could be flutter. I think this is worth talking about with your doc. They can soon test it in A@E - they drop your HR with an injection to see what happens. Believe me it's not the best thing to go though but they will clock if it is flutter.If anyone else has to though this you'll know what's it's like. The feeling soon passes though and you know what it is. They had to do me twice as the first one didn't give a result - the second one did. They dropped my HR from about 140 bpm to 40/50 within secounds. I was hooked up to some sort of machine - just in case. The feeling soon passes so don't worry. Not good at the time (far from it) but dont worry.

Paul

[mjm1971 in reply to Paulbounce]

Hi Paul

They allegedly done my flutter when I had the ablation in March . So hopefully it’s not a flutter as they are supposed to be high rates of cure from ablation .

My bpm jumps about between 75 to 125 bpm when I’m in AF but average In 90

They have just done the 7 day holter so hopefully hear something soon from my team .

Thanks Paul

[Paulbounce]

OK Matt - good luck. I hope it goes well for you. TBH I would still like to drop my heart rate a little from 90.And yes you are right. An ablation for flutter tends to have a high succuss rate - good luck with it all.

Best,

Paul

[ObiDyer]

Hi My understanding is that the drugs protect your heart from overload caused by the inefficiency of the the pumping action caused by the AF. The body demands more oxygen, so the heart responds by increasing the bpm to levels that are likely to cause long-term damage hence drugs to limit the rate, bit like a rev limiter on a car. While the arrhythmia might respond to drugs cardioversion or ablation are typical ways out of AF but the combination of poor heart function and rate limiting drug therapy will inevitably curtail your energy and tiredness is the result.. I've been in persistent AF since February so you have my sympathy..

[Buffafly]

I’ve just had exactly the same as you - five days in AF with average rates of 90 ish but swinging from 60 to 125. I felt like a wet rag most of the time although I’m on diltiazem, not bisoprolol. If it was a fairly steady rate under 100 I think I might get used to it but the extreme variation with lots of thumps sometimes was very wearing. I certainly do have a nap because if I wake at 5 am my heart won’t let me relax again. So absolutely not exaggerating and I hope you get an appointment soon ❤️‍🩹

[Janey1955]

HiI’m not on any medication other than Apaxiban. When I get afib a couple of times a week lasting about 12 hours I get very tired. So my guess would be it’s probably the afib itself

Take care

Jane

[123Abc123]

The drugs you are on didn't suit me at all; both made me tired plus ... I am now on Atenalol and that also makes me very tired but I don't seem to have any other side effects. I often have a power nap in the afternoons. I rather wonder if the on going fatigue is just the condition progressing or the tablets ...

[stargazer52]

I’ve been in af now for 2 weeks. I’m in 3.75mg of bisoprolol x2 daily. HR slowed but I’m exhausted. Can’t do anything including getting dressed without severe breathlessness and spikes in HR. I also have put-on weight which I think is fluid . Anyone else had that side effect? I’ve Not seen a cardiologist yet.

[Teresa156 in reply to stargazer52]

Hi Stargazer,I just noticed your comment, it might even be worth starting your own post with it, but hopefully others may also respond. When are you seeing your cardiologist? Do you have an appointment? Have you ever seen one? - as two weeks in AF is a long time - is this the longest you’ve been in it? Has your AF progressed suddenly? How long have you been experiencing these long attacks - have they diagnosed persistent AF? Is this normal for you - or unusual? Have you ever had tests and investigations? I am really not an expert, as I’m lone paroxysmal and controlled by a low dose of bisop, much lower than yours at the moment. I would say that both the fairly high dose of bisop and the AF are definitely causing your exhaustion, but you probably know that. Does your GP know you’ve been in AF for two weeks despite your meds?

Considering the way you feel and the length of time you’ve been in AF I think you deserve to be seen by someone quite quickly.

I’m sure others will come back to you very soon as I am unsure of what exactly you can do, but it doesn’t feel right that you are left like this.

Teresa

[Setschan]

I think you got some really excellent information in all the replies Matt so no real need for many more, obviously you are under a brilliant very knowledgeable clinic, although consultant by consultant can vary a little. AF is a very complicated problem caused by so many variables different person by person including the affect of medication varies on individuals. I guess though with BPM av 95 in AF for 5 days is like exercising non stop for 5 days by someone who doesn't have AF, which would make anyone tired and need a lot of recovery time. So best to rest when you can I guess. We can only share our own experiences to give comfort it can be overcome, managed and in some case solved (in differing ways), it is a little trial and error and needs patience. Keep having the review with the professionals.Sorry not much help to be honest. But good luck with everything, you will get there eventually.

[splashrollandplod]

How’s your sleep and does it vary depending on whether you in nsr or af? HR 125 instead of 85 is a bit like cycling all day - from experience I’m tired when I do that. No science from me just wondering.

[mjm1971 in reply to splashrollandplod]

Hi

My sleep never changes asleep by 11pm and up by 5am

Has been for last 20 years

Thanks

[Kimhari]

Hi I've had AF for about three years now My episodes are now more frequent and sometimes I have had cardioversion to slow me down.Im waiting for abulation for which I'm told long waiting list.I normally run at about 160 to 170 for about three days,then I get help from hospital.But after episodes of AF the next day I have no energy even walking upstairs is a no no,but after one to 2 days of laying on the couch feeling pretty unwell I'm back to normal.

[Cookie24]

My episodes are similar to yours as I am In and out of flutter or AT. I am tired and it is from the episodes. I take Diltiazem and Propafenone