How to lower beats per minute during AFIB

When I have afib, which could last up to 3 days, my pulse is often between 150 and 160 bpm. (According to my 6-lead Kardia.) Is there any techniques you've used to lower your beats per minute? And is such a high bpm dangerous? I'm in my mid-40s and have no other health issues.



Edited 1 time(s). Last edit at 01/18/2020 03:06PM by cirenepurzalot.

There are no "techniques." The answer is rate control drugs, which are usually beta blockers (eg, metoprolol) or calcium channel blockers (eg, diltiazem). Do you have a prescription for any type of rate control drug? There are also rhythm control drugs that might prevent these episodes entirely. Are you seeing an EP?

The fast rate isn't immediately dangerous, but you don't want to spend too much time in a rhythm like that. It will lead to remodeling, atrial enlargement, and longer, more frequent afib episodes and eventually persistent afib. And if you spend quite a bit of time in a rate like that, it can lead to heart failure.

A rate that's consistently between 150 and 160 could be atrial flutter instead of afib. Are you sure it's afib? Got a Kardia or other recording of it?

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cirenepurzalot
When I have afib, which could last up to 3 days, my pulse is often between 150 and 160 bpm. Is there any techniques you've used to lower your beats per minute? And is such a high bpm dangerous? I'm in my mid-40s and have no other health issues.

Generally beta-blockers or calcium channel blocker meds are used for rate control. Rates over 100 BPM are considered high and can lead to ventricular enlargement and ultimately a lower ejection fraction (EF). I don't know what the time frame is for the lower EF to happen. If for an extended period of time, can be very serious (leading to what is considered heart failure). Had a lawyer in his 40's who had to go on disability because of this. It was certainly longer than 3 days. You might look into something like on demand (or PIP - pill in pocket) flecainide for a relatively quick conversion. In my case, usually an hour or two. A standard protocol is to give someone a beta blocker when afib starts, then give the flec after 30 minutes or an hour. The beta blocker is a relatively low dose, like 25 mg and the flec can be either 100 mg each hour up (don't take the next 100 mg if you convert) to a max or a loading dose in the beginning. The max flec dose is 200 mg for those under 70 Kg (154#s) and 300 mg for those over.

At the very least, I'd get an on demand rate control med to drop your HR down <100 while you are in afib. No need to take it all the time. Recently got a script exactly what I suggested above for my 32 year old son-in-law. He's had afib for 4 years, but the episodes mostly convert on their own in a short (1 hour) period, though the rate is high. He used his first flec dose a couple of weeks ago and converted after the first 100 mg.

George

Good the hear George that your son-in-law did so well with his first PIP Flec dose of only 100mg!

Was very nice speaking with him (and you too, of course) on the phone last month and it is good to hear that he's getting the support he needs from his Military EP.

Please give him my best wishes,
Cheers!
Shannon

Thanks for the feedback. Very informative!

Yes, I have Kardia (6 lead). Those readings say 150-160, but if I take my own pulse I only count around 100 bpm (counted for 15 seconds.)

Yeah, my cardiologist prescribed me 25mg of metropolol, but I was scared of dependency or side effects. I also didn't know if it was safe/effective to start and stop it as needed, like a PIP. So, I went to see an EP. I really wanted a pill in the pocket and heard positive things about flecainide, but, for some reason, my EP, who I only saw once, didn't want to give it to me. Instead he wanted me to take Multaq 400mg, along with metropolol. But Multaq was like $600 per month! Not sure why he was so hesitant to give me flecainide.

So I'm trying to get to the root cause of this and am on several supplements.(CoQ10, Magnesium Potassium, nattokinase, Vit D + K, etc.) I really want to avoid meds if possible because I'm only in my mid-40's with no other health issues.

So frustrated....



Edited 1 time(s). Last edit at 01/18/2020 03:03PM by cirenepurzalot.

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Carey
There are no "techniques." The answer is rate control drugs, which are usually beta blockers (eg, metoprolol) or calcium channel blockers (eg, diltiazem). Do you have a prescription for any type of rate control drug? There are also rhythm control drugs that might prevent these episodes entirely. Are you seeing an EP?

So interesting...I am taking Natale’s advice for now (I have yet to ask which beta blocker he will prescribe) but my regular EP heard my freak show pvcs during a recent visit and I think he wanted me on either of the two above drugs. Which is the one usually not prescribed if one has asthma? He gave the name and then asked if I have asthma and when I said I have a nebulizer he said forget it and said to go back on Tenormin.

I’m at the airport waiting to return home and the plan is to stop the multaq once I land. I will probably need to be back on a beta blocker. Since 1987 I’ve been on Tenormin (atenolol) but stopped during multaq. I’m curious which one I will be on. I didn’t ask natale in December. I wonder if there is one better suited for high burden pvcs ?

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cirenepurzalot
Yes, I have Kardia (6 lead). Those readings say 150-160, but if I take my own pulse I only count around 100 bpm (counted for 15 seconds.)

Can be hard to count manually as the pulse wave amplitude varies and can be small enough that you miss those beats.

