It's done! Had MVR, LAA Closure & Maze Procedures

I was supposed to have surgery. In June but for several reasons I ended up having it earlier. I had my mitral valve Robotically Repaired, my LAA Occlusion via Sutures and a Cryo Maze procedure. I believe the method of LAA Closure used Gore-Tex Sutures, but I will confirm this with my Surgeon on follow up. All of this was done by Minimally Invasive Robotic surgery. The Surgery was done by Dr. Chikwe and her incredible team at Cedars-Sinai in Los Angeles. I am writing this from the hospital as this is 4 days post surgery and I feel amazing! I am scheduled to go home today and that is hard to believe considering how I felt the first 2-3 days post surgery. This minimally invasive surgery is
more painful than a sternotomy but has a better recovery time and better long term results.

Some important things to mention.

I was able to keep my own Mitral valve and directly upon waking up and now 4 days later, I've been in Normal Sinus Rhythm. My resting heart rate is 60-70bpm and I honestly have more energy then I have in decades! And this is just 4 Days after surgery! My heart was getting a
pounding from both the AFIB and the Severe Mitral Regurgitation. Due to both of those things, it was very difficult to ever get my heart Rate under 120, even at rest. I am extremely elated to be in NSR with very few PVCs 4 days Post Surgery. I know the first couple of months can be the toughest while the heart and body are healing but I haven't gone out of NSR once.

I should also mention (and I was well aware of this pre-surgery) my ejection fraction dropped. I was told this is likely before surgery, so I expected it. I feel amazing, have no shortness of breath or dizziness or any issues other than pain which Cedars has managed with some pain
Medications. I pushed myself hard to walk on the second day and have done all breathing exercises asked of me. I want to thank everyone on this forum for all the support and incredible knowledge, as my first diagnosis, multiple cardiologists and EPs all said I just need an ablation. Had
I listened, I would of made my heart more scarred and ablations would of done absolutely nothing in my case. It was here on this forum sharing an echo, I was informed to look at the Mitral Valve more closely. After doing so, I found an amazing cardiologist and EP at Cedars-Sinai who diagnosed me with Valvular Afib and fast forward to today, I feel so amazing 4 days post surgery I honestly can NOT believe it.

Cedars-Sinai is world class as is Dr. Chikwe and her team who saved my Life. With the severe mitral regurgitation, I was estimate to have Cardiac failure within 3 years. I could see the Echos were starting to get worse. I wasn't about to wait any longer as I was still asymptomatic prior to surgery. Again thank you all, I hope to contribute great knowledge and info here for others. If anyone has any questions, please feel free to ask. Thanks to All.



Edited 10 time(s). Last edit at 03/07/2024 01:51AM by cornerbax.

Incredible good story All the best for the future.

Quote
Incredible good story All the best for the future.

Thank you Calvin! I just hope to stay in NSR but no matter what getting 100% blood to my body vs 50%! It is so much easier on the kidneys and
every other aspect of my body. I never had Kidney failure but was actually getting close as my egfr was in the 60s-70s. Two days after surgery it was 99 and creatinine was exceptional! That's the highest it's been since I was diagnosed with MVP with severe Mitral Regurgitation and Valvular Afib.

Another thing to mention is my surgery was about 3 and a half hours long and I was only on the lung bypass machine only 70 minutes! The cherry on the top is I may have no scarring but at the most VERY little scarring at the incisions are only 5cm each on the upper right side of my body. I am getting discharged today and looking forward to rehab and getting healthier then ever!



Edited 4 time(s). Last edit at 03/07/2024 12:08AM by cornerbax.

Congratulations and continued NSR to you!!!

Such great news! You never appreciate NSR until you’ve lost it. What is the program going forward—you mentioned rehabilitation—is that inpatient or outpatient?

This is a great outcome. Very good of you to share your experience with us. I wish you a full and speedy recovery. You can look forward to a wonderful spring and summer.

Thank you very much, I really appreciate the kind words.

Quote
Such great news! You never appreciate NSR until you’ve lost it. What is the program going forward—you mentioned rehabilitation—is that inpatient or outpatient?

