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In and out of Afib with long pauses
Hello! I am new to the cardiac/AFib world. I was recently diagnosed with my heart going in and out of AFib while having long pauses and bradycardia. My cardiologist said he is unable to treat the AFib with medication due to my resting HR normally in the 40’s and sometimes as low as the 30’s. (I do have sporatic dips throughout the day as well) My average awake HR is 60-70, I am scheduled for a sleep study next week to rule out apnea. If the low rate is not due to apnea we will discuss PM/Def. Has anyone corrected their bradycardia with getting apnea treated? Also, what medications have you used for AFib if your HR is on the lower side?
Heartfe6878, March 8, 2019 9:40pm EST
I guess I would ask why your heart rate is so low normally? Have you had this worked up....Do you have symptoms from this?
muddynwv, March 8, 2019 10:00pm EST
I am not sure what the low HR is attributed to other than I do walk several miles a day. I can have symptoms from the low heart rate at times, headache, dizziness but feel more of the AFib symptoms. (Chest flutters, racing, dizziness) I just recently finished the 30 day monitor so we are just now in the process of elimination I guess. I have a consult for the sleep study next week
Gene157, March 9, 2019 1:55am EST
Interesting, this is about my situation. I am in and out of AF, but the sinus periods are getting shorter, from years in between when this started 15 years ago at age 71, to months now. I was just in AF for app 14 hrs, that stopped when I went back to sinus a couple of hours ago, but with a bang, from 95 bpm to a full stop for 5 sec. then a single pulse and an other stop for 3 sec. After that in sinus at 45 to 75 bpm all recorded on my own Holter. When sleeping my HR has been as low as 38 bpm but more likely between 45 to 75 bpm. This low HR has been going on for a long time partly aggrevated by 80mg Sotalol twice a day. Did have an ablation in July of 17, that helped but did not fix it.
My mitral valve was replaced with a tissue valve late last year, scar tissue from the ablation may have caused that. The LAA was closed and a Maze was performed at the same time.
A few month ago 225 mg Propafenone was added, 2 ea pd when in sinus and 3 pd when in AF. The combination seems very effective, but only time will tell .Plus Potassium, Magnesium, Acetyl L-Carnitine, CoQ10, I feel that these help but do research on that, be careful with anecdotal stuff like this post.
In the beginning I wore Holters on and off with nothing ever happening. So app 6 years ago I bought a made in China Holter for app $250 and was then able to get proper medical attention when presenting the print outs to the doctors. They just love that plus the knowledge I gained from the likes of Cleveland Clinic, Doctor MD etc. BTW my ejection fraction was 55 to 60 when tested when tested 5 month ago and my heart is not enlarged.
I had a bypass of my lower left descending artery that was blocked 90% 36 years ago that closed about 2 years ago, per angiogram. My heart must have build some collaterals during the 36 years since I do fine on stress tests. The human body is just amazing!!
we all picked a good century to live in.
After reading this I feel I went overboard.
TR, March 9, 2019 5:11am EST
Your cardiologist or EP would certainly be the one to try and figure this out, but here's some info on low heartrate.
