I had my first recorded (though probably 3rd in 3 years) AF incident on Sunday and have got 1.25mg of bisoprolol and 5 mg x 2 pd of apixaban. I am a runner so my resting overnight HR is usually low, say mid 40s. My heart returned to its normal rhythm on Sunday night after about 19 hours in AF. So now overnight my HR is dipping down into the 35-40 range which is obviously low. The first night the lowest was 38, last night was 35. I have a fourth frontier chest strap which gives a continuous ECG so I can see what is going on. I sent the 38 low to GP yesterday and didn’t get a response. I don’t know whether to follow up again today. I wonder if I need the bisoprolol now that my rhythm and rate are normal? I have got a follow up call next Thursday but I don’t want my HR to go lower and lower. Is this likely? What do people think I should do?
Should I be concerned about lower res... - Atrial Fibrillati...
Should I be concerned about lower resting HR on bisoprolol?
Thats what beta blockers are supposed to do plus your history so if your body is used to such low rates, ( I would be unconscious at anythng less than 60 lol) then fine. For most people a drop from say seventy two to mid sixties would be fine after all but athletes apart from increasing the likelyhood of AF will usually have much lower heart rates. I once found an 80 year old ex lifeboat coxwain who's normal resting rate was 35!. It disturbed me far more than him.
thanks. Very helpful.
I'm no medic but I most certainly would not be happy with a heart rate in the 30s, athlete or not.
I would suggest that you need the advice of an EP rather than a GP. The Bisop will drop your rate but you are only on a low dose. How do you feel at 38bpm? Presumably ok. My heart rate drops to 50 at rest but my pacemaker kicks in and keeps it at that rate.
Fit people have low heart rates and we often judge by how we feel. An assessment by an EP might help longer term.
I was told that so long as the bradycardia isn’t symptomatic, it is generally safe. I only take a beta blocker (bisoprolol 1.25mg) as needed and often this is for multiple ectopics as my AF us infrequent. This dose can bring my rate to the mid 40s.
I suspect you’ll be told much the same as me.
Steve
thanks Steve, I think that’s me. I wonder if they’ll take me off it as the AF episode is over for the moment. How often do you end up taking the bisprolol on an as needed basis?
I take 1.25mg bisoprolol (I’ve been told to take up to 5mg) whenever I get AF, but that is unusual (February was the last time). I more often have a kind of mild racing and runs of ectopic beats (i.e. palpitations). If that brings on mild chest discomfort (as it often does), then I take one tablet which helps a bit. This last month or two I’ve been taking quite a few. I find a single tablet, even of 1.25mg reduces my heart rate for well over a day and often into the second.
Steve
I have a resting overnight and sometimes daytime 39 to 45 and I am not worried about it at all. If you go to the British Heart Foundation page there is a 24 hour nurse on telephone call who you could speak too.
my resting hr is 50
I take flec every day and Bisoprol when in AF
For me I break it down into two simple rules. Flec is for the inconsistent rhythm and Bisoprol to reduce the speed.
On that logic I personally would not take Bisoprol at your low speeds.
Sounds like your situation is similar to mine. I have always had a low heart beat and whilst I wouldn't call myself an athlete I do go to the gym every day and used to run marathons. When my AF kicked in at around 50 my resting HR was 48, with an initial 2.5mg dose of bisoprolol it dropped to 42 and at night always fell well below 40 (recorded by my apple watch). After my ablation the consultant put me 5mg of bisoprolol with side effects worse than the AF. My resting heart rate continually dropped below 40 and I had continual alerts from my watch. I went back to 2.5mg but have since reduced to 1.25mg. Resting HR is now around 45 with the odd drop below 40. Interesting to note that medication also limits my rate when exercising, on a hard bike ride it will only go up to 135.
I asked my cardiologist about my low heart rate and he wasn't concerned in the slightest. His only concern was if it started affecting my life, i.e lightheadedness, shortness in breath etc. I think this is the key, if you can do the things you enjoy doing then the low heart rate isn't really a concern.
thanks. I do feel fine, so I’m not going to stress about it.
I’ve been on Bisoprolol 10mg for over 30 years and my heart rates were in the middle fifties to lower sixties. As I’ve got older I’m now 77 I find that trying to do anything with middle fifties very tiring so have just now reduced it to 7.5mg with cardio permission of course so will wait and see
Hi, I would ask why are you taking bisoprolol if your rate is so low. Its normallly used to lower rate, but not so much. But depends how you feel. As BobD said I found dropping from 55 to 40 after a successful cardioversion knocked me out and docs stopped the biso . However, contra to some comments, my docs seemed more worried about low rate. I thought I was fit, did half marathons, played squash etc, in my 50s, but docs said low rate was due to leaking heart valves. So might be an idea to have heart scan. I now have a pacemaker to stop it going below 60.
The hospital put me on it when my HR was 120 in the middle of an episode of AF. I think now that my heart is in normal rhythm I don’t need it, but having raised the question with my GP, I can probably hang on until my call with them next Thursday unless it goes much lower. I do feel a bit spaced out at times and I wonder if that’s the bisoprolol. I had a heart scan back in 2020 after first episode and found to be structurally sound.
if biso is taking your pulse too low you may sometimes be short of blood for the brain which can make you feel giddy/faint. good about scan
Thanks everyone. My GP has called me and taken me off the bisoprolol and kept me on the apixaban until I have seen cardiology. I am happy with that.
