Occasional atrial fibrillation and metaprolol question

[Lorne675]

I had my first episode of atrial fibrillation at the end of August. I had two beer that evening and went to bed. Shortly afterwards felt my heart beat irregularly. I was diagnosed in emergency and given 50 mg metoprolol and aspirin. They checked me into the hospital to monitor me over night and my heart converted back to normal sinus rhythm during transfer from emergency to the hospital room. The doctor prescribed 50 mg metaprolol twice a day as well as aspirin. I later cut this in half. My sitting heart rate was in the low 40s (normally it had been in low 50s) and I felt very listless. Since then I have occasional bouts about one every week or two. When I felt my heart go into AF I took the second half of the metaprolol pill and my heart converts back a few hours later.

They always come on when I lying down, often leaning on my left side when my heart rate drops into the low 40's.  I can usually convert back a couple hours after taking the second half of my prescribed dose.I also found I can  convert back by going for a reasonably brisk paced walk.I'm scheduled for an echocardiogram, holter monitor and stress test in January. I take 80mg Micardis to control high blood pressure (now 128/68) and 10 mg lipitor to control cholesterol. I am 5'7" 230 lbs, dropping from 235 in past month by taking the dog on 2 -40 minute walks/day. Since my AF episodes all start when my heart rate drops very low, usually when I'm lying down, do you think it would be wise to stop the twice daily dose of Metaprolol and only take the medication when I have episodes. always know when start/stop

[dquenzer]

I had paroxymal afib like you have.  Generally a beta blocker like you are taking is geared toward keeping your heart rate slower while in AFIB.  The aspirin is to prevent clots.  I'm surprised that you are not on coumadin.  50 mg of metaprolol is not a high dose.  I don't have AFIB anymore but I take 50 mg of atenolol per day to prevent any irritation of the heart muscle.

I would question the beta blocker because it is not intended to keep you in rythmn.  My cardiologist basically said that the goal of treating AFIB is to keep in rythmn.  He was not happy with me going in and out.  I was given Rythmol and then when that didn't work Tikosyn (SP?).  They are intended to keep you completely out of AFIB.  The philosophy of your doctor seems to be control rate rather than to keep you out of AFIB.

I would recommend going to an EP.  It is a cardiologist that specializes in arrythmias.  My cardiologist had an aggressive approach and when I didn't stay in rythmn I was sent to an EP at Mayo for a radio frequency ablation.  I had this done about 3 years ago and it worked.

An EP will probably suggest treatment through meds first.  My cardiologist had the philosophy that if two meds fail then you go toward a radio frequency ablation.

[tanns]

I just have a question.  I posted earlier about a shaky, vibration type thing that happened the other night.  It happened three times and although my heart was racing, I think my pulse was normal.  Dquenzer, you mentioned afib.  My doc says no way, but he says that without an event monitor to try to catch it.  I guess my question is:  Can afib start and be gone in a matter of minutes?  When you are in afib does it feel the same the entire time--whether it is minutes or hours?  I certainly didn't shake for more than minutes.

I read about converting back to a normal rhythm and I did feel weird for the next day or so but I thought that was due tp the extreme anxiety I was feeling based on the incident.

Lorne675, this too, has happened to me only at night and usually when I'm laying on my stomach/somewhat left sided.  I never thought about the correlation between heart rate and the "vibration".  I'm sorry I can't answer your questions though, I wish you well.

[dquenzer]

If the arrythmia is only lasting minutes I doubt it would be AFIB.  I would agree with your doctor.  It could be short bursts of tachycardia.  I've had that happen before.

Generally AFIB shows up as a fast erratic heart beat for a fairly long time.  I have gone into AFIB and in a minute or two it was gone.  But that was rare.  Generally it would last for 1/2 hour to a day.

I think that your problem is partly anxiety.  I understand that. When I started experiencing arrythmias it WAS very disturbing.  After all we only have one heart and it is kind of important!  I am surprised that your doctor doesn't try a monitor to find out what they are.  If anything it would give you peace of mind.

If you are having anxiety problems I would seek something to help control it.  I went to a biofeedback specialist and I was able to learn how to relax and destress.  It helped alleviate the PAC's I was experiencing.

[Lorne675]

My Afib episodes are relatively similar. I occassionally have little ones lasting just a few moments and the longest lasted about five hours. I never had a very fast heart rate at the best of times  and during my first Afib bout never got above 140BPM. I understand this is a little unusual though.The emergency room people called in others to look at it because they had never seen such a slow motion afib before.

In my bouts I have three or four rapid beats, then a pause one or two slow beats a couple normal ones  and then back to a fast rhythm. There is no definite rhythm to it, rates speed up and slow down erratically. These I was told were the classic afib symptoms. When mine start I feel an slight electric current is running up my chest. It doesn't hurt, it just feels weird. The next day after a longer attack I feel very drained and achy.

I'm not on coumadin yet because I always know when I'm having one and they have been very short termed. I was told if I didn't convert after 18 hours to get to the hospital for conversion quickly. I was told there was very little chance of clots developing before then.

I still haven't seen a cardiologist yet,just ER doctors and my GP. It takes a month or two to see cardiologist in Canada when  classified as a non-urgent case but on bright side its free. I have a holter test, an echocardiogram and a stress test sheduled for after Christmas.

Thanks for your info dquenzer. I appreciate the advice and have some questions to ask my cardiologist when I see him.