Daisy here on this forum was the one who told me about their mitral valve issue and to really get it checked further. Daisy had a similar situation and found out your mitral valve was a big issue as was mine. I will PM you but your info and direction to Dr. Natale sealed the deal! I actually mailed my echo CD to Dr. Natale where he reviewed It and said an ablation isn't going to help as I have severe Mitral Regurgitation. I have to get the Mitral Valve repaired. It was then where I sought out a top Cedars-Sinai EP and Interventionalist. And it was there where it was deemed I have Valvular Afib, just as Daisy suggested and exactly what Dr. Natale said. You also aren't kidding how amazing NSR feels. Even with few PVCs I feel absolutely no palpitations at all and have so much energy just 4 days after surgery. I really hope for NSR to remain but my entire body is so much better getting blood flow vs 50% shooting with an eccentric jet back into the Left Atria. Amazing!

It is outpatient rehab. Slow and steady,but I just walked with the Physical Therapy Nurse and walked up and down stairs with Zero issues! I am more elated than I can even write.



Edited 10 time(s). Last edit at 03/07/2024 01:53AM by cornerbax.

So happy for you! I miss my cedar Sinai cardiologist. They have the best umbrella cardiac care.

I wanted to be as detailed as possible in order to hopefully help others who have similar situations and find this post via this forum or Google, etc. With that said I should mention I had a Cryo Maze. When I follow up with my Doctor I will ask what made them choose Cryo over RF as they do them both. But a Cryo Maze was done for my procedure. And to just mention the not so fun things.
1) woke up with a big breathing tube down my throat and couldn't say a single word. I was also strapped to the bed as they have to ensure the breathing tube isn't taken out. It had to stay a few more hours while awake but my wife was there. My blood was acidic post
surgery so the tube had to stay until they got the levels right.

2) Had a swan tube down to the heart to check pressures of the heart post Surgery. 3) had two chest tubes post Surgery to remove any Excess fluid. 4) had epicardial wires in my chest attached to a huge pace maker to protect the heart from beating too Low/Bradycardia. 5) had an IV inserted in my neck. 6) had a nearly 6-8 inch arterial IV in my left bottom wrist which showed a live blood pressure every second. NOTE: the benefit to the neck and Arterial IVs (A-lines) were blood can be drawn instantly at any time from them and quickly without making a needle jab or having to find a good vein in an instant.

7) Had a catheter inserted down below. 8) had countless blood draws and IVs Inserted in many areas of the arms and hands.Sounds like lots of fun, right? Fun it was NOT, but I would take all of this and lots more to have the successful surgery I did and give me a new lease on Life!



Edited 7 time(s). Last edit at 03/07/2024 12:15AM by cornerbax.

Quote

I wanted to be as detailed as possible
In order to hopefully help others who
Have similar situations and find this
Post via this forum or Google, etc.

Yes, this is very important, particularly seeing as how many might be told, as you were initially, to just get an ablation and all would be well. I also am very thankful that Dr. Natale advised me to get my mitral valve repaired and THEN to come back for an ablation.


I considered having the repair done at Cedars Sinai but it is quite difficult for out-of-town patients to arrange all the logistics and since I was going to get a MitraClip and there was someone very experienced in that in the city where I live, I opted for having it done here. Not so with the ablation though and I happily traveled to Austin for that, but then they make it easy for a patient to have the procedure done with just one trip.

Daisy, two cardiologists and an EP at the SAME HOSPITAL told me all I need is an ablation and to schedule It as quickly as possible. This is both laughable and outrageous. I wanted an outside opinion as my echo showed Severe Mitral Regurgitation and only the hospital primary care doctor mentioned anything about it. That's what got me to focus on it more. When I pressed these doctors about the valve they said just get an ablation and all will be well. When I found the first EP outside the hospital,he said we can try medicines first and If that doesn't work we need to do an ablation to correct the Afib. I asked him about my Mitral Valve and he said something about the leaflets facing backwards and he couldn't see them well on the echo. Then he just stood there and looked. He didn't suggest we find a way to "look at the Mitral Valve closer" like with a TEE, he just made that idiotic comment.

