Can Bradycardia trigger AF? and Bisoprolol !

[wendy6]

3 weeks ago I started to get long runs of AF after being AF free for 6 years after Ablation.

After almost constant runs of AF and Ectopics for 2 weeks, it settled for a few days, but has come back now 3 days. But what's happening is I have a slow heart rate, its averaging between 50 - 60. I have a heart/ECG monitor . its showing Bradycardia and arryhythmia.

I have been going to bed with mild AF, I seem to be ok when I wake up, get up heart rate is 70 - 80. then soon after the odd beats start culminating into AF by lunchtime with heart rate slow 50 - 60.

Even when I have AF I never have fast heart rate it always was 70-80. But this time its running very slow even when in AF. So Im feeling quite dizzy and uncomfortable as it feels like there are long waits between beats.

I went into A&E twice during the 2 weeks it was worse, they checked me out and sent me home not concerned as I didn't have a fast heart rate with AF and Im on blood thinners anyway.

I do however take Bisoprolol Beta Blocker as well. I was taking 1.25mg morning and evening. But reduced this to just 1.25mg morning 2 weeks ago. Im thinking I should stop taking it. Will try to contact GP tomorrow but can never get appointment, its phone only. So could be days or weeks before I manage to speak to her.

Has anyone else had Bradycardia causing AF ?

[Desanthony]

I found that the bisoprolol was the worst part of AF for me as I had low rate AF - resting heart rate in mid to high fifties and bisoprolol was taking it down to 40 and occasionally under so felt like poop. Felt much better when I came off it. It may be time for you to have this discussion with your EP as after being on it for so long you would need to be weaned off slowly under your EP’s supervison

[wendy6 in reply to Desanthony]

Thank you - I have reduced to 1.25mg every other day. Unfortunately not under EP or Cardiologist as was discharged 2 years ago. So now GP has referred me to Cardio again will be a long wait!

[stoneyrosed]

After my ablation in June this year I was told to take beta blocker only 2.5 mg a day. My pulse averages between 45-55 so quite low. When it has been as low as 45 I have gone into AF but I cannot be certain that is the cause. When I’m in AF my pulse races up to 170 bpm. Stick to the beta blockers until told otherwise by either your GP or cardio nurse I think.

[wendy6 in reply to stoneyrosed]

Thank you for reply.

[MPA9]

Yes, sounds very similar to my experiences. My HR was often going to under 40 overnight and I would wake up with AF. My cardiologist said that a low heart rate can sometimes cause an episode of AF (as the heart tries to "catch up"). I'm now off of regular doses of Bisoprolol and use it as a pill in the pocket along with Flecainide, to be taken as and when needed. If I get an AF episode I take 100mg of Flecainide and 2.5mg of Bisoprolol and this seems to resolve the issue within a few hours.

[wendy6 in reply to MPA9]

That sounds a bit like what is happening to me. Unfortunately as AF free for 4 years, 2 years ago I was discharged from my Cardiologist EP who did Ablation and also local Cardiologist. So GP has now referred me to Cardio and wouldn't do it as urgent so will be a long wait for tests etc. GP also wont give me any meds to help. I used to take Flecainide.

[guy3555 in reply to MPA9]

This sounds very similar condition I have. The results of my 24 hour heart monitor showed a bias towards bradycardia, some tachycardia but most of the graph showed bradycardia. At bedtime into the early hours I seem to have regular episodes of bradycardia. I am on daily dosage of 1.25mg of Bisoprolol. I have a fitness watch and have seen my hr drop to around 45. I’m wondering if it’s the Bisoprolol that’s triggering it. I noticed these episodes started when I started to exercise alot more hence my HR lowered even more during rest. Also if my stomach is digesting a heavy meal it most certainly will trigger AF. The GP mentioned taking Bisoprolol as a pill in the pocket and take when needed. I might trial this to see if episodes of AF reduce.

[Ppiman]

I haven't, but I have read that a low rate can predispose to more ectopic beats, and these are a known precursor of AF, so that might be relevant.

When I take bisoprolol, it's 1.25mg as needed, rather than regularly, and this, usually, brings my tachycardia of 105-135 down within 2 hours to a normal rate. It doesn't cause bradycardia till the next day, oddly, when the high 40s is possible. It's effect on my heart is odd in that respect as I'd have thought it was well out of my system by then, but it seems not.

