After two and a half years of investigations, 2 cardioversions and two ablations, I was finally pronounced free of af in April this year albeit with some 14% ectopic beats as shown on my last 48 hour Holter monitor.
My heart rate was between 50 and 60 regular bpm, I was exercising again and I thought I had finally turned the corner.
However, on Saturday, as I was watching my bid on something on EBay, I realised that my heart didn’t feel right. I checked on my Kardia and there it was! ‘Possible Atrial Fibrillation’ and a heart rate of 152bpm.
I contacted my EP who recommended that I increase my Bisoprolol to 5mg twice a day but so far, this has had little effect. Still well above 100 and up to 140+.
To say that I’m depressed about it is an understatement! I’m so disappointed to think that after all this time I’m back to square one.
Does anyone have any suggestions for me? I’d be so glad to have some advice from fellow sufferers.
Thank you
Written by
frankiec5
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sorry to answer a question with a question, but how long has this been going on? If since Saturday with an HR between 100-140 then I'd personally get back in touch with your EP asap!
Sorry about the episode. The realistic goal of ablation (or any afib treatment) is not to eliminate afib 100%, but to significantly reduce it's burden. Hopefully, this is just an odd episode that will only happen very occasionally.
If that's the case, you need a plan with your ep what to do for these infrequent episodes. Apparently the increased in bisoprolol is not working, so you need a better plan.
When my episodes were infrequent, I always had a cardioversion in the hospital (ECV). In the US, we can get these almost immediately, but I understand that there can be a wait, sometime a long wait, depending on your health care system.
Another plan, especially if the episodes become more frequent, would be to use an anti-arrhythmic like Flecainde on as an "as needed" basis. This is called Pill-in-Pocket (PIP), You take the pill(s) per your ep's instructions at the onset of an episode. In my case, I always converted within 1-4 hours. Your ep may want to run a few tests first to make sure you quality for the drug.
So give your ep a call right away, because you want to remain in afib as little time as possible. Explain you're still in afib despite the extra bisoprolol and you would like either to be cardioverted and/or given an anti-arrythmic like Flecainide for PIP use. Press a little if need be. Meanwhile, make sure your rate is controlled and if not, press your ep again for instructions on how to get it down.
A good plan as discussed, may be all you need if the episodes remain infrequent. Should they start becoming frequent and impacting your quality of life, a touch up ablation may be in order.
Thank you both so much for taking the time to reply.
I tried to contact my EP today but he’s away until September. I have an appointment with a colleague of his in a week’s time but I think I probably need some kind of intervention before that.
I’m now considering going to A and E but I did that last time this happened and it wasn’t the best experience.
If your heart rate is remaining high for a sustained/continuous period, highly recommend you go to A&E or ER. They can reduce the heart rate to normal, do an EKG, evaluate and determine your medication dosage.
I think you’re probably right. I’m going to wait and see if the increased evening dose of Bisoprolol helps bring my heart rate down and if not, I’ll have to seriously but very reluctantly consider a trip to A and E.
is the high rate steady/regular or irregularly irregular I.e. definitely AF?
Just wondering if it might be atrial tachycardia - fast but regular and typically around 140bpm - which is quite frequent after a couple or more AF ablations.
I afraid my heart rate is both high and irregular so I’m guessing it may be af again. Very upsetting after months of normal sinus rhythm.
I’ve increased my doses of Bisoprolol to 5mg twice a day as advised by my EP and I’m getting some (not all sadly) readings below 100 so I guess that’s progress. But I don’t have much energy any more and I’m afraid of doing too much and setting everything off again. Daren’t even go for a walk round the block at the moment😔
Does sound like AF - sorry to hear. But ATach no fun either and arguably worse as AF responds way better to rate control drugs like bisoprolol. Good advice from Ppiman below. Hope things improve soon.
The bisoprolol will almost certainly work but can take a few hours. The high rate won’t harm you unless it goes on for very long time, all else being equal, and you would have been warned about that already by your doctor if so.
In A&E there’ll be a long uncomfortable wait, and maybe even a night instead holding ward worsening the situation, and likely just hooking you up to a monitor while the bisoprolol slowly works its magic. If deemed necessary, a CV or infusion of something like magnesium sulphate or a tablet of digoxin might be tried.
I think your heart rate will settle soon and, with luck, that will be that for another few months.
Thank you so much Steve. Your reply has lifted my spirits. I really am so very upset about this latest development. Just when you think you’re in clear water …. Bam!!! Here we go again.
Thank you again for your optimism. I’m going to try to stay away from my heart monitor for a while and hope the Bisoprol will do its thing successfully.
As we know, we are all different but in my case, taking 100mg of Flecainide am and pm has virtually put an end to episodes of AF. I started taking it just as a PIP with an added 1.25mg of Bisoprolol on the rare occasions when my heart rate was over 140 twenty minutes after taking the Flecainide. As episodes increased I was advised to take it regularly 50mg twice a day at first and now the 100mg. Of course it comes with side effects, increased fatigue etc! Good luck finding what works for you!
I’ll certainly mention this to my EP when I see him.
My heart rate has been consistently high for 5 days rather than episodically. Every time I think it’s coming down to an acceptable level, it suddenly goes up again for no apparent reason. Very unsettling. But thank you for your encouraging words. Maybe Flecainide could work for me too.
Sadly, not if your AF has become permanent or is it tachycardia - just the fast heart rate without the irregularity? If so the Bisoprolol or something similar is more appropriate.
