JRBTucson
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JRBTucson, April 26,  2021  6:09pm EST

New to Support Group -- Diagnosis Bradycardia & AFIB

Hello Everyone. My name is John and I have recently joined the AHA Support Network – profoundly grateful to find all the great information and support available. I am 76 years old and had always thought I was blessed with a strong cardiovascular system. That impression lasted till November 2018, when I had a blood clot and resulting pulmonary embolism. This condition was resolved over the next few months, but my physicians were never able to pinpoint what caused the DVT – other than maybe a genetic predisposition for blood clots. As a result, I was told I will likely be taking Xarelto for the rest of my life. I did buy an Apple Watch for myself at Christmas and did go a little crazy taking EKG readings but found nothing alarming. A follow up 12 lead EKGs and a treadmill EKG found no evidence of AFIB. An Echocardiogram did indicate a slightly heart valve that the cardiologist said was not a concern and they would do a follow up Echo in a year.

In January of 2021, I got the results of the Echo and my cardiologist said the results were good and probably slightly better than last time and he was ready to send me on my way. Before leaving I took the time to cover my concerns about having my blood pressure running higher and very erratic. Also, I was getting AFIB readings on my Apple Watch nearly every day – after having only 2 or 3 AFIB readings in nearly two years. This really developed over the last quarter of 2020. After showing him the documentation history of my BP reading and Apple Watch EKGs, he thought I was probably fine, as I had none of the typical symptoms, but he decided to order a 48 Hour Holter Monitor. We reviewed the results in Mid-February, and I was diagnosed with Bradycardia and paroxysmal (intermittent) AFIB. My cardiologist said the next step would be to go on a blood thinner and possibly a statin, but since my *** had already done that, the next step would be an inserting a pacemaker. I was a little taken aback that I was good a few weeks ago and now I needed a pacemaker. I asked about medications or other less invasive procedures and his response was that “my electrical system is just wearing out and needs a little help”. He may be totally correct, but I was perturbed at such a quick diagnosis with little investigation or determining if there was something else triggering the AFIB. After expressing my thoughts, my cardiologist said we could wait and have a follow up visit in 6 months. So, I am taking this time to monitor my BP, AFIB and possible symptoms – also to learn as much as possible about my condition. I appreciate the opportunity to be a part of this community and learn how others are managing their conditions. Hope I can contribute some useful information or be of help.

9 Replies
  • AHAModerator
    AHAModerator, April 27,  2021  8:34am EST

    Hello John,

    Thank you so much for sharing your experience with the MyAFibExperience community. We are happy you are here and sorry you are going through all of this. We hope you find a sense of community and support here as you continue through this journey and monitor your BP. As you wait to hear from others, I can share some resources on Bradycardia, AFib, and Staying Motivated.  

    I encourage you to continue interacting with others in this community and please keep us updated on how you are doing! 

    Best wishes,

    AHA Moderator

  • Thumper2
    Thumper2, April 28,  2021  10:10am EST

    JRBTucson, welcome to the AFib group (though we're always sorry to hear you have AFib)!  THanks for the detailed description of your condition.  My first question is: are you seeing an electrophysiologist (EP)?  They are cardiologists who specialize in treating AFib and are usually more up-to-date in treating it than are general cardiologists. I urge you to see an EP to discuss the questions you have, especially since it sounds like you were the one who picked up on your AFib symptoms.  Whether or not you need a pacemaker is something to ask an EP (my husband and I both have them-- they are not a bother).  But I urge you not to just "wait and see" about treatments for AFib.  I did that for some years, under the care of a cardiologist, and I had no particular symptoms -- but in the meantime my heart was quietly deteriorating and badly needed treatment by an EP (long story).   Please ask for a "second opinion" by an EP, and let us know how things are going!

    Thumper2 (Judy)

  • Larkspur
    Larkspur, April 29,  2021  12:44pm EST

    Yes, John, 

    I second that--please see an electrophysiologist. From what you've described, the advice you are getting is not optimal. Most EPs would take steps to stop your Afib as "Afib begets Afib" and is usually progressive if left unchecked and can become permanent. How low is your bradycardia and does it happen only in association with Afib or on a daily basis? Many of us have moved from a general cardiologist to an EP and experienced a very different treatment protocol--one that works!

