Afib and slow heart rate.

[Johnmanc]

Hi.I'm a 59 year old man, I've recently been diagnosed, after an a&e admission, with an afib episode of 160 BPM. I've known, I've had an issue for at least 10 years but it finally came to a head.

So I've been given apixaban, ramipril and bisoprolol.

My main issue is a slow resting heart rate. Rarely above 50 BPM and sometimes as low as 38 BPM. I'm generally fit, walk 3 to 5 miles a day. Do kettle bells, stretching and band exercises, 4 to 6 times a week.

But the slow HR does seem to be the trigger. I can feel it getting slower, then a skip followed by a few rapid beats. It can repeat this every 10 seconds or maybe not for another 5 hours, just depends.

Yet my GP doesn't seem to be concerned about my slow HR, as long as it's not racing. But I feel, if my heart wasn't as slow, it wouldn't trigger any palpitations. I also wonder, should I still get regular palpitations now I'm on medication? To add the medication does seem to have prevented another prolonged fast afib episode.

Has anyone a similar scenario?

Many Thanks

John

[Oldforge73]

Hi John, I assume you were told the action of each drug. If you have under normal circumstances a low heart rate Bisoprolol will lower it further, but on the other hand when in Afib you appear to get a high heart rate so it should slow it down. It could be you need to stabilise on a low dose of Bisoprolol but get the ok from your GP to increase the dose when in Afib. I was getting Bradycardia on 5mg Bisoprolol and passed out, attended to in A&E who halved the dose, this was while on holiday, on my return my GP took this very seriously and halved the dose again but with the option of taking extra as needed. This could be a solution for you so run it past your GP. Beta blockers do not necessarily stop palpitations, indeed I found they gave me feelings I had never had before which I believe are called ectopics, probably because of my slow heart rate I notice them more, they may have been there all the time. I have been on Bisoprolol since 1st August 2023, I can describe it as a learning curve, initially bad then ok when on the right dose. Still get Afib once or twice a week but it is controlled by me as to the rate by taking extra Bisoprolol if needed, it terminates spontaneously on its own within 10 to 16 hrs, other than that I would not function well at all. Unfortunately we are given drugs on a one size fits all scenario, we then find out the hard way what suits us and must then be proactive in informing our GP of our concerns. After all it is our body and well being, not theirs.

Regards Kathleen

[Johnmanc in reply to Oldforge73]

Hi Kathleen. Thank you for your helpful reply.I think you're right, it is a learning curve and It's all a bit new at the moment.

I'm probably being more aware of things that are happening. I too, think I'm getting ectopics and need to feed back and discuss with my GP.

Thanks again.

John.

[Oldforge73 in reply to Johnmanc]

In six months I have learnt so much on how to handle this annoying condition and what powerful drugs can do against me and for me. To be honest I don't think the average Dr has a clue what it feels like to take a Beta-blocker, so it is up to us to inform them and keep on informing them until we are happy with our treatment. I was extremely lucky when I passed out on a hard kitchen floor to sustain no injury and on anti-coagulents, so my faith in the medical profession was diminished. I will never again take any drug in blind faith thinking they know what they are doing as they clearly don't. It can take a few months for your heart to adjust to Bisoprolol, when it does you may find your ectopics become less frequent. Also look into taking Magnesium Taurate or Glycinate along with COQ10. You may find it helpful watching on You Tube Dr Sanjay Gupta a UK based consultant cardiologist from whom I have learnt so much on this condition, watch the one on Magnesium and Ectopics. Very reassuring to be armed with knowledge as you will probably not get much info from your GP. I have also found this forum has educated me so much, its all about self help and we get it from here. Do post how your Afib journey progresses, be reassured it will get better as time goes on.

Regards Kathleen

[AAJJTt]

Hi,

Similar. Prior to my formal Afib diagnosis and treatment - ectopics were always the harbingers of an AF episode.

I was a healthy and active person until I had a heart attack (nstemi type2) suspected root cause - undiagnosed and untreated atrial fibrillation. Angiogram with no interventions, discharged with medication and exercise.

For me, this is nearly 5 years ago, my arrhythmia is now well controlled by some low dose anti rhythm control medication (Flecainide) and I have been ‘Afib free’ for 3.5+ years. Post heart attack, I was also left with slight left ventricle dysfunction but this has gone and my heart is ‘structurally normal’ again.

I was on Bisoprolol and Edoxaban for a few years too but these have been removed, as I don’t really need them. The former was removed as my HR was just dropping off too far and I was tired/fatigued. The latter was initially a precaution but since I am stable and under the threshold for anti-coagulation it was ok to withdraw.

Despite my Afib being well controlled with medication, ectopics did initially trouble me. I suffered badly from these, they drove me ‘mad’, robbing me of rest. The catalyst was anxiety. I eventually turned to a course of cognitive behaviour therapy and for a period, an evening sedative. This worked for me, it broke the cycle and it all settled down. I am now much more relaxed about it all and can control my emotional response to the cycles of my heart. Still have ectopics but no Afib and no stressing.

I do have a low HR too, usually mid 50s at rest, dropping lower in the evenings - cardiologist not concerned. I think this is a combination of fitness and maybe genetics. I am not 100% sure how it all hangs together. My cardiologist did say then when your HR is low, it’s got more time to throw in ectopics.