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Yeah, my cardiologist prescribed me 25mg of metropolol, but I was scared of dependency or side effects. I also didn't know if it was safe/effective to start and stop it as needed, like a PIP. So, I went to see an EP. I really wanted a pill in the pocket and heard positive things about flecainide, but, for some reason, my EP, who I only saw once, didn't want to give it to me. Instead he wanted me to take Multaq 400mg, along with metropolol. But Multaq was like $600 per month! Not sure why he was so hesitant to give me flecainide.

My understanding is it is OK to start and stop metropolol, ending after the episode. This is my son-in-law's script. Flec is a no-joke drug and some guys don't want to prescribe it. If you have a healthy heart, it has been shown to be a very useful tool. In my opinion, no sense taking a med all the time when you are only out of rhythm occasionally. However, very useful for those occasions, as can shorten the episodes dramatically. 15.5 years ago, I had episodes that converted on their own in 6-9 hours, that lasted for two months. Then I had an episode that lasted 2.5 months and I converted with 300 mg flec. I've pretty much converted almost every episode since (that I couldn't convert very quickly with exercise) with flec. Because of the electrolytes and other things I do, I don't have to use it frequently. I've had two doses in the last 21 months, with the most recent being 9 months ago. My philosophy has been to absolutely try to keep my time out of NSR as short as possible, to minimize remodeling. Have a local friend that had to try several EP's before he found one who would prescribe flec on demand. Fortunately my son-in-law's military cardio was on board with this approach.

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So I'm trying to get to the root cause of this and am on several supplements.(CoQ10, Magnesium Potassium, nattokinase, Vit D + K, etc.) I really want to avoid meds if possible because I'm only in my mid-40's with no other health issues.

Root cause is hard to come by. My remission approach with a) calculated exercise intensity and volume, b) electrolytes including magnesium to bowel tolerance, 4 g potassium as citrate consumed over the day in water, 2-4 g taurine powder and minimizing calcium is not "root cause" but as close as I have been able to get and effectively good enough as I've had zero progression in over 15 years.

GeorgeN, you post is full of great info! Thank you so much. And I'm glad you've enjoyed zero progression in over 15 years!

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cirenepurzalot
Yeah, my cardiologist prescribed me 25mg of metropolol, but I was scared of dependency or side effects. I also didn't know if it was safe/effective to start and stop it as needed, like a PIP.

Metoprolol is a giant “nothing burger”, especially in low doses. Don’t be afraid of it. It’s not habit forming, doesn’t require ramp-up or ramp-down, and you can easily use it PIP. The worst thing that happens is you’re still a little “blocked down” after you convert and might feel a little sluggish. It wears off quickly. 25mg is the lowest dose. It goes up to 250mg.

The risks of having a HR that high far outweigh the risks of side effects from a rate control Drug. I have had Heart Failure caused by too high a HR while in AFIB. It took over a year to recover. Long term use of these drugs may bring about the need to be tapered down on the dosage, but not with the short time frames you are dealing with.

Advice needed. As I have posted before, I am 2 weeks into my blanking period and have had a few bouts of arrhythmia the days after the ablation where my Dr. said to use Flecanide as needed - 100 mg. In the first four days post ablation I took one pill each day after some arrhythmia showed up each day and then converted, then 7 days with no issues. Early Sat. morning, another bout where the arrhythmia lasted for 19 hours where I took one Flec when it started and another 13 hours later, then back to normal about 6 hrs after.

Is there a better way to respond with the Flecanide to avoid the long period in arrhythmia?

Thanks wolfpack. "Nothing burger" lol. I appreciate your advice.

Also, thanks Anti-Fib for your insights as well.



Edited 1 time(s). Last edit at 01/19/2020 12:15PM by cirenepurzalot.

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Ken
Advice needed. As I have posted before, I am 2 weeks into my blanking period and have had a few bouts of arrhythmia the days after the ablation where my Dr. said to use Flecanide as needed - 100 mg. In the first four days post ablation I took one pill each day after some arrhythmia showed up each day and then converted, then 7 days with no issues. Early Sat. morning, another bout where the arrhythmia lasted for 19 hours where I took one Flec when it started and another 13 hours later, then back to normal about 6 hrs after.

Is there a better way to respond with the Flecanide to avoid the long period in arrhythmia?

Can you describe your arrhythmia a little better? Do you know how fast your HR was? Do you know if it was AFIB?

I would consider taking the flecainide twice daily for the first month or so instead of waiting for episodes to occur. A lot of EPs prescribe a daily antiarrhythmic for the first month or two following ablation just to keep the heart quiet and let it heal.

Agree with Carey. Check with you EP, but mine kept me on Flecainide for month post procedure for starters and is keeping me on it for another couple months as a precaution. This will cover the entire blanking period. The goal as I understand it is to avoid an afib episode during the blanking period in hopes that when i stop the meds, my heart will be properly "wired".

Good advice and I will check with my EP to follow up.

The Anti-Fib said:

"Can you describe your arrhythmia a little better? Do you know how fast your HR was? Do you know if it was AFIB?"

