I am a 59yr old diagnosed with Hypertension about 15yrs ago. To the best of my knowledge this has been fairly well controlled and i take 5mg of Ramipril each day. I haven’t lived the life of a saint but have kept myself fairly fit. I love my cycling and until this year would be doing anything from 6,000 to 9,000 miles per year which has been great for keeping my aerobic fitness and weight in check. About 2yrs i started to notice odd occasions when my HR on my garmin device was jumping up to 160bmp and back down to the 80’s in just seconds. I also noticed that my fitness had dropped in general and on occasions was light headed.
After several referrals to my local cardiology dept i was finally diagnosed with paroxysmal AFIB in April 2023. The Dr has prescribed Edoxaban to reduce the chance of a blood clot but has not prescribed a beta blocker at this stage because he felt my heart rate was quite low when i am in NSR and he was worried about the drug lowering it further. I have been referred to an EP called Dr Heck at Papworth, Cambridge and have my first consultation in October 2023. My local cardiologist believes i could be a good candidate for a catheter ablation. Over the past 6 months i have seen my AF episodes increase from every 7 to 10 days to twice per week. Which is worrying. I have started to identify something triggers which include alcohol, caffeine, stress and strenuous exercise 😢
I have been reading a lot of the posts and can see this is a really strong community with members who are knowledgeable and very helpful. Now to my questions:
1. Should i be on a beta blocker or other drug to reduce the chances of further episodes? I am concerned because my episodes, which normally last 24 - 28hrs are increasing and i am concerned about damage to my heart.
2. Despite being in NSR rhythm most the time i find that i feel really tired all the time. I wake up every morning and feel shattered. I am also getting occasions where i feel lightheaded although my kardia reading will shown a normal pulse rate (62 - 65BPM ) and NSR? I thought i would only get the normal AF symptoms when in AF??
3. I read on the forum some tips on how to calm the heart and get back to NSR - breathing exercises and vagus nerve exercises - i have found this has worked on 2 out 3 occasions. anymore info on ideas will be gratefully received?
many thanks
Chris
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1 High rate for prolonged periods can damage your heart. Your problem is that taking medication to lower your HR in AF will then lower it too much in NSR. There are medications to help prevent the AF but they generally have to be taken in combination with a rate lowering drug for safety (it’s complicated!) However you haven’t been in AF for a prolonged period so not to worry.
2 Unfortunately the ‘shattered’ effect is common particularly if you are having frequent episodes, also it is possible you are having AF while asleep. AF messes with your BP even when an episode ends while your heart is recovering.
3 I’ll leave that one for others!
4 Answer to the question you didn’t ask: Yes, be careful with strenuous exercise - your heart doesn’t know the difference between high heart rate due to exercise and high HR due to AF so if you rush out to exercise as soon as you are in NSR, rather than taking a recovery time, you may damage your heart yourself.
Thanks for the advice and especially the question i didn’t ask. I do have a tendency to want to get back out on my bike as soon as i am back in NSR. I guess i need to learn to listen to my body 👍
Your age and excercise profile make you a prime candidate for AF I'm afraid as I am sure you will have been told so some life style changes will need to be considered. Regarding beta blockers there is a very real risk that these may induce bradycardia (slow heart rate) if you were previoulsy a fit athlete which may result in it dropping too low . Antiarrhythmic drugs may well help keep you in NSR but can only be prescribed initially by consultant level so something to discuss with the EP in a few weeks.
You should know that any and all treatment for AF is only about symptom control (quality of life-QOL) and provided that your rate is controlled and you are anticoagulated for stroke prevention ( AF increases stroke risk by 500%) then AF is not life threatening or limiting.
Sounds familiar to me. Apart from dropping your heart rate beta blockers have some other undesirable side effects.As part of my pre ablation journey following the loop recorder was the pacemaker this allows low pulse rate to be controlled whilst I managed, as best I could the other side effects of the beta blockers. The added benefit is 24/7 AFIB monitoring via telemetry back to the clinic. Gives an extremely accurate map of AFIB load.
No sneaking too many drinks any more!!!!
2 1/2 years on from ablation and no AFIB. Importantly was able to stop beta blockers a few months after ablation. Only medication is Zarelto 15mg.
Not sure what the UK protocol is this regime seems standard fare in Australia now.
I recollect well after my first emergency hospital visit with AFIB my initial denial of the journey proposed by the treating EP. He got it right I had no idea as I kidded myself AFIB was just a passing ship in the night!!
It sounds like you may be offered an ablation in the short to medium term. A good outcome may restore you to good health so stay positive. It does seem that recently your AF burden has been increasing.. Try to identify yor triggers and modify where appropriate. Arate control drug may encourage bradycardia but it will also discourage tachycardia. My view is that the high heart rate during afib promotes fibrosis within the heart.My pulse used to be mid 60s at rest. I now take bisoprolol and it now settles at low 50s. I feelconfortable at this rate. I cycle, walk and do resistance training without any problems. I try to avoid oxygen debt and keep my pulse below 120 .