Hi
Good.
But Bisoprolol 2.5 mg night doesn't move my H/R. It does keep my BP down.
I'm interested to see what is your H.R now 48 hours after stopping.
cheri JOY
According to my sports watch rather than chest strap, the average was 43 rather than 40 with no dips down into the 30s. Plus the spaced out feeling has gone.
my resting HR has gone down to 57 on 5mg biso. Sometimes it has gone to 46. My EP isn’t bothered - says it’s fine and it probably goes to 40 overnight.
Mmm, mines been going below 60 to very low 50’s for a long period at nigh. Well, week las Tuesday I got up bit too quick, sort of rushed around. Walked down a corridor to a lift and seriously couldn’t breathe 😵💫 Got in lift to go down and thought I might end up on the floor! My HRs been going this low for ages and all the ruddy medical men keep telling me the rates ok! Well, sick of this response and said ‘it’s NOT ok for me’! I’ve a cardiologist Consultant appointment next week.
Hi
How do you feel on the lower H/R avge night.
Mine is 47. But day now controlled rises slowly as I get up to
have my thyroid tabs (thyroidectomy due to discovery thyroid cancer).
By 9 ish it is 60s. Just took it before 2pm it was 62! That's pulse/heart pulse.
30s is too low. You need intervention.
But if you move about, food, high drink it should rise.
At night time it is expected to have a low H/R. Athletic or not. I used to run short distances and still was late 30 years.
Can't now with AF and enlarged LV.
cheri JOY
Hi! I know that it is a little late to reply to your 9 months old post, but maybe it is never too late... I was not a runner, but was exercising eagerly when I was 15 to 20 yo, so earned, at least I believe so, a strong heart. Measuring during my whole life, my resting HR was almost always 48, without any problems. When I would start loading myself with any physical load, it would go to about 90, meaning that the heart was capable to respond to demands without going in too high BPM. If, stating from increased load, I would stop, the heart would go down, to 48, in couple of seconds, with a little irregular behavior (some stumbling). It should have been also a good sign - the faster the heart goes down, to resting HR, the better you are trained and the better the condition of the heart. It lasted like this for almost to 65 yo. Lately, my resting HR has increased to 48-52 for some time, to drop back, to lower values again (46-48) in the past year. At night, I would say that it goes as deep as 30. I like to hear it, beating slowly and steadily. As it was said in an article, if the low HR is the consequence of prolonged exercise, than it is a good sign and such people last about 30% longer than the rest of the population.
I never took the medication, especially not Biso! It does slow your heart still more, so it may go under the necessary values for your body. Without drugs, you heart will naturally go to the BPM which is suitable for the needs. Any depressing it more down, may lead to feeling poorly on the base of reduced blood circulation.
I know well that the addiction to exercise may present a lot of problems. people tend to never stop with exercise, believing that, no matter what age, it is beneficial for the body. But it is not so. When we get older, when the heart starts having problems (arrhythmias, poor functioning valves and similar), it is reasonable to stop. I did it at the age of 60. I am still physically active, but never exercise as I did in my younger days. Please, do not ask me for an explanation, but I would advise the same to you. Following inertia, your heart will remain fit for the remaining years to come. BTW, running is one of the worst activities you can do. No wonder that footballers die frequently in the past years, they are in principle also runners.
Wishing you all the best,
Peter
Hi Peter,
Thanks for responding. Things have moved on a bit since I posted this. I am only taking apixaban now because of likely ablation. My resting heart rate at night has gone up to low 50s from mid-high 40s, I think as a consequence of dialling back the exercise. I do run but keep my HR under 120, go to the gym twice a week and swim once. I have just had a load of tests: CT angiogram, MRI and exercise tolerance test. Haven’t had any feedback yet apart from the exercise test which took my HR up to 171, provoking a few ectopics, no AF and showed I was still quite fit for my age with a VO2 max of 32. For sports geeks this was much less than my Garmin prediction which suggested 41.
Sorry to say so - addiction, it is all about addiction... Please, do not run! Exercise, or any other physical activity, count to "body manipulations", which influence our body far more than other factors - food, drinks, air we breathe, medications, ... Only stress is comparable to body manipulations. Running will deteriorate your body's condition and you do not need it at 60+. Limit your exercise to walking or brisk walking on even ground, it is not the time for running, cycling, weight lifting, rowing or similar. Believe me, even the young ones, if exposed to inconvenient "body manipulations", have serious consequence, including cardiac arrhythmias. We see here more and more people in their 30ties or 40ties.
Me and my cardiologist will have to agree to differ on that one. It is my experience that people who have not trained and don’t do sport see what is really a moderate amount of exercise as completely over the top. What I am doing now is massively dialled back from what I used to do. I monitor my heart rhythm very closely and discuss what I am doing with my cardiologist. Feeling fit, which I do, and which allows me to do a lot, brings me joy and so I’m going to continue while I can. I realise that I am very lucky compared with many people here and I feel thankful for it.
It would be indecent if I would persist... Wishing you many happy years in the future!
Stopped Digoxin but now have Bradycardia - an update. 
should I be concerned? 
Successful Cardioversion 
HOW LONG IN AF
Linesteps1 
