ecg reading please

[mjm1971]

hi all

can you cast your eye over this please

I know I’ve sent one recently but I’m weaning off of Bisoporol as an experiment and it’s been 48 hours without any .

My normal rate while on bisop was circa 48bpm average

[mjames1]

Bisoprolol is primarily a rate control drug, not a rhythm drug, so I don't see how coming off of it would effect your afib at all. If the Watch said normal rhythm, then I'd go with that. As you know, we're not ep's, so no one should make any decision based on how we read ekg's. In fact, most GP's and even many cardiologists can't read them accurately. Ep's are trained for that.

Jim

[mjm1971 in reply to mjames1]

hi Mjames

I used to get a NSR reading on my Apple watch ecg even when I was at 80-90bpm so hence I don’t trust it 100%

[mjames1 in reply to mjm1971]

You can be in normal rhythm at 80-90bpm. As mentioned, only an ep would have my full trust interpreting an ekg, but I'll take Apple's call over most here, including myself

Jim

[Hidden in reply to mjames1]

Cardiologists read ECGs constantly in their day to day work. EPs train in general cardiology before subspecialising in cardiac electrophysiology, and are experts on cardiac rhythm disorders.

(In the UK there are five main cardiac subspecialties - interventional cardiology, adult congenital heart disease, cardiac imaging, electrophysiology and device therapy, and heart failure management.)

[mjames1 in reply to Hidden]

I think its that extra training that makes them more adapt at reading ekg's, especially when it's not so clear cut, as happens. A good ep almost never looks at the automatic diagnosis from the machine, because they are trained be more discerning. Almost all GP's and even many cardiologists, just take what the machine says. But even with ep's, it's not always clear cut. I showed the same ekg's to several an a difference of opinion between afib, SVT and flutter on some of them.

Jim

[Ppiman in reply to mjames1]

I take bisoprolol and it reduces my rate and ectopic load and (fingers crossed) prevents my AF, so it perhaps isn't as black and white as you suggest. I have always thought that that would be the case with the majority of AF sufferers since a DOAC and a beta-blocker seem to be the primary treatment.

Beta-blockers don't act in the ways the anti-arrhythmic drugs do, for sure, but better-behaved also seems to be a better behaved heart, rhythm-wise.

Steve

[mjames1 in reply to Ppiman]

Back in the day, before afib became an industry, you didn't walk out the door with a beta blocker and a thinner, just because you were diagnosed with afib. They had something called Watchful Waiting. No drugs. No ablations. Just see if afib is really a problem or a one or two off. I was on Watchful Waiting for over 35 years, before drugs like beta blockers, etc.

I'm not saying they haven't helped some, or even aren't necessary under certain circumstances. But they are primarily a rate drug, yet dispensed to many where rate is not an issue and the consequence often is significantly diminished quality of life from the side effects. Not everyone, but many.

If a doctor is going to prescribe something like a beta blocker, the least they can do is trial the patient both on and off of it, to see if the benefits of being on the drug, outweigh the side effects. This is something they hardly ever do. Not good medicine IMO.

Jim

[Ppiman in reply to mjames1]

That’s fascinating. I’ve read on this forum from several people who have suffered side effects and, looking at trial data and patient reviews, it seems to be under 30% with negative outcomes, which seems pretty good given the nature of the complaint and especially compared with anti-arrhythmic medicines.

A friend with longstanding AF was put straight onto warfarin but nothing else many years ago. Luckily, he’s never had tachycardia from his AF.

My own worry is what happens if my 1.25mg needs to be increased over time to keep AF at bay. Bradycardia will be the main issue I’m certain and, I imagine, a pacemaker would be needed.

Steve

[mjames1 in reply to Ppiman]

Except that before you got near pacemaker range, they would/should either reduce or eliminate beta blockers and/or replace with a calcium channel blocker like Diltiazem, or intervene with catheter ablation. And again, just because beta blockers reduce your rate and ectopics, doesn't necessarily mean they will reduce your afib burden. That's why I suggested a trial off of them. Ectopics, by themselves, while a nuisance, in most cases is benign and does not require treatment.

Jim

[Ppiman in reply to mjames1]

Thanks for those thoughtful reflections! I'm unable to take flecainide or sotalol thanks to the wide QRS / LBBB, I imagine. I hope I never need amiodarone.

Steve

[mary70 in reply to mjames1]

agree - I was offered Bisoprolol (beta blocker) usually after being diagnosed with Atrial Fibrillation. Still survived well but without using Bisoprolol.

[Palpman]

Your heart rate has increased to 75 bpm if I read it correctly but I fail to understand what you are worried about. That is a text book sinus rhythm.

[Peony4575]

if you are weaning off a beta blocker there is a rebound effect , the inhibiting effect of the beta blocker is removed and you get a fast heartbeat until the situation in your body normalises again

[petmice in reply to Peony4575]

I hadn't heard of that before (I am so ignorant of all this). I just weaned off of Metoprolol (and Flecainide) and have noticed my heart rate is now in the 80's and 90's; it was in the low 70's before Metoprolol (and the 50's-60's while on the drug). It never dawned on me that it's my body adjusting to the medication change. I'm going to ask my Pharmacist about this - it would be wonderful to know my heartrate could go back down to the 70's again.

