I've long had a slow resting heart rate, especially when very relaxed on bed (reading, music, etc.) and nothing feels amiss. Feet and fingers warm.
I have paroxismal AF and if it breaks through it's mostly not as fast as many suffer, unless it goes into SVT which happens occasionally (more likely when on Flecainide for sure!).
It's got slower since I've been on Flecainide and Bisoprolol. So I try to take the lowest dose I can. (Today 2x50mg Flec / 2.5 Bisoprolol.)
Feeling absolutely fine, and appreciating the fact, and wondered what my pulse was up to... it was just 36 bpm, NSR.
I don't know if it's my imagination but there might be the occasional longer pause between beats.
My heart feels very comfortable. It soon speeds up if I get up. I walk a lot (incl steep hills) and although I probably could do more, I'm wary of too much exercise with the condition... I have a real trigger point.
I know Bisoprolol affects HR. Does Flec?
Thanks, and have a great day.
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Garaidh
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Yes, Flecainide can affect both hear rate and rhythm. Although this doesn’t sound like an emergency it is something you would be wise to get checked out, sooner rather than later.
Have you got something like a Kardia or iWatch which can take an ECG? This is something you should go report to your specialist, not your GP. If you are able, get a few ECG’s traces to take along with you. Otherwise go to your GP to report these symptoms and ask for an ECG saying you would like it checked by your specialist.
If you start to feel unwell, dizzy or faint don’t hesitate to get to A&E or call 999.
Thanks for the reply, CDreamer. I've never had a Kardia but should maybe look into that. My Samsung watch isn't good with HR stuff, very basic. My resting HR before I started Flec or Bisoprolol was always low. Then like now I felt fine. I'll take your advice though! 😊
According to Roxane Laboratories, a manufacturer of generic Flecainide:
"Flecainide does not usually alter heart rate, although bradycardia and tachycardia have been reported occasionally"
So it can be a cause of bradycardia but it usually doesn't. Bisoprolol on the other hand does reduce your heart rate. It's aim in AF is really to limit your heart rate during an episode but unfortunately it often reduces your heart rate generally, including when resting i.e. produces lower lows. We're all different and I'm not a medical professional but it's more likely to be your Bisoprolol.
Although the low rate doesn't appear to be symptomatic, as suggested by CDreamer, you should get checked out anyway as 36bpm is unusually low.
The first question I would ask given seemingly no adverse symptoms is how representative is your 36bpm and how was it recorded/measured? I often have resting heart rates in the 40's, including low 40's when sleeping. When I get into the 30's I start to question whether there was a problem with the measurement, especially if unable to be confirmed.
FYI I'm on Metoprolol and Flecainide - and like you, have always had a below average resting heart rate and don't have any ill effects from my "low" HR.
Thank you very much for your reply. Much appreciated BeanCounter.
I hadn't picked up that side effect awareness about Flecainide. I certainly know from experience that while it's really effective for me (my burden / time in Afib is down 90% in the past few years), if I get an episode, it's worse and I'm more vulnerable to SVT (which is horrible). I try to keep the dose low as poss. EP cleared it to 300 but I'm on 100 and will try to get to 75mg soon.
I'd not take Bisoprolol at all, but for the way it works with Flec. The EP reminds me "not to forget it"! But as with the Flec I'm pretty much left to figure out my best dose. I'll reduce the Bisoprolol and see how things go.
I recorded my HR finger on pulse looking at a stopwatch. At the moment it's morning, I'm sitting down but have been doing things, and it's around 50. I'll check again after two days on lower Bisoprolol.
Lifestyle changes are really the key with me in terms of avoiding Afib. Basically, if I behave myself with sleep, diet, etc., I need less medication. But two triggers, cold air an d stress, are hard to avoid.
I often wondered if my nighttime Afib, the dreaded 4am wake up with it, was related to my naturally low pulse. Flecainide has all but completely stopped those episodes.