This was a MAJOR red flag to me as he didn't even attempt to see the mitral valve more clearly he just said an ablation was the way to go. Fast forward to today, thankfully I had the sense to research this out on my own and with my own feelings and the help of forums like this I am feeling better than I have since I was in my 20s! I should mention the LAA Closure was done via suturing. I believe Gore-Tex sutures were used but I will confirm this with my surgeon on follow up. I should also mention the first post surgery Echo showed trace mitral regurgitation where virtually 100% of blood is finally flowing in the right direction and not 50% flowing back into the Left Atria and being wasted to nowhere while dilating my Left Atria even more! My surgeon said they shoot for zero regurg but zero or trace are essentially the same thing. All other valves and ventricles are good or great. I am beyond thrilled.



Edited 3 time(s). Last edit at 03/07/2024 12:19AM by cornerbax.

Quite the ordeal, but as with so many other trials in our lives, they become distant memories in time. Meanwhile, beat after beat, day after day, the weeks and months roll by and we continue to live, to love, to hope, to aspire, and to build. Life's like that.

Yes, my post MitraClip Echos show “trace” regurgitation and all the cardiologists involved have been very pleased with that. When reviewing my latest Echo with me, my local cardiologist showed me the recording saying “Look at her go!” Seeing the recording really highlights how important it is to have a well-functioning Mitra valve, so congratulations. I am also really glad that you can actually feel the difference.

I don't want to get too excited but it's been 6 days post surgery and I've maintained sinus rhythm 100% of the time. I have been home for a little over a day. In the hospital, post surgery I was 100% in sinus Rhythm with very few pvcs on top of it. At home I use my galaxy watch 6 Classic which has an insanely great heart rate monitor and EKG. I don't believe any watch is better from what I've read and I've attached a picture with Cedars EDG and my watch showing the exact same heart rate. In some cases there was a 2-3bpm variance between my watch and the
Cedars-Sinai ekg but in much of the case it was exact. My average resting heart rate is 62bpm.....a massive relief to the 120-130bpm average afib rate when I had the severe mitral regurgitation. I used to always see my heart beat through my shirt with AFIB and now I don't feel my heart beating at ALL. I literally haven't felt a single beat in 6 days!! I know I'm not out of the woods just yet, but being the first weeks are the toughest of it and most arrhythmias occur while the heart and body heal and adjust....I am feeling Pretty good!



Edited 3 time(s). Last edit at 03/07/2024 12:21AM by cornerbax.

Amazing, ain't it?

Quote
Amazing, ain't it? 

I can't even express it in words. The energy level I've had is not even believable. The Severe Mitral Regurgitation and Afib were miserable.
At the worst times the pounding heart rates and shortness of breath,and just being downright miserable. To feel like this is a completely new
Lease on life. I just have to stop checking my watch so many times to make sure I'm still in NSR. With the severe mitral regurg and Afib my
second to second heart rate Daily would be something like this...95,117,128,102,94,132 no matter what medicine I was on or how relaxed I was I never had a controlled heart rate. Same thing when I did an ekg from my watch. It would show beat to beat a nearly 30 beat difference often times. I just did an EKG in my watch earlier and my heart rate didn't fluctuate from 68bpm the entire 30 seconds! I'm not out of the woods but from my understanding every hour you are In NSR is a better chance the arrhythmias don't come back. I've thanked this forum on many posts
And can not express my gratitude enough. The doctors estimated another 2-3 years Before my ejection fraction really dropped and or my left ventricle became majorly dilated. I definitely didn't have long to live. This forum and all the useful and priceless information here LITERALLY saved my life. I'll be making another donation soon and once again, can't thank everyone here enough.



Edited 3 time(s). Last edit at 03/07/2024 12:24AM by cornerbax.

Quote
cornerbax
I just have to stop
Checking my watch so many times
To make sure I'm still in NSR....I'm not out of the woods but from
My understanding every hour you are
In NSR is a better chance the arrhythmias
Don't come back.

Yes, it takes a while before you "trust" your newly fixed heart and actually forget about it--what a luxury that is! Hint: you won't jinx it by taking your eyes off your watch! You may not be completely out of the woods but you have passed through the major hurdles and if anything does come up it will be so much easier to deal with than what you have been through.

