Afib and bradycardia

[Crimson2020]

Hi, I have paroxysmal afib with episodes lasting about 24 hours every 14 to 21 days on average.

My daily resting heart rate measured on my Fitbit watch ranges from 41 to 50. After an episode of mild but obvious palpitations it rises to about 50 but falls back to the low 40s after a few days. If I exercise the resting HR tends to fall less quickly.

The onset of a new episode may follow a large meal or a glass of wine or beer but often without an obvious trigger. However it always recurs after 2 to 3 weeks.

The only obvious trigger is my resting HR falling to the low 40s.

I am interested to see if others have a similar afib cycle.

By way of background information, my resting HR was about 45 to 50, but after commencing Bisoprolol 5mg once daily in November 2021 it fell to its current range of 41 to 50. My consultant said I could skip a day if my resting HR fell to the low 40s but as yet this hasn’t really changed much.

[BenHall1]

There are many on here hopefully will reply as to yheir experiences. Food (appeared after about 6 months from 1st onset) as my trigger. After putting up with all the medical processes I turned to a Nutritionist for advice. Drinks, hot or cold, alcoholic or non alcoholic never played a part. The Nutritionist provided much advice, starting with eating foods which were gluten free, wheat free and oats free. And that was just the start !

[Kendalghost]

I was finally diagnosed with AF in 2017, two years after my minor stroke. I have had a low pulse which was first noted on my medical records around 2000. On my second ablation my pulse dropped to 30 and I was advised that I needed a pacemaker. the consultant thought that the low pulse, which did at times drop to 30 at night was causing some of my AF episodes. he said that the heart realised that it was going to slow and that it tried to speed itself up and flipped into AF. I still have AF even though I have the pacemaker but not as often.

[secondtry]

Sorry, I don't have a similar AF cycle but your post and my AF experience suggests to me:

To better manage the AF: It would be good to ask your cardiologist (or another for a second opinion) about Flecainide and whether you can take it without the Bisoprolol. I did this 200mgs (medium dose) successfully for 11yrs.

To stop the AF: I stopped it (except 2 v brief episodes) for 11 yrs by using a hybrid approach of Flecainide & many lifestyle changes largely gleaned from this Forum.

[Thomas45]

I think a large meal including alcohol is probably the trigger.

[Desanthony]

Avoid eating big meals late at night. Much better to eat smaller meals more often. This is a known trigger for AF

[mhoam]

HI Crimson2020

My HR was always relatively low, often in the 40s. must be genetic as I have never done any fitness training! When my AF kicked off some years it was always in the middle of the night and it was suggested to me that it was because the low HR had triggered the heart into AF. At that time my HR was high (150+) during the episodes.

Since my ablation my HR during the infrequent AF episodes has rarely reached 90-100, even though the palpitations are as uncomfortable. My dosage of Bisoprolol was reduced a couple of times after a number of episodes of syncope (dizziness etc) by the cardio team. Now I just take 50mgx2 Flecainide with no Bisoprolol and the HR during my infrequent AF episodes remains low.

It seems AF does not always result in a high HR, even though it is irregular and very uncomfortable. Not every one needs to take Bisoprolol with Flecainide so that may be a question for your Cardiologist.

Good Luck

[Vonnegut]

Low 40s for your heart rate doesn’t seem a great idea! I was taken off the lowest dose of Bisoprolol after only three days as my heart rate had gone down there and I felt so much less energy .

[OzJames]

my normal resting HR approx 65 I started a year ago on metoprolol which is similar to Biso but brought my rate down quite a bit. 7 months ago I commenced Flecainide and when combined with the beta blocker my HR would be in the 40’s. We tweaked the dosages twice and eventually settled with 10.5mg of metoprolol which is about 1mg of Biso and 20mg of Flecainide both twice daily. Some people have a bigger variance when taking these drugs. My resting HR is now in the 50-58 range. It seems to keep me out of AF so hopefully for a long while. I’m an anti drug taker and like others have taken many lifestyle changes and supplements to help support my body

[Crimson2020]

Many thanks for all the replies which have given me much to think about. By coincidence I am in AF at the moment since 10:40 last night. It is 12 days since my previous episode but in that time my daily Fitbit RHR had dropped from 47 to 42. Overnight it has jumped back up to 45.

My symptoms were mild flutters and palpitations but also polyuria and neck pain. I have noticed these before but both were more extreme than usual. The polyuria was fine after midnight and I slept soundly until 7:00 am. and has now ceased. The neck pain remained and had extended to the head and shoulders but a couple of paracetamol has cleared this.

My symptoms are now currently non existent but my Kardia monitor is still showing me as being in Afib.

My consultant has confirmed that the polyuria is a reflex being an increase in NTproBNP when the atria stretched. He said it was not a cause for concern.

I have not mentioned the neck pain to my GP or my consultant as it is more recent observation. I have no idea if this is medically significant.

A further problem is that my 2 consultants at the same hospital released me back into the care of my GP. The first time in Nov 2021 and now in May 2024. The May 2024 appointment took over 12 months from referral to appointment although they did arrange a 7 day Holter monitor in April 2024 which I guess caused the long delay.

This may have been a communication failure as I had only requested an appointment but decided to take up the 7 day monitor offer and accept the delay when I spoke to them in Nov 2023.

Hence a simple conversation with my consultant as some have suggested is easier said than done.

I have considered going private but my PAF is well controlled and mild and the risks are mitigated by Edoxaban, Bisoprolol and my common sense. Therefore I am on balance not unduly concerned.