My first post after lurking a good while and sorry if it is over long, I am very confused at present, being diagnosed has been such a shock. In feb 2022 I spent 3 days in hospital with Afib and high blood pressure (180/104) no symptoms or pain etc, discharged with bisoprolol, ramipril and rivaroxaban and had a cardioversin a month later. I am 59. This worked then I went back into arrhythmia after 10 days. A week later I self converted back to nsr. I have vagal afib lasting a few hours, normally at night a couple of times a month. I could not tolerate the bisoprolol, felt like I was going to die and they changed me to Sotalol. Better. My average BP is now 110/65 my resting pulse is generally around 50-60. I notice when I am about to get an afib event my pulse is consistently in the 40s whilst awake. So I am worried that bradycardia is causing some of my problems. I function normally no pain other than tired after an attack. I walk three to 5 miles most days without issue and have lost three stones, so I know I am fortunate. The cardiologist who I have never seen wants to change my meds to flecainide and digoxin instead of the sotalol as I am now getting ectopic beats and get white fingers sometimes. I am really worried about this as I am terrified my heart rate will go too low. Is there anyone who is on the same combo please? Or has experience. I am titrating the sotalol in preparation and am currently on half a tablet twice a day and my pulse is still under 60bpm resting. Oh and I had an echocardiogram in October and my heart is normal it has relieved a lot of anxiety, for which I am very grateful. 😊Feeling very alone on this journey and this group gives me some balance. Thank you!
Flecainide and Digoxin: My first post... - Atrial Fibrillati...
Flecainide and Digoxin
- Bisoprolol
- Atrial fibrillation
- Flecainide
- Rivaroxaban
- Ramipril
- Digoxin
- Sotalol
- Cardiovascular disease
- Echocardiogram
You are not alone, we all struggle from time to time. I've always assume my AF is vagally mediated as was usually dropping off to sleep.It is a worry, this AF especially as everyone has their own variations on a theme. Only ever had digoxin for two doses when in A and E to try and stop an episode so can't help with that. I had same issue with bisoprolol so even a teeny dose was stopped as my pulse in the 50s at times and I felt awful. Have been on flecainide ever since, over 10 years. My pulse is now high 50s or low 60s except when I get runs of a sudden higher rate prob about 120 which last a few minutes and are very disconcerting. Am still waiting for cardiology review which changed from 3 months to " in due course" 15 months ago!!
Welcome. We are all unfortunately in the same boat. I have learned to accept the problem and get on with things despite it after a worrying time . Try to relaxand have a good day. x
See what others say. I heard that beta blockers were not a great option if your AF is vagal. Check put the York Cardiologist YouTube channel for more info. Flecainide is an effective anti arrhythmic so it might serve you well. The digoxin will be a partner to the Flecainide and also assist with the high BP. It was suggested to me at one time though in the end I stayed on Diltiazem. Every case is individual so I'd recommend pushing to see an electrophysiologist in the New Year. They are better at heart rhythm problems than the cardiologists as a rule as it's their speciality.
Hi there - welcome to the feeling alone and worried club! 
From discussions with a Leicester cardiologist EP who seems to me to be unusually switched on to current thinking, I was told that low heart rate (which a Zio patch showed I have now and then) isn't a worry unless it is symptomatic but that in some people, it can precipitate ectopic beats which can then trigger AF. That might be happening with you? I was told that I couldn't either sotalol or flecainide, but that the latter was far preferable being a targeted, "cleaner" modern drug.
When you say "vagal AF", I was wondering whether you meant that your episodes occur more often when the parasympathetic autonomic nervous system is more dominant, i.e. when you are resting in bed, or are digesting food (“post-prandial AF”)? I notice some mainly American sites tend to use this phrase to suggest AF supposedly brought on by so-called “irritation” of the vagus nerve itself. When I asked my doctor about this possibility (as I have a hiatus hernia and lots of gastric symptoms alongside my cardiac ones) he told me that he was deeply sceptical of this possibility, telling me that any such irritation would result in severe bradycardia followed by swings of tachycardia.
Steve
I believe it to be vagal as I seem to fit with the episodes occurring after eating and at night or when tired etc.
Oh you’re not alone here.
I’m not on same meds as you, but my heart rate was 44 and was told to stop Perindopril by one doc and Atenolol by another. When I said I couldn’t stop both, and that I was ok off the Perindopril, I was told to start it again and stop the atenolol which I did, after being on it for 40 years. I felt like I had aged ten years in 4 days, so got in touch with doc yet again, and now back on it again with no Perindopril and hr around 55, and am fine. Please try not to worry and have a good Christmas x
Bisoprolol I’m on too, but now down to a minimum of 1.25 a day. You are otherwise obviously fit and healthy and that’s the moan thing. Beta blockers lower my blood pressure and that’s a problem. I don’t feel like the bracycardia is a problem for you or most people.