Well I have to report that I didn't maintain 100% consistent sinus rhythm. I went to the bathroom around 2:30am and felt and saw my heart rate monitor from my watch was at 104bpm and just sitting on 104bpm without changing. I know when I've seen this in the past it's due to Afib.
The only full proof way to know is to run the watch ekg which showed 145-152bpm. I ran it a couple more times and my rate showed 115 and Afib. I grabbed my kardia monitor, ran it and my Heart Rate was 136bpm and said possible afib. So Afib came back but from what I know the first 3 months don't really count in my case as the scar tissue takes 2-3 months from the Cryo Maze to develop to where the erratic signals are completely blocked. The 90 days ends on June 2nd so I won't allow myself to be concerned with what any ekg says until after that point. I will say for over a half hour my heart rate was 120s-152 while in Afib and I had no symptoms at all. I was not short of breath or dizzy, or anything else. I stayed Calm and after 30 mins of higher heart rates, I took 400mg of amiodarone. After about an hour my heart was back in sinus rhythm but reverted to Afib Multiple times. However, this time at a much lower 80-115 heart rate. I am sure that was due to the 400mg of
Amiodarone.

I'll call my cardiologist and/Or my EP to see if I should still take my morning amiodarone dose. I'll also ask what they suggest should this happen again. For the last 90 mins or so I've been back in Sinus Rhythm and not going In and out of Afib like I was an hour after taking the amiodarone. Lastly, I couldn't go back to sleep so I took time researching Maze procedures,and found a video on YouTube from The Cleveland clinic that mentions that Cryo Ablation for a maze is the BEST Method. They state that only Cryo can get to the mitral annulus and Ttricuspid annulus which they state is the only way to do a COMPLETE MAZE. I was wondering what made my surgeon use Cryo over RF and I'm sure this is what they will say when I ask.



Edited 2 time(s). Last edit at 03/07/2024 12:27AM by cornerbax.

The latest research suggests that the few bouts of AF that typically happen in the first few weeks offer a much better prognosis than those that only show up after the first few weeks. IOW, if you are having the odd run now, and it's within four weeks or so, that's good. Not great, natch, but it's a lot better than if you thought you had it licked, and then at seven weeks you began to get PACs or even AF...that's NOT good.

Best to let it go, relax, try to avoid the incidence of 'spasming' that might come with rapid standing, heavy lifting, rapid body movement, anxiety....keep calm and let's hope the incidence reduces and eventually goes away. Happened to me.

BTW, if you do go into AF during the blanking period, my outreach nurse said to start a low dose of metoprolol, as in about 25mg daily, and to seek a cardioversion if it persists more than 24 hours. Your heart is a new model after an ablation, so it can be treated as if the AF is brand new and you should be corrected easily with cardioversion. Keep your EP team abreast of worrying developments, persistent ones, at which they may advise taking propafenone or Flecainide...whatever you know works historically.



Edited 1 time(s). Last edit at 03/05/2024 02:40PM by gloaming.

Thank you for that helpful info. That is great news! From my understanding 1/3 of people who never had afib prior get it after valve surgery at some point. That number is high considering they never had afib before. However, 94%, of those people never have Afib again after 3
months! So for the majority of people after 3 months Afib is gone permanently. Apparently the Atria don't like to be disturbed or take a tolerance to Inflammation well, which is likely why the the afib after surgery for most. In my case I also had a Cryo Maze on top of the valve surgery and from my understanding the scar tissue doesn't fully form for up to 3 months as well so some erratic signals can still get through.

I'm only 7 days post surgery and this morning was the first Afib episode I have had. You also nailed it right on the head. My doctor prescribed many medications (one or two with Blood pressure lowering ability) but not metoprolol. They said they want to see how I do in the days out of the hospital but did consider prescribing it prior to discharge. I Called this morning to let them know the issue and when I said my rate
Got to 155 (fortunately with no symptoms) They immediately prescribed Metoprolol 25mg which is actually ready for pick up
Right now. The good news is I've been in NSR since about 6am which is going on 6 straight hours. I charted the lone bout of Afib up to this point, and just like this morning I won't get concerned if it comes back within the next 83 days. If it does, hopefully at a much lower rate
with the Metoprolol.