Steve

[wendy6 in reply to Ppiman]

Thank you for reply - I was put on Bisoprolol couple of years ago when I started to get Runs of Ectopics. To be honest I probably shouldn't have been on 1.25mg morning and evening but 1.25mg a day and extra as needed. This slow bradycardia is new for me...was noted when I was in A&E they asked me if normal I said no. Which is why I think its relevant to sudden onset of AF. But Ive been reading up on my symptoms the different arrhthmias and I think that Ive got Brady-Tachycardia - slow and fast AF. My heart rate doesn't show as fast on monitor during AF it averages at 70. But its the fibrillation is fast then beats slow . This would explain why its making me feel dizzy, with pain and breathless sometimes. As I said was in A&E twice once for 18 hours, they weren't concerned!

[Ppiman in reply to wendy6]

Hi again, Wendy (my wife's name, too!). I think a 2-week Zio monitor might help your doctor know more. On the NHS, this is unlikely t present and would cost about £700 privately, I think. Sick sinus syndrome ("tachycardia-brady") can cause slow and fast rhythms, and arrhythmias, but only a long-term ECG will uncover it, I should think. They only treat this if it's serious enough, for example, long pauses of the heart or fainting.

Steve

[Chrissy7 in reply to wendy6]

Totally understand.. and how awful. You do sound very similar to me in the way that I would want to faint/be very dizzy.

I had dizzy spells for years before I found out I had arrhythmia…

[Bunnyuk]

I have been wondering the same thing. I'm on nebivolol, down to just 1.25mg in evening. But it does lower my heart rate and I often get bradycardia in 40.s. When I get low HR I seem to get more ectopics, and that can flip me into afib. I've started to get afib in the night which I never used to get (they were always in the day), and I'm wondering if its because my HR goes even lower in my sleep. I did talk to my afib nurse but she was quite dismissive. I asked if I could cut back my dose even more and she said no, as I was already on the lowest dose. So I'm considering taking un the morning instead (I'd taken in evening to avoid the side effects during the day!) Im even wondering about trying without it.... but think I need to talk with afib nurse first .

[Auriculaire in reply to Bunnyuk]

I cut my Nebivolol in half so I am only taking .65mg . If I get an attack of afib I take more to reduce heart rate though it does not work as well as Bisoprolol did for that. If you are getting side effects from 1.25mg Nebivolol then maybe beta blockers are not for you as Nebivolol seems to be better tolerated than most other beta blockers.

[wendy6]

Thank you for your reply - Yes I was taking 1.25mg it in morning and bedtime. So have been only taking in morning, as felt that during night heart rate drops anyway. But for fast few days if I take it in morning my heart rate drops from 65-75 down to 50 - 60 so have stopped Unfortunately Im not under any Cardio specialist or nurse any more...was discharged 2 years ago as had been AF free for 4 years after Ablation. My GP cant/wont help, because I went to A&E with the AF chest pain and breathlessness a few weeks ago (twice) she has done a referral to Cardiologist but wouldn't do it as urgent and cant give me any meds.

[Chrissy7]

Hi Wendy so sorry to hear this. The last time I had atrial tachycardia episode (and I don’t understand … why it’s now atrial tachycardia instead of AF…but I used to get AF - but you may just have explained it)

At that time .., I also had bradycardia.. of about 40.. would drop from 170-180 to 40 and back.

On diltiazem 125 mg .. I was dropping to 42-45 at night.. then cut back to 90 mg and now only goes to 50-60 during sleep, also like you.

Diltazem at this seems to keep me fairly regular now.. but I’m often in the 50s esp during sleep and don’t worry about it..but never have AF anymore…

Don’t stop taking Meds without seeing a doctor.., can you go to a clinic or ER? (Just editing.. guess you answered this already…,)

I hope you get help soon.. I could not tolerate beta blockers at all.. made my condition Far worse (and caused constant ectopics) just like you.., now I rarely get them ..

good luck and keep us posted.. I certainly understand how you feel.., I think..,

[Tapanac]

Just to put your mind at rest 50-60 is not too low. On average I am told 60 is an ideal rate, but anything from 60-80 is fine and also only low 40's is considered bradycardia.

