There are 4 different posters on here right now who report HR's in the low 40's in the evening. Mark, Benj, me and I can't remember the 4th. The pattern is errily similar--fit person, low HR normally, and at the end of the day it goes down and afib is a big threat.

How many of us are there who experience this? Maybe this is something for Hans to look into? Please share your age, general fitness level, and HR experience.

John

Age 54
Generally very fit--ran a lot and have always worked out and played basketball.
Resting morning HR-low to mid 40's.
Lowest resting rate I have caught on my HR monitor-39 when starting to fall asleep.

Guilty of low HR...

Age 47

Very fit. Nine marathons since 1994. I generally run 25 miles a week including one 10+ mile run. I was basically able to maintain this while fiibbing also, but at a much slower pace.

Non-fibbing mid 40's resting HR. When I was in the hospital with fib, they woke me up at 3:00 am one night to see if I was all right. The nurse told me my HR kept dipping into the 30's and they were worried.

Mark

As mentioned, I personally feel the low heart rate, given the right circumstances, can trigger an afib episode as a 'compensatory' safety mechanism...i.e., when the rate dips into the 30's during deep or REM sleep catecholamines are released which MAY set off an afib experience.


I may be 'all wet' with this theory but feedback may lead to a proposed solution to the sudden wakeup and subsequent results.

Age- 63, weight, 158#, 5'9", workout regularly having jogged 2-3 miles a day when younger; body fat approx. 16%.

Having a low heart rate is very common among highly athletic vagal afibbers.

The generally low heart rate can lead to bradycardia (excessively low heart rate) during rest and this can provoke an overly exuberant compensating adrenergic reaction which then results in an afib episode.

It may be possible to increase the heart rate before bedtime just enough to avoid the bradycardia-induced episodes. I do not have the vagal kind of LAF myself so I have not been able to try them out; however the following approaches come to mind:

. take 0.5 mg sublingual Ativan before bedtime

. have a cup of coffee before bedtime assuming this does not set off an episode or prevents you from sleeping.

. have a cup of hawthorn tea before bedtime

. take a couple of cayenne pepper capsules with food prior to bedtime - assuming your stomach can handle cayenne pepper

. put on a nicotine patch before going to bed (remove it in the morning) - this is not a long term solution but may work temporarily.

Some afibbers have found relief by sleeping in a recliner or propped up by lots of pillows.

The long term solution is probably to cut out the heavy exercise and limit it to two brisk walks a day.

Hans

Hi John,
I'm also guilty of low heart rate, regularly around early to mid 40's during the evening, and also registered a number of 38/39's at bedtime.
Through weight reduction, cutting out all alcohol(what a bore!) and stress management I've gone over 2 years without AF attack.Quite a lot of skipped beats, which I've had for years, but escaped going into AF.
So for me consistently low HR hasn't made me go into AF.

John Negus v55

I have low heart rate (infact it has been known to drop to less than 20 something when sleeping), but I am not what you would call an endurance athlete. I did a lot of sport (swimming, diving, long jump, high jump, 100 metres etc) and gymanastics and ballet when younger and often pushed myself to the limit as I had to win. I did no training only competed - unless you call back flipping etc in the garden training. I got AF at the age of 22. Then I went off the rails a bit and lived life to the full - despite AF.

Fran, 43, can still tumble and do back flips and swims in the loch when weather permits. Also physically active person who loves to do manual labour. Also stopped AF for two years now due to avoiding free glutamate but still heart rate goes down to 40 in bed at night. My average heart rate during the day when working is between 55 and 65.

You all say you have low heart rate but are you taking any Beta Blockers. When i was on them Sotalol i found my heart rate went down to 39 bpm but it doesn't now. I was told i had Bradycardia but i believe that was due to the meds. i get the occassional Flutter/Palpitations am now trying to contact my Cardio as i wont be seeing him offically till May i seems now.


I've never been an athlete but used to do a lot of rushing around over the years. Could never sit still for long... always felt guilty if i did but never again.

I was away at Blackpool for weekend and decided to go for short walk(was bit brisky there), well turned out bit longer than i thought and i didn't get the chest pains i normally get, it doesn't happen all the time.

Babs

Babs, I take propafenone, but am trying to only take it when I am having flutters or afib. My HR was that way long before I ever heard of afib. I have always believed that the low HR was more heriditary than a result of exercise, but I do think the long term exercise contributes significantly.

John.

Forgot to mention i also suffer with a certain type of Arthiritus and i get pains at back of my head my GP offered me antidepressants Nortriptyline just one small dose at night. He knows how i object as i don't agree with them but as they are meant to be used as a pain killer to i said ok. But i only took them recently for less than 2 weeks. I felt that my heart was fluttering differently felt so very uncomfortable and slightly unwell that i stopped. i will one day find a way to help apart from taking suppliments which don't help with the full pain of muscles.

I am a spiritual healer you would think i could help myself, not so easy. But i do feel a lot calmer in myself.

Babs

FWIW, HR as I sit here having just come in to my house at 10am and sat down here at the PC is 55bpm. HR dipped to 39bpm around 3am whilst asleep when last on Holter 24hr monitor a year ago.

Mike F.

Add me to the list of low heart rate afibbers. I exercise 3-4 times a week but am by no means a fitness freak or an athlete. My resting heart rate during the day is around 60. Halter monitors have shown that it goes down into the 40's during sleep.

