When I was on Sotalol for paroxysmal Afib my heart rate was typically in the range 70 to 125 when in Afib and 60 to 75 in NSR, as measured on my Kardia. For the last month I have been on Flecainide and Verapamil. There now seems to little difference between Afib and NSR heart rates both being in the 60 to 90range . I thought Afib heart rate is expected to be higher as the heart works harder. I am feeling fine and have no symptoms.
Has anyone any thoughts on this please?
There are absolutely no norms. Some people never have a raised HR when in AF.
Changing drugs has obviously helped and is working better for you than the Sotolol would be my none medical observation.
Thanks for your much appreciated observation.
I think that Cdreamer is right. Some people have the the irregular rhythm without the raised rate. Some like me have a raised rate. I believe that this is sometimes called RVR or rapid ventricular rate. A very uncomfortable state to be in. For some their HR becomes very labile. I guess we are all different.I think that what you are describing is an increased efficacy from your medications.
Regards
Thanks. It’s just not what I expected but as you say we are all different.
I gather that the response from down below (i.e. the ventricles) to what's happening "up top" (i.e. the atria) is usually to experience tachycardia but varies a lot by individual. This creates different levels of irregularity, heart rate and, it seems from reading here, widely varying physical effects. My heart rate in AF used to be 85-130bpm, but the last three times it has been 150-185bpm which made me feel far more anxious.
Steve
Yes that sounds high but hopefully it doesn’t last too long?
Thankfully, it’s been a maximum of a few hours but I even managed to get to sleep with it, amazingly. Some people truly struggle but the worst effect for me is a feeling of anxiety.
Steve
Crikey 185 , I’m not surprised you were anxious
And I was driving on one occasion. I tapped my watch and saw that figure and pulled in to check it was right. I was on my way to give my daughter in law a lift home from her job as a nurse at our main hospital. I thought I would be sitting in A&E rather than picking her up - but it slowly eased.
What a life!
Steve
It is more common for the heart rate to be fast with AF but it is possible for the heart rate to be within accepted limits or slower and still be in AF. We all respond differently.
My PAF is characterised by a fast rate (130+ bpm) with RVR albeit I haven’t had any episodes for quite a while. At rest in NSR, it’s between 50-60, relaxed/ chilled - 40-50. I am taking Flecainide too (4+ years) but I couldn’t say I saw any discernible difference to my ‘norm’ when i started.
Yes we are all different!
When in PAF my heart rate is 140-150; but the rest of the time it is now very low - sometimes below 50; and I feel wiped out, giddy etc. I do not know why it is so low - they have now got me on the tiniest dose of propranolol, so it should not send it so low. Bisporolol has been tried but I am a total wipe out on that.
However the PAF is pretty infrequent - 4 times a year roughly - so I would rather deal with that when it happens than go round with such a low heart rate that it impinges on my normal day-to-day life.
Anyone else been in this situation?
Sorry to hear that. Perhaps someone can suggest a solution
Just thinking. Would a pacemaker benefit you to maintain your heart rate at a reasonable rate?
As I mentioned above my resting HR is quite low. Initially, after diagnosis, I was put on low dose daily bisoprolol, along with the flecainide. I found this beta blocker dragged my heart rate even lower and it did leave me feeling quite tired and listless. On discussion with my cardiologist, this was removed but it is still available to me as PiP. In the event of an episode, I can take 2.5mg to try to slow down my rate.
Everyone is different and it’s finding a solution that suits you. I find rhythm control ( daily flec) with no rate control ( bisolp) suitable for me at the moment. My ‘norm’ is a low-ish HR but I have no problem raising/lowering it while maintaining NSR. After a couple of CPETs , I was given an ‘aggressive’ target HR and I do exercise hard, as well. I do feel fine and energised because it.
Unless I am in Afib, I don’t need a beta blocker, maybe you could do without it? I’d certainly discuss it again with your GP or Cardiologist.
Thanks. A good idea .
Thats helpful
Presumably you can only have an HR target when not in Afib; otherwise with a racing heart you cant sort out true heart rate elevation through effort from AF spiking.Do you exercise when in AF?
Yes I do e.g play tennis, but I don’t monitor my HR
Hi, target HR is for NSR. I haven’t exercised while in Afib but I haven’t had any sustained arrhythmia for 3+ years either. I do monitor my HR with a Polar monitor (when exercising) and I also use a Kardiamobile for general monitoring/awareness of my heart and condition.