Edited 5 time(s). Last edit at 03/07/2024 12:29AM by cornerbax.

I\m so pleased that you have a responsive team willing to take your calls, listen to you, and then to actually...you know...HELP!

In case you are new to metoprolol, it's a fantastic drug, but it does have a tendency to put some users into bradycardia....heart beat persistently, or very often, below 50 beat per minute. That rate isn't so bad, but if it gets down to 40 or below, you should cease the metoprolol and again let your team know that your heart rate is too low on that dosage. They may give you a lower dosage, at which you simply begin to take it again with that first scheduled tablet. Or, they'll agree that you should cease it altogether. So, monitor yourself. Often when our hearts calm and want to stay in NSR after that twitchy first coupla weeks, metoprolol puts it down to low and you'll get dizziness and fainting, or falling. So, keep a sharp eye on your pulse rate for the first week.

@gloaming,

This is excellent information, thank you. I know there was a reason that my cardiologist didn't prescribe metoprolol with my other medications. They just said when prescribing my medications that metoprolol was one they were gonna hold off on until they see how I do without it the first week. Well, I got through right to the 7 day mark before the Afib yesterday morning. When I called my cardiologists office this morning I received a call back within the hour telling me they were prescribing metoprolol tartrate at 25mg two times a day morning and night. Yes, I am very thankful for the entire medical experience I have had at Cedars-Sinai. Technically, I have 3 doctors there. My cardiologist who is an
Interventionalist, my EP, and my Surgeon. There's a lot of avenues to reach out should I have an issue and to see that prompt response was
a great feeling.

With this said, I took my first dose of 25mg Metoprol Tartrate with my night medications around 8pm which was 4 hours ago. The lowest my heart has got too was 63bpm but seems to average around 65ish or so. It doesn't seem changed much from my resting heart rate prior to adding metoprolol. But this is one dose so well see how I do the first week or two as you said. I will keep a very close eye on it. They have me on a taper downcschedule with Amiodarone. For the first week I take 400mg of Amiodarone twice a day for 800mg total. After the first week
I take 200mg of amiodarone twice a day for 400mg total and the taper down continues through the first month. Also, I have been back in NSR for about 18 hours since the Afib episode yesterday morning and I still feel loaded with energy and great! I will report back to this thread with
any pertinent info each week or two the first month post surgery and then again right at the 3 month mark.



Edited 2 time(s). Last edit at 03/07/2024 12:32AM by cornerbax.

Wow, I was in EXACTLY the same situation in early August of '22. Six days after my first ablation, I was in the ER with HR upwards of 145, sometimes much higher. They told me to stop metoprolol immediately. Why?!? Because, said the nurse who hurried in to check on me, holding her two index fingers eight inches apart in front of her, we watched your heart stop beating for this long on the readout. Metoprolol was making me have long pauses, and when I was in NSR for short periods, it was 30 BPM, meaning only my AV node was keeping me alive.

Like you, I was prescribed Amiodarone, which I challenged. I asked why the Big Hammer? Because, said the ER internist, it's the 'right hammer'. So, I had the same tapered regimen, except with two days to go at 200mg PO, I broke into AF again. Two more weeks at 400, then try tapering again was the decision. It sort of worked. I was AF free during the Holter three weeks later, but I had a ton of PACs. Eventually, I was back in AF and was scheduled for another ablation. Happily, for me anyway, and the missus, this one took and I just celebrated my anniversary on Feb 14th.

It sucks hugely when, like me, you're in the Great Unwashed 35% whose first ablation fails. You're far too early to be worried, but do recall that there's a sobering and hefty chunk of failures for all but the top 30 EPs on the planet.

I don't know about you and your constitution, or how much scarring is taking place in your atrium, but I have fallen back from running to simply walking. I do well, and can push the pace, including climbing 300 feet vertically on a popular spit where there's a steep cliff with over 300 steps.and climbing path. My HR, even at 71 with a disordered heart, tops 140 when I do this, and there's no hiccups that I can feel. The rate falls shortly after I reach the top and continue a moderate pace, still walking.