This is all part of the vagal connection - almost all of my afib episodes happen when I'm very relaxed. I used to call it Sunday morning syndrome since I so often had episodes on Sunday morning while reading the paper which is probably my most relaxed time of the week.

Low HR here. My low heart rate is also accompanied by a low BP. My afib started in 1996, and I got a pacemaker in 1998. That was before overdrive pacemakers were in use and the device was implanted in order for my cardiologist to be able to try to treat me with beta blockers and antiarrhythmics. I also had a history of syncope. In the 3 years that I had the pacemaker I never had any fainting spells but had limited improvement in my afib. The major problem was that the ventricular lead had perforated my anterior right ventricle so that the tip was up against my chest wall and every time it fired it stimulated my chest wall and caused contraction of the intercostal muscles. The pacemaker was surgically removed in 2002 and I have had 2 sudden drop blackouts since that time.

It has been recommended that I get another pacemaker; but I am so prone to bad luck with any invasive procedure that I can't deal with another risk. There is a gray cloud that follows me around.

I have high hopes for the future of overdrive pacing, especially having read links posted by James D. I would think that AAI pacing at rates above the intrinsic SA node rate plus overdrive algorhythms would have to work. Perhaps the technology is too new and needs twinking, but the principle is a good one.

Pam

Dave,

Like you, my a-fib generally comes on when I'm totally relaxed. Like yours, it very often starts on wekends and when I'm reading the paper. All the years I was involved with stress-inducing activities I never had a-fib. It really started when I more or less retired from those activities.
Since last fall I have cut way back on sugar and glutamate intake. I last had wine in April 2003, I cut out coffee for about 6 months and started taking magnesium in addition to the usual vitamins & supplements. The a-fib has actually become more frequent!
Perhaps the secret for us vagal types is to get more active, have more stress in our lives and not relax !
Just a weird thought from Vancouver, B.C.
CHeers, RK

When my heart rate went down to the 20's when sleeping I was on sotalol. I'm sure it doesn't go this low now - though 40 odds in not uncommon for me without any meds. Sometimes when I am tired I think my whole body goes into a hibernation.. Is this not what happens to hibernating animals - the heart rate, BP etc drops right down to conserve energy.

Fran

I too have a resting heart rate in the 40s. But I'd like to know what your rates are when you're exercising. I'm on a beta-blocker (50 gm metaprolol twice a day) so I rarely get my rate up to 90 when I'm doing 4mph on the treadmill for about 20 minutes. However, I'm 75 years old but, other than LAF, in excellent health. (Never been in a hospital except to get afib regulated 2 1/2 years ago.) And, I might add, the metaprolol seems to do an exc ellent job. Seems a little strange to me though: I take metaprolol to "slow down my heart" but I'm supposed to exercise to speed it up. Huh?!

Hans,

How might Ativan work to compensate (or intercept the adrenergic response) for the low hr?

How does sleeping in a recliner or being propped up on pillows work effect the heart rate?

Carol

Carol,

Ativan has been found to decrease vagal activity while increasing heart rate by about 6 beats per minute (page 99 in the book)

The vagal system is predominant when in a horizontal position while the adrenergic system is predominant in the vertical position. Thus avoiding a totally horizontal position when sleeping may just be enough to keep the adrenergic system somewhat activated and therefore avoid the reduction in heart rate accompanying vagal predominance.

Hans

Carol, and Hans, I have really been helped by not jumping into bed and laying down immediately. Somebody suggested "easing" into it, and that does seem to help.

My really low time of day is when I leave my office, which involves a stressful type of work. I can literally feel my body slowing down, like the hibernating animal RK mentions, and my pulse is usually in the low 40's at that time of day, while driving home. If I do something active at home, I am usually ok. But sitting down can put me over the edge. And laying down to sleep can be awful

So maybe we should all be actually drinking coffee in the afternoon!

John.

When I used to have episodes of AF (now I'm constantly in AF) my NSR heart rate was about 50. When it would dip into the low 40's then PAC's would creep in-- often that was a precursor to AFib! I was active but hardly a "trained athlete".

Despite many measures to improve diet and try supplements, then meds, flutter ablations- the AF became worse and now eventually constant. Perhaps it’s the low heart rate that is so easily overcome by PAC’s and AF; it certainly can deteriorate if you don’t find a way to improve it.

Anton

Me to,
Rest early am 45/55, living 60/90, exercising 80/135 (now), use to go to 155/165! In af 90 and have been as high as 215 David S vlaf 66 yy.

I have a resting HR of 48 and anywhere from 60 to 66 or so when active. I am 52, overweight and out of shape. Not physically active. Try to walk once in awhile. I weigh 235 lbs., and this is from changing to a mostly paleo diet and doing bowel cleanses over the last two years when I found out I had uterine cancer. I started out the whole journey weighing 313.

I am probably vagal. Afib was first triggered one month after surgery a yar ago by drinking cappucino. I have had three more episodes since then. My afib is definitely triggered by bloating and constipation. I have to sleep in a recliner or my heart threatens to go into afib.

I take magnesium glycinate, Vit. E, fish oil. Vit. C, CoQ10, potassium. I notice that when I forget to take supplements, I have fewer PACs. Go figure that one! I am going to try taking the magnesium only (I take it out of its capsules and take it as a powder with water).

k

Kestra:

I wonder if the bowel cleansing could be causing a drop in you electrolyets, specifically potassium. Such is the case with the habitual use of laxatives or diurretics, or just having diarrhea. Just guessing here Kestra. Does your potassium usually run normal?

Pam