Since you asked this question, I haven't had any arrhythmia, but when it's present, the rate is probably under 100. My original afib without meds was up to 180, so I am not sure what I have been encountering.

However, I did get with my EP via his nurse about taking flecainide daily to prevent the arrhythmias rather than taking it as they occur, and he said to take it full time (every 12 hrs) for two months post ablation, so that's what I am now doing. No issues for the last 5 days.

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wolfpack

Yeah, my cardiologist prescribed me 25mg of metropolol, but I was scared of dependency or side effects. I also didn't know if it was safe/effective to start and stop it as needed, like a PIP.

Metoprolol is a giant “nothing burger”, especially in low doses. Don’t be afraid of it. It’s not habit forming, doesn’t require ramp-up or ramp-down, and you can easily use it PIP. The worst thing that happens is you’re still a little “blocked down” after you convert and might feel a little sluggish. It wears off quickly. 25mg is the lowest dose. It goes up to 250mg.

I take50mg Metoprolol once a day and 1/2 of Metoprolol TAR 25mg for breakthru afib if my bp systolic is greater than 100 and my heart rate is higher than 110bpm. My blood pressure has always been on the low side of normal my entire adult life. With this med it drops. For the last 4 days my heart rate has been between 103 to 118 bpm with blood pressure anywhere from 80/60 with 103bpm to 110/76 bpm118. With my blood pressure coming down this low would adding an ace inhibitor not make it down worse? What exactly is this flecanide that I read so much about?

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merri
I take50mg Metoprolol once a day and 1/2 of Metoprolol TAR 25mg for breakthru afib if my bp systolic is greater than 100 and my heart rate is higher than 110bpm. My blood pressure has always been on the low side of normal my entire adult life. With this med it drops. For the last 4 days my heart rate has been between 103 to 118 bpm with blood pressure anywhere from 80/60 with 103bpm to 110/76 bpm118. With my blood pressure coming down this low would adding an ace inhibitor not make it down worse? What exactly is this flecanide that I read so much about?

Why would you want to add an ACE inhibitor? Hypertension certainly isn't a problem for you and lowering it any more would be a really bad idea.

Flecainide is an antiarrhythmic. It can prevent and sometimes stop afib episodes. I don't know if the tachycardia you're experiencing is afib or something else but if it's afib then flecainide might be something to consider. What sort of doctor are you seeing?

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Carey

I take50mg Metoprolol once a day and 1/2 of Metoprolol TAR 25mg for breakthru afib if my bp systolic is greater than 100 and my heart rate is higher than 110bpm. My blood pressure has always been on the low side of normal my entire adult life. With this med it drops. For the last 4 days my heart rate has been between 103 to 118 bpm with blood pressure anywhere from 80/60 with 103bpm to 110/76 bpm118. With my blood pressure coming down this low would adding an ace inhibitor not make it down worse? What exactly is this flecanide that I read so much about?

Why would you want to add an ACE inhibitor? Hypertension certainly isn't a problem for you and lowering it any more would be a really bad idea.

Flecainide is an antiarrhythmic. It can prevent and sometimes stop afib episodes. I don't know if the tachycardia you're experiencing is afib or something else but if it's afib then flecainide might be something to consider. What sort of doctor are you seeing?

After my first cardioversion failed after 2 months my cardiologist suggested an ace inhibitor "might" elevate my Left ventricle ejection fraction. Before the cardio it was 30%, afterwards it went up to 42%, that's better but it should be at least 55%. After a 3day patch they said my heart rate was "all over the place" and then they talked about an anti arrhythmia drug, Tykosin. My dilemma remains that all of these drugs lower blood pressure, which has always been low anyway. During Nov, Dec and Part of January I was perfectly normal but the last 5 days I am constantly at a heart rate above 100 up to 118bpm. My doctors are at Cleve Clinic so I am very frustrated that I can't get an answer about the ongoing too low bp.

Oh, okay, an ACE inhibitor makes sense for the heart failure, but you're in a tough spot with the BP. You definitely don't want to go lower than 80/60.

Tikosyn isn't known for lowering BP. It's an antiarrhythmic and a fairly effective one at that. In order to start it you have to spend 3 days in the hospital being monitored. I wouldn't worry about the BP issue since you'll be in the hospital where they can monitor it.

But you haven't said what this rapid heart rate it. Is it normal rhythm, afib, or what? Since they're suggesting Tikosyn I'm guessing it's afib?

I have paroxysmal afib. The cardioversion brought it to normal rhythm for 2 months, then back to afib.

You asked about flecainide earlier, but flecainide is completely contraindicated for you. I hope nobody suggested giving it to you, and if they did get a second, third, fourth and fifth opinion before agreeing to it.

It sounds like Tikosyn would be a good choice for you. I wouldn't be afraid of trying it. And if you do try it, give it time. When I was put on it people told me it became more effective the longer you took it, and I found that to definitely be true. So if it only seems marginally helpful during the first week or two, don't give up on it. Take it at least a couple of months before deciding.