I wish you continued success. There's a really good chance you're going to be okay if your heart is back in NSR and you feel pumped.

that is definitely scary, having your heart stopped. But like you said, there are side effects for some on all medications and the idea is that the overall medications will do far better than worse when it's all said and done. I am glad you are still able to work out and enjoy the things you like. It is day 2 for me with Metoprolol and interestingly enough my doctor prescribed Metoprolol "Succinate" today. They told me to keep the Tartrate as it's more instant acting and if my heart rate does go over 130 or so for a prolonged period of time to take 1 of the 25mg Metoprolol Tartrate pills. For daily dose, they want me to start taking 50mg of Metoprolol Succinate (XL long lasting). Congratulations to you on your Anniversary and your continued SUCCESS of NSR!! These are the success stories of this forum that put a smile on my face. I have been back in NSR for a day and a half so since Surgery 8 days ago, i've had 1 lone bout of Afib that lasted approximately 1 hour and that's it. I have my watch set to inform me immediately if my heart rate drops below 50 or above 140. My energy level 8 days in is still through the roof. There is no doubt in my mind, that my Severe Mitral Regurgitation was far worse to me and my body than was the Afib. Having half the blood or more being robbed to your body with each and every heart beat pump is almost unbelievable. Congrats to you again "gloaming" and to long continued and endless success!


P.S. Thank you to Carey for informing me of the structure of my posts where they appeared long and stretched. I was typing a lot from my phone so my screen appeared to show my posts being chopped when too many words were typed per line. That wasn't the case so i've spent several hours going through each of my posts and correcting that. They should all look "normal" now.



Edited 1 time(s). Last edit at 03/07/2024 02:03AM by cornerbax.

I wanted to update this post to mention I had at least 3 more Afib episodes yesterday, none of which I felt. Once again, I had absolutely no symptoms. Unlike the first episode I had where my heart rate was steady at around 150, this time the max heart rate showed 115. I didn't have Metoprolol during the first episode. I also had another episode of Afib within 2 hours and my average heart rate for that episode was low at 68.

I do about 15 EKGs a day as I'm like my own case study. I try to not be overly obsessed with The EKGs but I definitely want to do enough in a full day to get an idea of how often
I'm in NSR or not. I caught 3 total episodes throughout the day/night yesterday and everything else was NSR. Today is day 9 post surgery which I had on February 27th.

So it looks like this: Days 1-5 post surgery in the hospital (and still on IVs) I had 0 bouts of Afib or any arrhythmia as I was attached 24/7 to an EKG which showed NSR 100% of the time. Relased from the hospital and Day 6 at home I had no episodes that I caught on EKG or my heart rate monitor. Day 7 I had at least 1 episode of Afib which I caught that lasted about an hour and in which my heart rate was hovering around 150 most of the time. I didn't have Metroprol on Day 7. Day 8 I caught 3 different Afib
episodes where my heart rate ranged from 68-115 and In which I had taken Metoprolol that day. All of the episodes yesterday lasted LESS than 10 minutes and In which I IMMEDIATELY converted to NSR where I've been many hours since. The first afib episode lasted around an hour and the 3 yesterday lasted less than 10 minutes.

It looks like the Metoprolol is working for rate control but I'm not sure if it's also helping to lower the time of the Afib episodes when I do have them. My lowest heart rate on it for two full days has been 58. I won't post daily here as I figure I will have more bouts of Afib during the healing process. I will, however, post anything of significance.



Edited 9 time(s). Last edit at 03/07/2024 09:16AM by cornerbax.

I think you can assume that metoprolol helps both ways. It helps to calm the heart, so if you do get a few blips, even for a couple of minutes running, metoprolol is apparently helping with both the amplitude and the duration. At least, so it would appear to me based on your reported stats.

Were you given colchicine by chance? It calms the heart and inflammation and quite a few EPs are giving it before and after ablations, including Natale.

I was thinking the same thing that Metoprolol is working great in both ways. I guess as the days continue to go by we'll see if that continues to be the case. So far today I haven't seen an Afib episode and 3 days into metoprolol 50mg my heart rate has averaged 62-65bpm. It hasn't gone too low even at rest.