Go to sleep wearing your Garmin. It MAY indicate your HR is jumping around at night as well which could indicate you are going into AFib. My Garmin (with chest belt ) trace was the reason I found I had AFib, but it was obvious for me as I was about 165 bpm resting most of time in Afib. However you need to be aware you can still be in AFib at low heart rates so this COULD be occuring and explain your tiredness.
Also your heart pumps less efficiently when in AFib so that could also explain tiredness. (apart from high HR I was asymtomatic in AFib, I ASSUMED that the high rate in AFib offset the poor efficiency.
Also consider that AFib messes with your head! If you go to bed worrying you will be tired.
Also worry affects the heart rate (adrenaline) so this can also explain changes in heart rate and can cause palpitations. So best to not worry excessively.
Beta blockers are a rate control drug and are best avoided IMO ( I could not tolerate them as they massively reduced my HR when not in AFib.) Others swear by them. I was on calcium channel blockers as I needed rate control owing to my high HR WHEN in AFib. They were much better ( for me) but if you don't need them better still IMO!
High heart rate and damage. Very difficult to advise as people have such a range as " normal" but if I was you would follow your doctors view.
I was always scared that the high HR would cause Atrial remodelling and make the AFib permanent . My resting HR was 70 ( varied depending on my excercise fitness.)
However my 12th Afib attack had me at 165 to 195 bpm resting for the best part of 8 days. After an PVI CRYO ablation which permanently stopped my AFib,
I later developed Atrial flutter and was rate controlled at a constant 140bpm for a month before an ablation stopped that.
Neither caused any permanent damage, as after the ablations I went back running to get fit, and got back to only 20 seconds a mile slower over a 5.5 mile hilly cross country route, and that was explained as I no longer pushed up hills as I made the decision to limit my max HR to 155.
I was 58 when I had the ablations and was reasonably fit with no comorbidities. Hence was a good candidate for ablation according to my EP.
That was 5.5 years ago and I have not taken any drugs since 3 months after the ablations and have had no AFib.
I am not medically trained. All this is just based on my own experience with AFib and Flutter, and your reactions could be different to mine. AFib appears to be very "personalised".
As you already have a referral I would make sure that everyone concerned knows that your episodes are increasing, and if possible ask to go on the cancellation list for an appointment.
1. Not necessarily. Beta blockers alone have a very weak anti-arrhythmic action and are primarily for rate control. So if your rate is controlled between episodes, they may end up doing more harm than good. On the other hand, anti-arrhythmic's like Flecainide, can often help prevent or reduce the frequency of future episodes. Speak to your ep to see if that makes sense for you.
2. For me, I always felt fine when not in afib, the caveat being it it took me several days to recover from an episode. So when I was in afib twice a week, I was always tired and often light headed. So it could be that. I found staying hydrated the most helpful and would use sports drinks with electrolytes during episodes and to recover. The other possibility is that you're in afb more than you're aware of. A 7-14 day patch therefore might make sense. Alternatively, many have found home monitoring helpful with devices like Apple Watch or Kardia.
Royal Papsworth has a very good reputation and they were the first in the UK to do Pulse Field Ablation (PFA), a newer and safer ablation technology. Good luck.
I have concluded that breathing is something all AF sufferers should look into as part of 'the cure'.
Ref: James Nestor's book Breathe, Patrick McKeown Oxygen Advantage see YouTube for both.
Also saw on YouTube recently a good explanation as to why nose breathing is so important:
'A highly beneficial aspect of nose breathing is it creates Nitric Oxide. Nitric Oxide is a vasodilator, which helps expand blood vessels and improve blood circulation. This lowers blood pressure, boosts heart health, increases oxygen levels to the lungs and cells of the body, it improves physical performance, increases brain function, improves your sleep and boosts your energy levels.'
PRACTICAL TIP: I walk a mile x2 per day and at the same time keep my mouth shut and breathe solely through my nose; slowly just 6 per minute. I think this may also have improved my mild sleep apnoea - will find out when I get tested again in 6 months.
Thanks everyone some really valuable advice to help me navigate the new world of AF. It’s scary stuff for me. In the space of 6 months whilst waiting for my first appt with the EP (due 5th Oct) i have gone from episodes every 7 - 10 days to currently twice per week. Each lasting at least 24hrs. I have cut out alcohol completely in the past 2 weeks and mainly drink decaf coffee. I cycle a lot and usually can comfortably sit at an average of 140BPM over the course of my ride (although this has often triggered my AF. Yesterday i did a ride on the peleton of 45 mins at an average of 115BPM and 30 minutes later AF struck me !!! This was purposely a very sedate ride for me. So depressing.
I now understand the difference between a beta blocker and anti-arrhythmic's like Flecadine. My Cardiologist when referring me to the EP put me on a blood thinner but not anything else as he was worried about lowering my heart rate too much.
Advice please on whether I should go back now and get advice on whether i should be started on an anti Arrythmic or with 42 days to go until the EP appointment just sit out and check with the EP then?
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AFib, exercise and meds
Persistent/ permanent AF episode and exercise 
Are beta blockers prescribed in paroxysmal AF without proper consideration?
AFib/Atrial Flutter Burden
I am confused