Rogochef, March 9, 2019 10:16am EST
Your situation somewhat mirrors mine. Last April my fun and games with Afib began. I have had a long history of bradycardia and a 3 plus year hx of irregular HB with no adverse issues. In March/ April I had some shortness of breath and during my regular 6 month check-up was dx'ed with Afib. The cardiologist immediately put me on Eliquis (blood thinner) to help avoid stroke and multaq to Rx the Afib. He also prescribed a sleep study and we discussed a pacemaker implant. Two sleep sessions confiremed complex sleep apnea which is both obstructive and central apnea and I was put on permanent ASV (adaptive servo ventilator) therapy. CPAP is for basic obstructive apnea and ASV for complex. This, however, does nothing for afib except perhaps keep it from getting worse. I was given a heart monitor to wear for a month to record afib episodes, but had no real reportable symptoms. Next I got the pacemaker to correct the HB issue along with prescription for Metoprolol. The PM implant was not totally successful as the one lead dislodged and a revision had to be done. During that time i had considerable AFIB events. Turns out I had bradycardia with partial AV block thus necessitating a dual chamber Pacemaker. The pacemaker, however, according to the cardiologist and the EP does not "cure" Afib. I am 78 and thankful these issues did not afflict me earlier. Now, I am heart "paced" which is good and the ASV therapy is addressing the sleep apnea. To digress, shortly after I began the Eliquis and Multaq I experienced side effects of some light headedness and general malaise and was taken off multaq. All of this took place during April thru mid August. Fast forward to mid January of this year when i had a near fainting spell, went to the ER and spent the night for observation. Next morning Medtronics tested the PM ; no afib events recorded. I was released with no explanation as to why I experienced the syncope. Next, my cardiologist referred me to and EP for ablation consultation. There to my surprise, I learned that the medtronics PM device had not recorded any afib events since last August when I had the PM revision! The EP was surprised to hear that I had a cessation of afib events even without Multaq: ergo, no ablation needed at this time. I did not feel most of my afib events, but a couple i did feel and one felt like a machine gun going off in my chest.
Now, I researched what foods/drinks might trigger afib and found that alcohol (definitely) and caffine (highly suspect) were mentioned as well as general other foods not considered heart healthy. Obesity and sedintary life style, also not heart healthy. I immediately cut caffine and reduced alcohol to just an occasional small glass of red wine. I have always shunned processed foods and sugared products and avoided all soft drinks save the basic flavored seltzer waters. I am working to get rid of 30 excess pounds and keeping up my exercise program. My diet is healthy, just need to reduce portion size. Neither my cardiologist nor my EP ever volunteered information on diet considerations and AFIB.
In sum: Please see an EP soon as he/she will be the expert in this area, much more so than your cardiologist. I suspect a blood thinner would be prescribed now to reduce the stroke possibility. My EP also suggested I take Vitamin D and B-12 as well as coQ-10. He also suggested a blood test for thyroid and I found I was hypo and now on Levothyroxine.
Last, I am so grateful that my afib experience is turning out to be so mild and wondering if my diet/lifestyle changes helped. Has anyone else had a similiar experience? I can't help but think that dietary considerations would be part of the Rx. Good luck.
jroers2109, March 9, 2019 10:49am EST
I have a long history of AFib, 1st one 2009, had a Cardioversion. Then in 2011 had 95% right artery blockage, stint put in. Then in 2015, low heart rate resulted in a pace maker. Since then have had numerous AFib's in 2017-18. In 2018 went in and out August-October. Was hospitalized 3 days to go on Sotalol at 120 mg. Then more short term AFib in Nov and Dec when my dosge was increased to 160 mg. Had 1 more AFib in early January, but now made it 2 months. Hoping the increased dosage does it now. Good part in recent years is the duration is 2-6 hours in AFib. Also, having the pace maker gives a record of exact times and duration of AFibs.
BTW, I wore a monitor to 2 weeks to record low heart rate, determined quickly needed a pace maker.
muddynwv, March 9, 2019 3:50pm EST
Thank you all so much! I am 43 and have been pretty healthy up to this point. Currently all blood work comes back looking great and I do not take daily medications. This has been a whirlwind over the past few months. I new I had bradycardia just due to my smart watch has always shown it. After the 30 day monitor and the diagnoses of AFib, stops, pauses and bradycardia I was in shock. This sight is the best out there and you all have so much information! I feel a little more comfortable talking to my doctor. ❤️
MellanieSAF, March 10, 2019 12:22pm EST
What medications are you on? Could medication be causing the low heart rate?
muddynwv, March 10, 2019 12:42pm EST
I have not been on any medications other than an occasional Tylenol or ibuprofen. Up until this new diagnoses, I have been pretty lucky. I went to the emergency room the first week of January for something completely unrelated and here I am waiting for the sleep study to see if it is causing the low HR so that I can be put on something to treat the AFIb.
MellanieSAF, March 10, 2019 12:46pm EST
Good to rule out meds as a possible cause. I hope the sleep study sheds some light on this.