[Janey1955]

I have paroxyl lone afib, they can’t find a reason. I have a very slow natural heart rate under 40 in the night. I know some performance athletes develop afib. So I think there could be a correlation between a low hr and afib in some cases Jane

[wendy6 in reply to Janey1955]

Thank you Janey, yes unfortunately cant put myself into category of a performance athlete! Trying to find reasons why AFib back now? what has changed in my life. Only thing was starting the new medication for Trigeminal Neuralgia - Gabapentin. I read a study online (Googling) that it is advised not to give to over 65's as cases of this age group getting Arrthmias and in the Contradictions leaflet in packet it states this also!!! However A&E doctors and Cardiologists who they spoke to said NO Gabapentin not the cause of my AF keep taking and increasing the dose as prescribed ( I was on very low dose increasing slowly) Since then was 2 weeks ago, I increased my dose slowly, my AF subsided after 12 days but has now returned again in 4th day. Im at a loss as to what to do. On waiting list for Cardiologist. (non urgent) GP wont/cant help me. She cant change my Neuralgia meds. All this is causing anxiety which of course isnt helping the AF,

[JOY2THEWORLD49 in reply to wendy6]

HiSaw my Dr last Thursday.

She has studied AF because she had it.

Dr says both BB Bisoprolol affect rhythmn as well as H/R.

So does Diltiazem!

You need to get your head around that.

Now controlled with persistence life AF who cannot have any operatione done as I have an enlarged chamber.

cheers JOY. 73. (NZ)

[JOY2THEWORLD49]

HiBisoprolol helps rhymn usually. Didnt do much H/R lowering. At 47 avge night I or them dont want H/R less.

Are you taking something else with bisoprolol because I have to take the bisoprolol away from CCB other drug. So one am CCB and Biso.. at night.

cheri. JOY 73. (NZ)

[wendy6 in reply to JOY2THEWORLD49]

My understanding is that Bisoprolol (a beta blocker) only affects heart rate, it slows it down does not help with arryhythmia . Whilst in A&E few weeks ago with sudden AF and chest pain after 6 years AF free. my HR was slow even in AF. I was taking 1.25mg in morning and 1.25mg at night. Doctor told me not to take 2nd Bisoprolol unless my heart rate goes above 90/100. and if it continues to average at a low rate below 60 to discuss with GP and stop taking it altogether. No unfortunately not taking any ant-arryhythmia meds as waiting for Cardiologist tests and appointment.

[JOY2THEWORLD49 in reply to wendy6]

Hi

Saw me dr last Thursday.

Bisoprolol BB and Diltiazem CCB

BOTH HELP WITH RATE AND RYTHMN! Says my Dr who has had an Ablation in Australia for AF.

Its important that you know.

CCB was a drastic lowering of H/R. stopped Metroprolol H/R 186 Day to 51 !80mg half dose. It did nor affect Night rate of 47.

Twinked. Diltriazem 120mg an and 2.5mg Bisoprolol night.

123/72. 77-88 H/R day. 47 Night.

BINGO

No more sweating and drastic STOPS in tasks.

cheri. JOY. 73. (NZ)

[javo123j]

I'm very similar with HR in the 40s and ectopics that lead to afib that can last for 12 days. On 1.25 Bisoprolol. Pulse can vary between 70 to 120 during afib. The answer from cardiology was to increase it to 2.5mg and it seems to be working. No ectopics no afib. No change in pulse rate. Early days though

[wendy6 in reply to javo123j]

Thats interesting. I used to be on 1.25mg Bispoprolol a day then I started to get increased Ectopics so Gp advised increase to 2.5 a day. Heart rate has always been 70-80. During my Afib episodes 6 years ago HR would fluctuate 70 - 100 but not very fast. However, now Im having intermittent slow HR with ectopics and AF so 2 minutes normal sinus then few minutes of AF mixed with Ectopics and repeat over 24 hours!! non stop - but heart monitor showing HR 50 up to 90 throughout . Im getting chest pain on and off as well. When I was in A&E twice, each time they took me in for 30 second ECG (twice) I was in normal sinus !!!! (thankfully I did take print outs showing ECGs from home monitor. ) then I would be out in waiting room for 18 hours and my heart was going in and out of AF like the above feeling dizzy with chest pain, they weren't too bothered. Its driving me crazy.

[javo123j in reply to wendy6]

I only went to A&E once and it was a nightmare. They did ECG after 14 hour wait then said not in danger so go home. I still think slow heart rate has something to do with the afib but I feel the Bisoprolol has cut down on my ectopics. Good luck with to getting off the Bisoprolol. Hope it does the trick

[wendy6 in reply to javo123j]

Yes A&E night really experience...said next time if I have to go in will be on a stretcher