2nd AF episode - has reverted -? ongoing meds

[Kcbhf]

Had an episode of AF 3 months ago.Treated in hospital & reverted within 36h -back to normal SR but quite slow in 40's & even dropped to 38. Was on bisoprolol then that was stopped once reverted. They were a bit worried about tachy - Brady /sick sinus problem but HR back to 50s once bisoprolol out of system. 2nd bout of AF this week - started on bisoprolol (as pip) as was told to use if happened again. Saw consultant who prescribed bisoprolol 1.25 , flecainide 50mh bid & apixaban.

Reverted again at about 50 odd hours & back to SR of 45-50. Didn't take flecainide that night as was worried about HR dropping further. Will try & speak to consultant but a bit worried re HR on all drugs in case go bradycardic again. Once AF has resolved is it normal to stay on beta blockers/flecainide etc

[Buzby62]

I would say yes, the majority take meds daily and a minority use the PIP method if suitable or for a medical reason. When I was on a small dose of bisoprolol my resting HR was regularly below 45 between episodes in NSR with the occasional 39 at lowest. They said it was ok as long as I felt ok with it. Bradycardia is technically below 60bpm and is normal for some people. Post ablation and stopping the meds my resting HR is usually above 60 now and I believe I feel better for it. I never took flecainide. I keep an update on my bio if interested.

There’s info sheets on all the meds in the patient resources here heartrhythmalliance.org/afa...

Best wishes

[Kcbhf in reply to Buzby62]

That’s really interesting. Hospital seemed to get in a tizzy about HR of 40 but think was a general ward & were more relaxed in cardiology unit.

Also interesting to read your bio AF history - definitely gives a good picture.

[Buzby62 in reply to Kcbhf]

It’s an electrophysiologist you need to have a consultation with or EP as referred to on here. That’s a cardiologist that specialises in arrhythmias or to put another way, the electricians of the heart not the plumbers. It’s all in the info sheets on the link in my previous reply. Start with the AF Fact File. The more you learn the better you will manage the condition.

Best wishes

[30912]

From personal experience, I can say that taking my AF meds regularly does help. I used to take Bisoprolol as PIP at onset of Afib but this did nothing to prevent another bout days later. I'm now on a twice daily dose (320mg total) of Sotalol. At this dose, it took me out of pretty persistent tachycardia that I had for weeks. Over the next two weeks, I had two bouts of self-converting AF lasting less than 20 hours. Roll forward another 3 weeks and I've been AF free. (Fingers crossed). Bliss.

I now have a slower HR of high 40s pushing up to a maximum of 64 when out walking (it won't go above that). I am more than happy with that and feel so much better for it.

So my opinion is that it may take a couple of weeks for your body to settle into the meds.

Wishing you well.

[mhoam]

Hi Kcbhf as you may know Bisprolol is a Beta Blocker that reduces Heart rate. Flecainide however is a drug that controls the irregularity of the heart beat. It doesn't reduce the rate.

Many people on this forum take Bisoprolol alongside Flecainide to manage their AF. Some need to take them on a daily basis, others as a PiP as and when required.

Good Luck

[dexter8479]

I've taken Flec/Biso/Apixaban daily since 2017. Biso at 1.25 once daily. My resting HR is in the low 40s, my iwatch occasionally records a 38 or 39 during sleep. It's the Biso that lowers the HR, not Flec. B is often prescribed for hand tremors, and sports people who use their hands took it (although I think it's banned now), most famously snooker players. Super fit athletes often have HRs in the 30s. I used to worry a little about it until I saw my electrophysiologist, who was very relaxed about it, and said it was absolutely fine. It will always cause some consternation in medical departments outwith cardiology, they aren't trained/knowledgeable enough to know much about AFib and they only use the "norms" which we don't fit into - one medic I met in A and E (not regarding AFib) kept saying with "Proximal" AFib blah blah (and what he was saying really was a load of blah) We all really need EPs in our lives!