Whether to exercise in Afib is an interesting question and one I haven’t had to really deal with yet. On past AF episodes I generally felt ok, bar the characteristic flutterings in my chest. I do recall A&E staff mentioning once that my haemodynamics were stable in AF, maintaining normal BP, etc. I don’t see why I couldn’t and have on some occasions in the past, I exercised in the morning (in NSR) after a nocturnal AF session. Like most things, I’d speak to my cardiologist and follow their advice before doing anything like that.
that’s interesting
I had atrial flutter 4 years ago, was cardioverted and have been fine since. AF has come back as PAF but no symptoms. HR jumps when exercising as before and my kardia regularly says ‘signs of’. Rest of time HR is normal and I feel OK. BP is fine and blood thinned.I am due to see cardiologist soon and am anxious not to end up feeling a lot worse on some of the meds I have been reading about. Currently I can exercise with care when in AF and don’t want to stop. Any advice appreciated
Hi, sorry thought, I’d replied to this. If you are concerned about exercise and your response to it then maybe ask your cardiologist if you could have a CPET?
I was fortunate , in that my local cardia rehab (phase4) offered 2 tests as part of their program. I found them very interesting and very reassuring.
Basically you are exerted (treadmill) in a controlled manner while monitored (ECG, BP, respiration) by trained staff (in my session, a doctor and cardiac physiologist). Your response and recovery is tracked and analyzed.
Basically, I got taken to my max HR with no Afib or abnormalities. That taken into account with a high capacity for exercise, I was given the target HR I mentioned previously.
It gave me the confidence to train high. I haven’t looked back, this was 4 years ago and I fully attribute it to my current condition: An excellent recovery from heart attack and stable/controlled AF.
Thanks. Very helpful
Quite a lot of good stuff in posts today about unsymptomatic
Asymptomatic v symptomatic has been a puzzle to me.
The ‘wake up call’ to my AF was a heart attack. After investigation and in the absence of any other causes, the conclusion is the undiagnosed and untreated AF caused a small thrombotic event and a transient clot went into my heart. Prior to this I was oblivious and asymptomatic.
Subsequently to this, AF episodes are acutely obvious to me, characterised by fast HR with RVR and the telltale chest flutters; can’t miss them. I also very sensitive to any changes in rhythm, rate or feeling.
I am less sensitive as the years go by but I really don’t see how I could been so unaware prior to my attack.
thats interesting
going back to HR targets what I’ m really stuck on is , now I’ m in AF a lot of the time, where before a given effort was 100+ it can now be 140 (maxish)
A big push up a hill before 115 now 160
OK not for long, comes down rapidly
I feel fine maybe a flutter at 160
so Targets ? and is it safe
My husband had similar but the clot went up to his brain causing a stroke
Yes I agree. The discussion has been very useful. Thanks everyone for your comments.
Hi golfwatcher. That would also be pretty normal for me when in AF. It might start out faster, but quickly drops into the 80-95 range for the duration of the AF episode. I take flecainide PIP (150 mg stops my episodes within 1 - 4 hrs). Sometimes it'll speed up again just before converting--weird, but there seems to be a wide range of "normal" for our episodes. And mine have gotten quieter & milder in the last few years... I'm not complaining! 
This is interesting. My late husband also had PAF and he was treated with flecainide as PIP. I have brought this up with the medics here in the UK and they all tell me that flecainide is out of favour and they will not prescribe it now. I have bisoprolol as PIP.
Interesting, yes, but seems that quite a few people on this forum w/ PAF in the UK are taking flecainide. I take metoprolol daily (similar but not identical to bis) but it's never stopped an episode, while 150 mg flec has never failed me. Drugs do go in and out of favour; is their issue the possible flec side effects? I am in Canada some of the time & flec is first-line here, with bisoprolol, while we're more likely to get flec and metoprolol in the US. I will say my drs. in both places are very open to changing and trying something new if I had side effects (have not had any, 4 yrs on it) or if the meds weren't working. I hope your husband was helped by flec and didn't have side effects. Best of health to you!
Hope it remains that way 😀
Hi
Your Vera..... is a CCB and will drastically bring down your heart rate.
My case when introduced CCB Diltiazem dropped from high 156 on Bisoptolol to 51 on 180mg. We lowered the CCB to 120mg AM and Bisoprolol 2.5mg PM.
I can never go without my CCB.
cheri JOY. 74. (NZ)
yes, makes sense
I'm also asymptomatic. I just ordered an Oura ring and may get a Kardia as well.
A fib by a purist definition is a rhythm problem but can also present as "rapid" a fib..which makes it the beast that it can be sometimes.
My average HR can be relatively low while in AF as I am now since yesterday afternoon. In a 30sec ECG on my Apple Watch earlier, 64 bpm average and in AF.
HR is not so easy to measure in AF as the beat to beat measurement is jumping up and down with every beat or few beats. I read that to take HR while in AF you should count how many beats in 10 seconds and multiply by 6. So when people mention their HR during AF, I wonder how many are looking at the individual beats jumping up and down on a device and how many actually quote the average.
Just my thoughts
Hi there
I , like you, have PAF with no symptoms. My HR remains low if I am doing normal things even if my Kardia shows ‘signs of AF’. But if I exercise vigorously then my HR deviates a lot. Do you find this?
I don’t vigorously exercise. I play tennis in AF and it doesn’t bother me too much
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