You will be monitored and you always can talk to the experts for advice now you’re on their horizon. So shout when you need to and ask away for advice, to them and us on the forum. Sadly we only give help in our experience of a similar vein (pun intended) but we have loads of it.
So rest well.
Keep fit.
Learn about yourself as you go
Happy Christmas one and all
Thank you Cigarboxblues. Yes I feel very fortunate when reading through other people's journeys. I still believe I can do much more to help myself too with diet exercise and mental attitude now i have got over. The initial shock!
I’ve been on Sotalol for 6 years now. What dose are you on?
I was taking 160mg twice a day until my ablation in July when the cut me to 80mg twice a day. They tried to wean me off it but as soon as I went to 40mg I started having episodes of A Fib. I am back on 80mg twice a day. I feel good. Heart rate runs 50-60 beats per minute. BP averages 120/70. When I was on 180 twice a day I was very tired with a heart rate in the 40s.
I’ve been on flecainide briefly and it did not work.
You could try it but pay close attention to your symptoms. And keep your doctor informed as well.
Each person is different so what works for one may not work for another.
Praying you get the treatment that makes you feel the best for a good quality of life.
I’m 66. I walked 3 miles a day before developing AFib. Now I can’t walk that far due to my knees. 😢
Dalmationangel, that is interesting. I have been on minimum dose of 40mg twice a day. I was reducing the dose in preparation for switching to the flecainide (which I am now hesitant about doing) and am down to 40mg am and 20mg pm. With no effect on heartrate bp or symptoms so far.. I was unable to function on the absolute minimum of bisoprolol so was changed to Sotalol which has allowed me to exercise relatively normally.
Sorry you have had to join our journeys 
we are all so very different but it is helpful to know you are not alone. My body doesn't tolerate most medications well at all due to terrible side effects. Solotol was one of those. On top of it all I gave a corn & corn derivative allergy making most meds a nonevent. Most of my drs have been complete none events as well except for my awesome arrhythmia specialist/surgeon who is the only one who listens. All my heart issues began after losing a thyroid to cancer. Since then my new HBP hasn't been well controlled. I am quite active with horses, underweight according to most drs, petite female, eat healthy, non smoker, non drinker, non coffee & non caffeine. Betablockers I tolerate to keep my HBP somewhat acceptable. After CV Dec 19/Jan 20 I had to quit working. Thought I was recovered and along came looong cv we thing. I lost all my strength, couldn't walk, numbness, needle stick pains mainly hands then feet, then arms and legs. Was told i had carpal Tunnel. What a joke. Worked with a good chiro to get past the numbness and needle pains. Then had a mini stroke. Mri ruled out MS no sign of clots. Then had a major stroke. Spent 3 days living in an ER room, all my tests were perfect! Even my HBP was gone! I said let me go back to my routine so I can recreate my real life. Left the hospital with a heart monitor before a weekend. 8am following Monday got a call saying get to your walgreens and get your Eliquis NOW. You are in afib. Apparently I've been stuck in afib for quite some time but my rural area had no real drs who seem to know anything. Sotolol was a nightmare, finally cardioverted me but was back in complete afib within 12 hours. Fired all the useless drs and headed to an arrhythmia specialist. Happy & grateful i did. I was a tough surgical case as well. Had to do the entire surgery in full afib since 5 cardioversions failed. My veins don't go straight to my heart but take the scenic route around then to my heart glad my Dr loves a challenge! My left atrium was also much smaller than all the prefab tests showed. Ended up freezing the entire back side of my heart. First morning after surgery I was afraid I had passed cuz I couldn't feel or hear my heart luke I had been for soooo long! It was so nice and quiet! Just had my 12 mos checkup and ekg. Dr was stunned, perfect ekg, machine even labeled it in print "normal". Surgeon said he never sees that! After all that mess and crappy life, I wouldn't hesitate again for the ablation. There was healing and a bit of complications since surgery had to be done in afib. Maybe not if I could have been properly treated early on.
My surgeon had said I would need a 2nd surgery (not uncommon) but he was so surprised at my 1 yr visit he said well see you in a year!
I will say, I felt a lot better 1 week after starting the blood thinner. I do know my iron gets too high so I prob need see some quality hemologist but finding one... not a good track record for me.
