Higher resting HR after episode

Had a short episode this morning and after it my resting HR is in the 80’s and standing/walking raises it easily over 110, with little effort. Any idea what could be causing it?

Note, it’s slowly getting better but it incapacitates me for a good part of the day.

On Multaq/Eliquis.

You could have converted from AFIB into Atrial Flutter, not all the way to NSR. Pulse would feel regular, if it continues an EKG would clarify whats going on.

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The Anti-Fib
You could have converted from AFIB into Atrial Flutter, not all the way to NSR. Pulse would feel regular, if it continues an EKG would clarify whats going on.

Thank you for this! Would you happen to know if a 2-lead ECG would detect flutter?

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hds
Thank you for this! Would you happen to know if a 2-lead ECG would detect flutter?

It will not.

A heart rate of 110 incapacitates you? How does it do so, you become short of breath?

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Carey
A heart rate of 110 incapacitates you? How does it do so, you become short of breath?

110 is only standing up. Doing anything else brings it in the 140 region, very easily. No shortness of breath.

It's a new thing. I have been doing quite well, with HR staying in the 70-80 range during episodes and no issues with HR. But after this morning's (45 minute) episode HR is more easily raised.

I will get some guidance from cardiologist, but the common response is "take Metoprolol", which I weaned off since it appeared to cause my HR to drop to 30's during sleep. Since I am on Multaq now it may even drop lower.



Edited 1 time(s). Last edit at 04/27/2023 08:49PM by hds.

Sounds like Anti-Fib might be right. You may have gone from afib into flutter. That's common in both directions (afib -> flutter and flutter -> afib).

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Carey
Sounds like Anti-Fib might be right. You may have gone from afib into flutter. That's common in both directions (afib -> flutter and flutter -> afib).

Thanks. It’s very unnerving so your responses and support mean a lot to me.

Is this something that warrants having my ECG checked immediately?

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hds
Thanks. It’s very unnerving so your responses and support mean a lot to me.

Is this something that warrants having my ECG checked immediately?

I understand that it can be unnerving, but you're in no danger. Always remind yourself of that. Nobody dies from atrial arrhythmias.

Is it worth getting an ECG immediately? No, but it's worth getting one sometime soon. Please don't go rushing off to an ER over this. But talk to your doc about it. Sounds like you could document what the rhythm is with a simple a stress test.

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Carey

I understand that it can be unnerving, but you're in no danger. Always remind yourself of that. Nobody dies from atrial arrhythmias.

Is it worth getting an ECG immediately? No, but it's worth getting one sometime soon. Please don't go rushing off to an ER over this. But talk to your doc about it. Sounds like you could document what the rhythm is with a simple a stress test.

Thanks very much for that advice. It was 2/17 I was diagnosed, and it takes time to adjust to this new reality. Cannot do work at the moment, I was a runner, and miss that too, and lots of other things that I enjoyed are currently not doable. I miss doing just normal things. Next week I will speak with my EP. He will have a treatment plan. I’m looking forward seeing some light at the end of this tunnel.

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hds

Sounds like Anti-Fib might be right. You may have gone from afib into flutter. That's common in both directions (afib -> flutter and flutter -> afib).

Thanks. It’s very unnerving so your responses and support mean a lot to me.

Is this something that warrants having my ECG checked immediately?

I agree with Carey, if going to an ER means waiting and the place is busy.

However there are other possible options to get an EKG quickly before a scheduled Doctor visit. Your EP will want an EGK to make a diagnosis and treat.

1) Go to your EP's office, as a "nurses visit" (this can be arranged in most offices within hours.)
1) Go to your Primary Dr. as a walk-in urgent case if possible.
2) Go to an urgent or quick-care facility.
3) Walk-in to your local Fire/Paramedic station.
4) Go to the ER room if its not busy.

On the 3nd option when I was in a similar situation, the quick-care Dr. took the EKG, that showed Flutter, then she wanted to call an ambulance to have me taken to the Hospital. I had to kindly sign a letter refusing medical advice.

On the 4rd option when I tried that it worked, and I got an EKG, in short order. I did however have to calm 2 of the young paramedics down, as they got anxious. I was in a "Fib/Flutter" at the time, which in and out of AFIB and Flutter, or being mixed.

The 5th option would be my last resort. If you told them about your irregular HR and symptoms at triage, they should get an EKG right away. Then the problem is waiting for the Dr. to have the time to see you. In this case be wary of interpretations of the EKG from the tech's/nurses in the ER. They are not reliable from my and others experience. I have just taken the EKG and left the ER after waiting for 3 hours. You can give or fax the EKG to your EP's office right away, for the nurses there to look at it.

hds, did you take additional dosage for this episode? I had experienced flutter after taking 150mg of Flecainide as PIP. Had to take Metoprolol to bring the HR down. I have no issue with my normal dosage, 50mg BID.