You have a similar low HR and no symptoms. I wonder if that's just genetic. I take encouragement from the fact my grandfather and father had "tachycardia", definitely Afib in my dad's case. Sadly they never had the help of Flec etc. but both lived very long lives and died from unrelated causes.
As above I would get this checked out with your medic. 36 is very low and it may be worth asking your doctor if it's a good idea to lower your Bis to 1.25 mg.
If you find it hard to get through to your doc ring your pharmacist or 111 - I'm sure you will be fine but best play on the safe side.
Paul
Edit - I would also talk to your doctor about having a pacemaker fitted. This would prevent your HR from falling too low.
Yes, I will make an appointment. I'm fortunate to have easy access and fast access to an excellent doc and she'll just contact the EP there and then. I usually get a phone appointment in a day from cardiology and can go in if need be. (SNHS Edinburgh).
I will lower the Bisoprolol, you're right. Perhaps the ratio of Flec (which I've cut down on a bit as heart calm atm) and Bisoprolol is out. I don't take high doses despite being a big guy and active.
Before I started Flec I was getting more and more Afib (say, up to 5 days) but it was in the background mostly. I walked to the hospital in Afib (5 miles) no problem for example. But on Flecainide and Bisoprolol, although I get far, far less Afib (no longer at night, just occasional breakthrough episodes, always from known triggers usually in combination), I cannot exercise in Afib. If I do, it'll go into SVT.
So, it's all a balancing act!
A friend in her 40s with no cardio history had a cardiac arrest just before last Christmas. She lives in the Hebrides. Thanks to a very nearby Defib Station she was saved and had a pacemaker fitter a few hours later in Inverness after a helicopter trip. She's absolutely fine now and was back at work in days (to my horror!). So, that's encouraging if it needs to be that route.
Great news about your doctor being on the ball - many are not! I would check with your medic first before cutting/stopping the Bisoprolol. I tried a little 'self-medication' myself in the past which which caused flutter IMO. Not a good idea! (flec was involved).
We can no longer post links on the forum without admin's permission!!! However, Google how to tell the difference between flutter and afib and all the answers to your question are on the first page 😉
I think 200mgs Flecainide reduced my HR a tad down from 60ish to 55ish.
I recently had a 48hr monitor and my heart rate at night dropped to 36 at one point.
I was fit at 60 doing lots of excise and had Lone AF and my cardiologist gave me just Flecainide at a higher dose of 200mgs (medium level), no Biso as he said it would make me feel unwell by which I assumed he meant sluggish. This approach is unusual but it worked brilliantly for me for 10 years.
Hi there G, good luck with trying to figure out all this stuff. I’m permanent AF taking Bisoprolol (3.5) and Rivaroxaban (20) and whilst I’m existing, life’s not fun. HB is steady but sweating and breathlessness is frustrating despite thinking that the Cardio’s have it all under control. My recent cardioversion failed 3 shocks despite my being told in 2020 that it wouldn’t/couldn’t work for me and then this year it might. I am now resigned to taking each day as it comes and keeping active. Sorry not to offer a silver bullet - (as Clint Eastwood proclaimed) they can be even more dangerous 😃
Sorry to hear things are a bit of a struggle but very impressive to hear you're active and yes, for sure, a day at a time is the way to go when it's tough!
I really don't like the effect of Bisoprolol at all. However it does seem to tame the Flecainide side effects. So I really try to make as many lifestyle changes so I can take as little Flec as possible.
On that point, I have to say I've improved my health a whole lot my making those changes. I think had I not, the Afib would have taken over.
It's low at rest (always was) and doesn't go much over 120/130 during real exercise. (I'm 65 and fairly fit.)
Even in normal Afib it's not a rate issue with me, mostly - but Flecainide can occasionally trigger SVT and that's another thing altogether and not in a good way! I saw 200 on the HR monitor once so didn't look again!
I have a smart watch and can see it fluctuate during a walk, for example.
I was on Flecainide for a few years and it work out but they took me off because when I had a heart test around my heart I had some fatty tissue and I never took Bisoprolol!
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Flecainide and PAF
Atrial flutter