  • JRBTucson
    JRBTucson, May 1,  2021  5:19pm EST

    My thanks to both Thumper2 and Larkspur for your thoughtful comments. You have caused me re-think my whole approach to managing my condition. I track my AFIB daily with my Apple Watch and try to find any patterns that could indicate what triggers it. I find AFIB on about half the days and no real pattern except I am more likely to have AFIB in the early morning and rarely from the afternoon on. The Health app on my iPhone (data from Apple Watch) show my HR range from 40 -- 140 and my resting range from 41 -- 52. Measuring throughtout the day, I am between 48 -- 60. I have a High and Low HR notication on my Apple Watch set to 100 and 50  -- have to be above or below this level for 10 minutes to give a notifcation. The 100 bpm notifcation has not happened yet. I get the Low Notifcation about 1 or 2 times per day -- usually about 48 - 50. I had the Low notication set at 45 bpm and it never registered. Maybe because I do not have any noticable symptoms, I am being too casual l with my approach -- sel-monitoring and lifestyle changes. I did give up wine for two weeks and did see a "little" improvement -- maybe wishful thinking. I was only having about one drink a day (7 - 8 oz), but is was "everyday". Going forward I will limit the wine to truly one glass and then just 2 or 3 times a week. Sadly, it is clear my lifestyle improvements are not going to make my AFIB go away.  Rather than continue collecting data prior to my next cardiologist visit in 3 or 4 months, I going to ask my *** to refer me to a Electrophysiologist  to see if I can better manage my condition. Again, I so much appreciate both of your comments and am greatful for your caring help. 

    John

  • MellanieSAF
    MellanieSAF, May 2,  2021  11:01am EST

    John,

    As everyone has recommended, seeing an electrophysiologist is necessary - they are the "electricians" of the heart whereas a general cardiologist is a "plumber." A cardiologist may be making recommendations that an EP would not make, so you need a specialist in afib and bradycardia.

    Pacemakers are generally used for bradycardia instead of afib (some exceptions), though since it appears you are not going below 45, it is worth discussing whether your bradycardia is really severe enough for a pacemaker.

    Did the cardiologist explain why the pacemaker for afib was being considered (the electrical system wearing out is not a medical term, and an electrician should be making such a judgement, not a plumber)? Was it to do an AV node ablation (also called ablate and pace)? That is often a procedure of last resort and there are other things that can often be done first.

    Mellanie 

  • Larkspur
    Larkspur, May 2,  2021  1:19pm EST

    John,

    "Rather than continue collecting data prior to my next cardiologist visit in 3 or 4 months, I going to ask my *** to refer me to a Electrophysiologist  to see if I can better manage my condition."
     

    It looks like you are in the US so probably on Medicare: If so, you don't need a referral to see an electrophysiologist--just ask for recommendations here or locally and make an appointment. I did this and my whole treatment plan was changed. Once Afib "settles in" there may be no identifiable patterns or triggers and you outcome will be better if  you get on an appropriate treatment plan pronto.

    45 is not all that low for your HR. An EP might prescribe a treadmill test to see if you can reach your target HR range with exercise. I was not able to (chronotropic incompetence) and that finding made my EP evaluate me for a Pacemker.

  • JRBTucson
    JRBTucson, May 2,  2021  2:11pm EST

    Mellanie, Larkspur;

    Thank you both for your helpful feedback. Without further ado, I am going in search of a good "electrician". So appreciate your caring concern.

    John

  • Patio7
    Patio7, May 2,  2021  4:03pm EST

    Hi John,  I developed afib and aflutter in the fall of 2017 and also had similar bradycardia. Controling my afib became an increasing issue and my hr tended to go very high (tachycardia) during episodes. Though my heart tests all showed no problems life became difficult and eventually my EP made it clear the meds that were needed to keep my heart from going too high were risky with my bradycardia. In other words treating my high heart rate during an episode might take me too low. The simple answer was a pacemaker; a thought that alarmed me! My heart was strong I had been told!  However I had the pacemaker inserted January 2020 and it was a simple procedure and I have never regretted it. My rhythm medication works better and I have felt much more in control.  And BTW I was 77 when diagnosed in 2017.  Good luck. Don't stress. Pat

    PS  off to play golf.  Life is good.😎

     

  • JudyKol
    JudyKol, May 3,  2021  8:17am EST

    Hi John,

    I also saw a cardiologist who suggested a pacemaker for my AFib. My average resting HR was in high 30s.
     

    I tried to find my triggers for AFib, nothing made a difference. Even though I cut out all alcohol, gluten, dairy, caffeine....

     I went to see an EP and he strongly suggested an ablation before a pacemaker.

    I had the procedure January 2021 and so far so good. My resting HR is now in low 40s, I understand it's not uncommon to have a higher resting HR following the procedure.

     

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