Thanks for your good advise, Anti-Fib!

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Yuxi
I had experienced flutter after taking 150mg of Flecainide as PIP. Had to take Metoprolol to bring the HR down.

When you take flecainide you should take metoprolol at the same time. This is because there's a very rare but potentially dangerous condition flecainide can cause called 1-for-1 conduction, usually written as 1:1 conduction. That's when the AV node begins conducting every atrial beat to your ventricles. During flutter (and afib) your atria can be beating at 300 bpm or higher. This isn't normally a problem because normally your AV node filters it and only conducts every 2nd or 3rd beat when your atria are beating that fast. If this were to happen, you could find yourself with a heart rate of 300 or higher, and that is not life sustaining.

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Yuxi
hds, did you take additional dosage for this episode? I had experienced flutter after taking 150mg of Flecainide as PIP. Had to take Metoprolol to bring the HR down. I have no issue with my normal dosage, 50mg BID.

Was the 150mg PIP you took in addition to your regular two doses a day? If so how much was the total Flecainide during the past 24 hours?
Do you weigh less than 154 pounds? If so and your weight is <150#, your maximum flecainide during a 24 hour period is 200mg. If you weigh more than 154 pounds than the maximum flecainide dosage in a 24 hour period is 300mg.

Flecainide is not a drug one experiments with.

Some reading:
[www.afibbers.org]

I always post this because it’s a dangerous drug if not taken correctly.

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Carey
When you take flecainide you should take metoprolol at the same time. This is because there's a very rare but potentially dangerous condition flecainide can cause called 1-for-1 conduction, usually written as 1:1 conduction. That's when the AV node begins conducting every atrial beat to your ventricles. During flutter (and afib) your atria can be beating at 300 bpm or higher. This isn't normally a problem because normally your AV node filters it and only conducts every 2nd or 3rd beat when your atria are beating that fast. If this were to happen, you could find yourself with a heart rate of 300 or higher, and that is not life sustaining.

Thanks for reminding me this, Carey. This happened a few months ago when I was with my 1st EP, who told me I do not need metoprolol because he thinks my HR (90-120) is not that high when in Afib. I was using 150mg Flecainide on demand (no daily dosage) at the time.

Since then, I have switched to see this new EP, he has me on 50mg of Flecainide BID, but still no daily Metoprolol. Do people normally take Metoprolol daily with Flecainide?

I am doing fine so far, but if I get a breakthrough Afib I will take additional Flecainide definitely along with Metoprolol.

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Yuxi
Since then, I have switched to see this new EP, he has me on 50mg of Flecainide BID, but still no daily Metoprolol. Do people normally take Metoprolol daily with Flecainide?

Just to confirm Carey’s point—yes a beta blocker should always be taken when you are on Flecainide.

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Yuxi
Since then, I have switched to see this new EP, he has me on 50mg of Flecainide BID, but still no daily Metoprolol. Do people normally take Metoprolol daily with Flecainide?

Most EPs insist on it, but a few are willing to take the risk. Just because your HR is 90-120 during an afib episode doesn't mean that's how fast your atria are beating. They could be beating at 300 bpm but your AV node is only allowing ever 2nd or 3rd beat through. Flecainide can remove that limit. Also, flutter works by a completely different mechanism than afib and can easily achieve very high rates. If I were you, I would always take the metoprolol with the flec when you use it as a PIP.

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Yuxi

W
Since then, I have switched to see this new EP, he has me on 50mg of Flecainide BID, but still no daily Metoprolol. Do people normally take Metoprolol daily with Flecainide?
I am doing fine so far, but if I get a breakthrough Afib I will take additional Flecainide definitely along with Metoprolol.

50+50+ PIP 150=250mg in a 24 hour period. Do you weigh more than 154 pounds and have the blessings of your EP?

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susan.d
50+50+ PIP 150=250mg in a 24 hour period. Do you weigh more than 154 pounds and have the blessings of your EP?

Hi Susan, I weigh 120, when the flutter happened, I was not on daily Flec but 150mg as PIP only, so it was within my limit. Knock on wood, I have not had an episode since I started daily Flec. 6 weeks ago.

On the other hand, after my 13-year break from afib (successful ablation) and it returned for a couple of months before my second successful ablation, I took only Flecainide as a PIP to stop the afib episodes. My heart rate when in afib at that time was 110 BPM with no rate control. In the very beginning 25+ years ago, afib with NO meds left my heart beating at up to 180 BPM.

I think no one dies from AF, but they do die from strokes, or worse, live as a vegetable.
I'd always err on the side of caution