[Peony4575 in reply to petmice]

my normal rate is 60bpm . After taking beta blockers for a day my HR shot up to 130 bpm . I got episodes of tachycardia on and off for a bit. I had previously weaned off bisoprolol and had rate and rhythm problems for a while . That’s why there is a warning on them to not stop abruptly and wean off . It will all settle down in a while . Your pharmacist will know it’s a very well known thing. Welcome to the minefield that is cardiac drugs

[mary70 in reply to Peony4575]

In principle, I have never participated with (beta blocker) Besoprolol - in my opinion a beta blocker can be disruptive in terms of tiredness and exhaustion - hence some patients suffer from the long term effects from beta blockers

[Ppiman]

The Apple Watch is a very reliable ECG monitor, I gather. NSR means that the ventricle has contracted because of a single signal coming from the sino-atrial (SA) node, which shows as a tiny blip ("P" wave) just before the big one ("R").

In AF there is no "P" wave as the fibrillating atria are preventing the SA node from functioning properly. Instead, multiple foci from the left atrium are sending signals to the SA node, thus the ventricles are relying instead on these, often fast and irregular signals. NSR itself can be at any rate.

Steve

[MaryCa]

Looks like your heart rate is up to 70+. That's what bisop does though, it slows the heart, so coming off it allows the higher heart rate. You've got a p wave so it's not AFib. If you're worried about it send it to your gp or EP.

[Teresa156]

Your heart rate looks like it’s in sinus rhythm which is good. Just try and take lots of deep breaths. I do find it helps if my heart rate increases through anxiety for example.

Out if interest, how long had you been weaning for?

When I tried to come off bisoprolol about 18 months ago ( and failed) my heart rate went up quite a lot as the adrenaline kicks in. It’s a known withdrawal symptom unfortunately. I reduced over a fortnight as recommended by my cardiologist, which was too quick. The ‘receptors’ go into overdrive as they’d been surprised by the bisoprolol. They say it takes a couple of weeks or more to settle, but some do take longer.

I weaned down from 2.5 to 1.25 last year and it took me 4 months with jewellery scales. A tedious, slow process where I’d take tiny bits off every few days with a cutter 😳but it was worth it as my heart didn’t even realise. I wasn’t going to take any chances, due to my experience in trying to come off it previously. I do think that going completely off it though is still the ‘hard’ one.

Deep breaths…deep breaths!

[Autumn_Leaves in reply to Teresa156]

A jewellery scale?! That sounds like very tedious work! How did you manage to accurately cut the tablets?

[Teresa156 in reply to Autumn_Leaves]

Hi Autumn leaves,

Yes it was! I cut them with a really good ( and inexpensive) pill cutter from Amazon. I spread out lots of pieces on a sheet of paper that weighed certain weights and would weigh about two/three weeks worth at a time. I was reducing by about .4 gms at a time 😳 until I reached 1.25. Admittedly towards the end, the increments got a little bigger, but probably because I was getting fed up! Jewellery scales are the only things that would weigh that low a weight,

It was worth it though and I’d do it again if it helps the withdrawal 😊

[Autumn_Leaves in reply to Teresa156]

Indeed.if it’s what you have to do it’s worth it.

[Autumn_Leaves]

I’m not sure what the question is 🤔

The rhythm appears to be regular and if the rate is under 100 bpm then that’s considered normal. As the others have said, your HR will increase if you stop the beta blockers, and as the P wave is visible it’s not AF.

Other than that, you’d need someone with expertise in reading ECGs to identify anything else that might be going on. The Apple Watch isn’t going to give a comprehensive picture anyway as it’s not a medical device. People seem to have quite individual waveforms too, and there are many varieties of “normal” so if you’ve noticed any changes in the morphology of the waveforms then you’d need to forward before and after tracings to your consultant.

[Ppiman]

We seem very much in the same boat. I'm pretty stable on 1.25mg bisoprolol, which I only started taking daily a couple of months ago. It gives me a resting rate of high 40s / low fifties so long may it continue.

Apart from occasional AF my main symptom (as I write this) are pretty frequent PAC / PVC and a general palpitation feeling.

Steve

[Ppiman]

From what I know of LBBB it usually is a permanent state of affairs, even if it starts differently. My Kardia ECGs do sometimes show normal NSR but mostly "wide QRS" which, I suppose, is the LBBB.

My GP told me it was rarely anything to worry about and shouldn't cause symptoms. Online reports suggest the same; however, I'm not sure about that at all and tend think it is the cause of my palpitations and generally "unhappy" heart feelings.

Steve

[Ppiman]

That’s interesting and I’m sorry to read that, too. Something more to worry about. My own list of worries grows, too. That said, I suppose not many years back that such a finding would be unheard of, so at least, these days, you will be treated for it effectively. I do hope so.

My GP has in fact implied that he blames my wide QRS for my symptoms during conversation but when it was first discovered, I was told (and the Internet suggest mainly this) that it’s generally benign and not symptomatic if not part of another pre-existing condition or following an MI or similar. A friend has had a replacement valve and he tried my Kardia out a while ago and found that he also had a wide QRS. He seems to have no symptoms from it. I do wish doctors knew more about this whole area but they seem not to - or don’t have the time to discuss it.

Steve