My regrets besides no quality medical care around me, was I was diagnosed sooner, dismissed for looking healthy and a woman, and all the mickey mouse treatments before my ablation. We all have different situations and bodies. My body is not a fan of big pharma. Still dealing with HBP and staying on the bloid thinner for now. My best advice is get additional medical opinions from other Experienced, Qualified drs!! My fired cardio office has me as an overweight male, who needs to exercise more, loose weight, and stop drinking alcohol. SMH.
I worked in medical, get copies of your records and make sure your "team" knows what they are doing. Don't be afraid to ask questions, if they discourage such and can't answer, find another team asap.
Yes, I am the square peg trying to survive in a round peg world and no most thyroid replacement meds do not work properly for me either. But God still has me here, alive and kicking I refuse to use my time worrying about what I cannot change & I change what I can <3 now time to water horses who are stuck in blankets with frozen troughs for a few more days.
Merry Christmas, Happy New Year and follow your gut feelings! YOU know your body best! <3
I sympathise with your square peg in round hole, sounds like your journey is a complex one. I feel overlooked and fobbed off with the usual meds because I can function well I am being sidelined. I don't want to follow this path and wait for a gradual decline as I feel there is more to it than being told to accept it. I have developed all this since the c in 2020. I think it tipped me over the edge! 🤨 Until being hospitalised I felt perfectly OK and the palpitations and ectopic have been with me since being on sotalol. Everything else is perfectly normal... Well as normal as I ever am.. 🤪 I am hoping to see an Ep in the new year. We have horses too. Its been tricky keeping them watered in the cold weather with a yard like an ice rink! Happy New Year to you and thank you.
Loooong CV is a definite thing!
And grateful to thaw out a bit now! Hope you will keep us posted and you can cut back to just one medication then!
So cheers, to a better 2023 for all of us!!
Thank you and I will here's to the future!
Together, in learning and sharing, we are stronger. We will find the answers inspute of a few doctors and with the help of a special "real" doctor here abd there has been my experiences in life ❤️
Carpe Diem 🎉
I was at the same age and with vagally mediated Lone PAF when I was put on first 100mgs Flecainide only and then this was increased to 200mgs which stopped all episodes.
Suggestions: Ask your cardiologist if you can take only Flecainide (a few on this forum incl myself do) but if you have other comorbidities/personal circumstances this may be dangerous re tachycardia. Check for sleep apnoea and use nasal strips at night. Avoid late night crime dramas and wind down slowly before bed, depending on the individual this might include Mindfullness, prayer and yoga. Last meal of the day eat early and light.
Thanks secondtry good suggestions, I will speak to the arrhythmia nurse about flecainide only - have never managed to speak to the cardiologist at all and don't even know who he or she is! - I am using mindfulness and visualisation techniques which I do feel help. Will look into yoga, I have been thinking of taking up tai chi (I used to do shotokan karate three times a week until C struck in 2020.
Welcome to the club. You are not alone. The Beta blockers and Flecainide combo can drop the heartrate. Before taking anything for AF my HR was 48. No symptoms. After AF and the beta blockers, Flecainide and Ablation my resting HR when in Sinus Rhythm was 43. That was OK. But then I went for an Ecg one morning and it was 36. No symptoms other than from the Bisoprolol- you know what that's like. Anyway a pacemaker was fitted. And now HR never goes below 50. . It works pretty well. But you are right, Bradycardia, high blood pressure and AF are linked, but there's lots can be done. Good luck.
Thanks Coco51, sounds familiar! I also had low heart rate prior to AF. Though my heartrate is still usually low 50s and down in the low 40s when resting I never have any symptoms, light-headedness etc. I know some people have said they can't function at such a low heartrate when I have had afib episodes my max heartrate is about 130bpm and lowest 41bpm. During an episode my BP is usually around 120/70 and rarely goes into pre hypertension. I was initially ushered off to hospital because my BP was too high when measured at the Dr's surgery 170/95I was not given advice or a chance to change it using diet and lifestyle changes. Ever since then my BP has been normal except when I went for my echocardiogram when it shot up to 180/104. (still felt perfectly OK) the Nurse wanted to keep me in but I declined and it had dropped back to normal by the time I got home..
Have you got a home BP machine? I assume you have. I now measure night and morning for a few days every month and my BP can be low. 110/70 even 95/60 at times. But if at the doctors it's always up around 155/95. Even higher like yours, if I am going for a procedure. I worried about this till the doctor said not to worry, it's normal for BP to go up if you're anxious or doing something active. The key is to avoid the anxiety I guess! Hapoy New Year!
Thank you everybody and best wishes for a Happy and Healthy New Year!
Decision time!
Exercise and beta blockers
Bisoprolol again and Digoxin.
Failure at getting off antiarrhythmic med