I was not given Colchicine, I have never even heard of it. Directly after the surgery I was on several IVs and amiodarone was one of them. I can ask my surgeon next week during my follow up appt about Colchicine but I definitely wasn't given that in the hospital or since my release.

Have a look: Colchicine in Cardiac Surgery: The COCS Randomized Clinical Trial [www.ncbi.nlm.nih.gov]

It's interesting how colchicine seems to have found renewed interest by the EP community recently. I received it following an ablation in 2014 but then never heard it mentioned again until about the last year or two. I consider the EP who did that ablation the best of the 3 EPs who did ablations on me prior to Natale, and I still use him as a local EP (though I haven't seen him since pre-COVID). So apparently he was a few years ahead of the trend.

I meet with my surgeon and their
NP next week. When I ask the questions I have regarding the surgery itself, I'll also ask about Colchicine to see what they think.

I didn't ''catch'' any bouts of Afib or any odd arrhythmia yesterday but my heart rate during sleep at one point went as low as 39. I have an alert on my phone should my heart rate go over 140bpm or under 40bpm for more than 10 minutes continuous. The 39 bpm reflects around midnight and it was brief, looks like a minute or less from what my watch chart shows. Within the last week my previous lowest heart rate at ANY time was 48 and that was also during sleep and also for a blip or a minute or less. The lowest my heart rate has gotten is 55bpm awake while sitting and my average heart rate is 62bpm.

With that said, should I be concerned about a very brief 39bpm rate during sleep? I am on 50mg of metoprolol per day and cutting to 25mg or even 12mg Is easy if need too.
Any thoughts on this?



Edited 2 time(s). Last edit at 03/08/2024 02:16PM by cornerbax.

Quote
cornerbax
With that said, should I be concerned about a very brief 39bpm rate during sleep?

That wouldn't concern me, but you could always cut the pills in half and take 25 mg. Or you could even just not take it daily and use it only as a PIP when an episode begins.

Quote
cornerbax
... but my heart rate during sleep at one point went aslow as 39. ...

With that said, should I be concerned about a very brief 39bpm rate during sleep? I am on 50mg of metoprolol per day and cutting to 25mg or even 12mg Is easy if need too.
Any thoughts on this?

If you are reasonably active and what could pass for 'fit', it is a low rate, but it isn't what should be cause for concern. When I was a competitive runner decades ago (and I firmly believe what I put my heart through then is why it is disordered today...), my resting HR while awake was 38. God knows what it went down to during my deepest non-REM sleep (REM is exciting and causes muscle movement, deep breathing, erections in males able to do it (ahem!) regardless of the subject of the dream...it's true ladies), but if I took my pulse first thing, before turning over or stretching, even scratching, it was typically 32-34.

I hate to suggest it because of the dangers inherent in the event, but syncope is often the best indicator of a too-low heart rate. If you get tingling around your temples or the back of your neck, feel weird, or get dizzy standing, or faint, then it's almost certain that your pressure and/or rate are too low.

[Edited to correct '24' to '34']



Edited 1 time(s). Last edit at 03/08/2024 03:54PM by gloaming.

Thanks for the responses. I will monitor my sleep heart rate and see if this is more common or not. I've been home 5 nights and the 5th night was the lowest it's gotten at
39bpm but my graph shows it didn't last a minute.
I do have metoprolol tartrate (pill in the pocket) as well as succinate so if I do end up cutting back the succinate, I do have the PIP with the tartrate should I need it.

@gloaming, I used to be in excellent shape and actually had a resting heart rate in the lower 40s. I never had a resting rate in the 20s. I had a polar F6 and checked my rate upon awakening every so often but it was almost always in the 40s. This was 17 years ago and ive gotten out of shape. I am going to get on a solid workout program as soon as I can and progressively build up to that point.

I have never had any of the symptoms you've mentioned on dizziness or tingling around templates and I haven't felt weird or off at all. Even with the Afib episodes where my rate was over 150, I only slightly felt the heavier beats. I'm sure after a year or so of severe regurgitation and Afib the Afib in and of itself is like a picnic to my heart lol.

CB, I corrected my post. I had intended 34, not 24. Sorry...