Anyway at the moment, the treatment has been working. I can live my live with no real limitations

That said, it’s all about to change. It’s a bit of an experiment but the rhythm control meditation (Flecainide) is going to be tapered off to see if I can maintain NSR without it with a PiP backup plan. Afib is a complex condition, some factors may have changed, so let’s see. Admittedly there’s a bit of trepidation but I will give it a go. If it doesn’t work out, I can go back on the meds. No harm in trying.

As you will see from this forum and others like it, everyone’s experience is different and one approach/solution doesn’t fit everyone. Work with your doctor and cardiologist to find a way forward for you.

Best - male, 57, UK

[Johnmanc in reply to AAJJTt]

Thanks for your reply. Ectopics seem to be the issue for me ATM.

[Rnfrds10]

hey, in February last year I got palpitations on the back of the bus heartrate going crazy. Got more palpitations and then my Apple Watch was telling me I was in afib. Went to cardiologist done a stress mri, it was clear, done echo it was clear, had a 2 week holter monitor and that was clear, still I was getting afib where my heart rate was over 100 cut to October I went a&e and they finally caught the afib went and had a angiogram no blockages but they changed my blood press medication from ramipril, and Indapamide to amlopadine and 2.5 mg bisoprolol. When I first started taking like you I got/felt these eptopic beats but they eventually subsided.my resting heartrate now is around 55 I take comfort in that when I get an afib attack it stays below 100. I am male 53 and normally very active and now on rivaroxaban as I have high blood pressure so at a low risk of stoke.

[Johnmanc in reply to Rnfrds10]

Thanks for your reply. It's good to hear the ectopics have calmed down.

[Blimeyohriley]

I have bradycardia with a naturally slow heart rate of around 50bpm dropping to 38 at night. Initially diagnosed with Afib in 2020 and prescribed low dose of bisoprolol after first presenting at A&E where I was diagnosed. A few more visits to A&E saw the bisoprolol prescription dose increase each time but I started to object as I noticed my Afib burden increased as my heart rate reduced. I was later given Flecainide as a pip by the cardiologist but didn’t think it worked. To cut a long story short, my heart rate remained around 41bpm on bisoprolol but I didn’t feel ill effects from it, just an increase in my Afib episodes. Because I didn’t have any ill effects from the low heart rate no one seemed concerned. However, I felt quite sure my episodes were increasing due to my even lower heart rate. I saw an electrophysiologist (EP) for the first time last year after wearing a holter monitor for 7 days. He said I was quite correct that my low heart rate was increasing my Afib episodes. Apparently it gives the rouge beats more opportunity to take over. He changed my meds to soltalol to see how it went. I used to get very symptomatic Afib approx every 3 weeks for about 12 hours+. On soltalol (so far) I’ve had one episode in 6 months (still very symptomatic). Having said that, I was also prescribed a medication for an unrelated issue that increased my heart rate to around 58bpm. My EP said this was also helping reduce my Afib episodes. So probably the combination of both meds is helping. I’m waiting for my next appointment with him to discuss. He said if soltalol didn’t work then we’d discuss ablation. So far I’m happy to stay on soltalol but I’m anxious the effects will wear off in time. Just my own experience but hopefully it helps.

[Johnmanc in reply to Blimeyohriley]

Thanks for your reply. It seems balancing the right meds is key to controlling things.

[bee2]

I'm having the same issues but not on any beta blockers. Heart rate drops to 32bpm now when having palpitations...

[Johnmanc in reply to bee2]

Yet, my GP doesn't seem to think it's a problem 🤷

[bee2 in reply to Johnmanc]

I went to see a private cardiologist last week who also thinks it's a problem 🥴 the NHS is gone I think

[Survivor1952]

No AFIB here other than immediately after my OHS.

My RHR is in the mid to high 50's. I'm on 1.25mg Bisoprolol at present. My BP is a little high and doctors wanted to increase my Bisoprolol dose but, as soon as they knew my RHR, they said they couldn't and went for a calcium channel blocker instead.

I'd talk to your doctor about your Bisoprolol dose if I were you.

[Johnmanc in reply to Survivor1952]

Thanks for your reply. I'm in 2.5 mg bisoprolol, which even that is probably too high for me.

[MWIC]

keep a close eye on your HR if you’ve started Bisoprolol - My resting HR is mid 50’s and that’s great for me but went down to 40’s on 2.5mg Bisoprolol and that was not Ok as felt like a complete zombie

[Johnmanc in reply to MWIC]

Thanks for your reply. Yes, I'm on 2.5, I think much too high for my resting HR.

[Deerhoundlover]

Slow heart rate, bradycardia; you should contact your GP or consultant.

[Johnmanc in reply to Deerhoundlover]

Thanks for your reply. I'm back at my GP, for a follow up in a couple weeks. I'll have to be more direct about my HR.

[andreasuperstar]

I’ve just contacted my cardiologist today as my hr swings between very low ( 39 and 130 plus ) at rest . I’m on 1.25 bisoprolol the lowest dose and I’ve started to only take it when hr is a bit higher . I’m getting a loop recorder in next week . Maybe your meds need reviewing asap

[Johnmanc in reply to andreasuperstar]

Thanks for your reply. Yes, I agree my meds do need looking at.

[dhep]

Hi I personally did still have the Palpitations and the rest of the problems and may extra, with these tablets I could not cope with the side effects so only on warfarin now, before my Ablation my HR would drop to early 30s and 190 high the Ablation hasn't worked other than my HR doesn't go below 40 bpm.