Perhaps you have tachycardia - a very fast heart rate which is usually treated with a beta blocker rather than the fast and irregular heart rate which is atrial fibrillation. The Kardia should be able to tell you that. Good luck. An EP we saw privately was only convinced I had paroxysmal AF after I had bought a smart phone and a Kardia and sent him the reading when he sent a prescription for Flecainide to my surgery. At first I took it as a PIP when episodes occurred but now take it regularly and only the v odd episode if I miss the am dose when taking one puts a stop to it quickly! The Kardia is quite fun to use and others are usually interested to try it! I find it a good companion together with the smart phone with all that offers!
Unfortunately the Kardia shows that my heart rate is both fast and irregular so I’m guessing that the AF has reared its ugly head again. Wish I knew why. I had a couple of stressful experiences recently (a near miss in my car and speaking at a very close friend’s funeral) so I’m wondering whether those things might ge the reason for this disappointing setback.
On the instruction of my EP, I’m taking 5mg Bisoprolol morning and evening. My heart rate has come down to between 85 and 98 when at rest but goes up to 120+ whenever I’m active.
I’ve already had two cardioversions and two ablations so I don’t know what the next step will be; unfortunately, my EP is away on holiday until mid September so he can’t tell me what he thinks will be best. And to make matters worse, I’m due to fly to Australia in October for a three week (and very expensive!) holiday. Hey ho! More stress and anxiety! Sometimes it seems that the gods are conspiring against you doesn’t it?
I’m trying not to be too despondent but it’s hard. I don’t feel ill. Just rather breathless when I go for a walk or do a bit of housework and a bit lightheaded- presumably from the increased betablocker dose.
Thank goodness for this forum. People’s responses really help.
How different we all are and you seem to have had a far worse experience than mine! I couldn’t manage 1.25mg of Bisoprolol daily so amazed that you are still going on eight times as much! Ha Flecainide ever been suggested for you? It works fine for me but as we all know we are all very different.
Really sorry to hear the "uninvited guest has returned" it is not unknown that AF episodes can return some time later. Unfortunately, there is no permanent cure for AF, it is an ongoing journey of managing it with the support of your doctor and their recommended advice about medication.
Please contact Patient Services if you would like any support or advice.
I suppose I was guilty of thinking it was all behind me after two and a half years of interventions and that now I’m back to square one. But as you say, it’s an ongoing journey. I’m just hoping I can get back to doing the things I was enjoying before this latest setback.
Going through a similar situation. My second ablation lasted almost four years. Then one day started with AFIB again and very high heart rate. Back to cardiologist and EP. EP said he has done all he can and they will work on rate control and must live with permanent AFIB. After a lot of badgering because I feel poorly, tired all the time with very little energy, he referred me to a cardiothoracic surgeon. She thinks that a convergent hybrid ablation could solve the issue and she could also use do a left atrial appendage clip to eliminate or lessen possibility of clots at same time. I also have an aneurysm that could be dealt with all in the same operation, if necessary. In the middle of taking a multitude of CT scans, echo's, chest x-rays and blood tests to see if all ok for surgery. Not sure what course to take, but I know I don't want to feel like this the rest of my life.
I asked the EP and he said you are getting older. Now 70, but I thought odd answer. I'm kind of at end of my patience, after 3 cardioversions (all failures even with flecainide and amiodarone) and two ablations. This next operation might stop the afib, but for how long and will I ever get off all the medicine. Those questions can't be answered for awhile after the op.
Sorry to hear about your travails Frankie. Do you have a device or phone app that shows the waveform of your heart rate? I find that when I am having the higher rate issues that the waveform displayed by my heart rate monitor on my phone stops being nice and smooth lines of regular and irregular beats. I becomes really jagged when this happens.
So I do some deep breathing which helps, using the 4 count inhale through nose, 7 count hold breath, 8 counts exhale by mouth. Do 3-5 times, then breath "normally." I also find that I have forgotten to take my special geart herbs so I go and take them. They are:
Hawthorne root 800mg capsule qty 1
Heart Formula from Banyan Pharmaceuticals. Click on link to see wgat's in it.
This is my main heart support. I do also take diltiezem XR 250mg twice a day, but the only thing it does it seems is provide a framework of semi-regular beats. I'm hoping to be off of it by Christmas 2023. If you look for my other posts you van see my regimen. I do not use any other prescriptions and take natural blood thinners.
How is your water intake? Drink lot's of water. I find that when I consume less water, I have more issues, helps thin the blood.
Thank you very much for all your information and suggestions. I have a Kardia which I probably use too often but it does help me to know what’s going on with my heart.
I take Magnesium Taurate and Vitamin D and I will look up the supplements you mention.
Thank you again. I really appreciate you taking the time to reply. And it really helps to hear from people who understand what this condition is like.
Joy2theworld49 - They used to have me on 2 x 360mg which felt to be too much. There are days when I only take one 250mg. I'm trying to wean myself off of diltiezem and it seems one 250 every day is sufficient at the moment.
At 180mg once made me lightheaded and no way could I drive.
Your supplements whether in natural form or pill could be interferring with the Diltiazem. Also the brand was changed to ACCORD here in NZ because of lack of supplies. We are back to original with medsafe back up. I think Myers.
Diltiazem is a serious drug and needs careful monitoring.
When I stopped the 120mg because 60s Day and 47Night avge heart beats reinstated my H/R over 100. So I showed that Couldn't do without it.
it’s so disappointing after having a normal rhythm for so long . Maybe ring your gp. If your really worries go to A and E as I don’t want to worry you but my husbands heart rate was above that and by the time we realised as he didn’t have any symptoms until two days before his stroke due to AF.
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High heart rate after ablation
Sudden increase in heart rate
High heart rate during workout 
High heart rate when walking. 
Low heart rate - high dose bisoprolol
