Low Pulse at Night as a Trigger

Happy Holidays to you!

It appears that sometimes, a low pulse rate at night triggers a bout of afib. We have moved my toprol to taking it earlier in the evening. Is there anything else I can try to elevate my pulse rate before I go to bed to keep it elevated while I'm asleep?

And what do you think is the cause of palpitations that sometimes turn into afib during a bladder call at night and upon returning and lying down in bed? And what can one do about it?

Thank you.

[CCF-M.D.-RCJ]

Rossi,

Happy Holidays to you.

Both the "low-heart rate" and "bladder" triggers are related to increased vagal tone.

The easiest way to decrease vagal tone is to let yourself get out-of-shape, which you obviously do not want to do.

Two medicines to discuss with your doctor are acebutolol and hyoscyamine.  Acebutolol is a beta-blocker with ISA (intrinsic sympathomimetic activity) such that it does not tend to decrease heart rate.  It leads to palpitations in some people, however.  Hyoscamine blocks vagal activity.  Although not approved for afib, we are considering a trial of this medicine for treating post-op afib.

Also, the vagal surge is greatest when emptying a full bladder.  Try urinating nore frequently, perhaps on a schedule, to decrease the vagal surge that then leads to afib.

Good luck.