Last October I was diagnosed with arrhythmia with a 24 hour Holter revealing 25,000 SVE beats or 28% of all beats in the 24 hour test. Subsequent testing indicated there was no structural problem with my heart and the EP prescribed a combination of 25 MG Metoprolol and 225 MG Rythmol twice per day, plus 325 MG aspirin. After several weeks on this medication a second 24 hour Holter Test was performed in January. Results indicated significant reduction in SVE frequency, however, my heart rate had dropped to 40 from around 48 and blood pressure dropped to 90 over 60. This caused dizziness upon rising.
Recently my EP increased the Rythmol dose from 225MG to 325MG twice per day and eliminated the Metoprolol. My symptoms have become much worse in the last ten days comparable to the period before I started medication. I am now wondering if it was the Metoprolol that was helping and the Rythmol is just a waste of money. Finally my EP insists that I continue with 325MG per day of aspirin since he fears I may go from short bursts of unsustained afib (paroxysmal) to permanent afib and develop a blood clot. Understanding which of the medications is important as my EP is saying that since I have "broken through", this is the last attempt at drug therapy and the next step is ablation .
My questions are:
1. Does anyone have experience with both Rythmol and Metoprol, and determining which of these two medications provided the initial relief ?
2. How are they supposed to work?
2. Is it possible to go into A-fib permanently and not know it?
I can't answer all your questions, but I can give you some information based on my experience.
I was diagnosed with afib and my first cardiologist put me on Rythmol. It worked for a short while and then I had break-through afib. She increased the dosage and it would work for a few weeks and I'd have break-through afib again. It got to the point where she increased the dose so high that I was blacking out. It too dropped my HR and my BP to dangerous levels. I ended up in the hospital during one bad episode and they finally realized I couldn't tolerate the drug.
Long story short, I switched to an EP and he put me on Flecainide, which worked great for me for almost 2 years. I recently had a PVI ablation because the Flecainide stopped working.
You can go from paroxysmal to permanent afib but I'm not sure how long that takes and it is probably different for each person. My afib always resolved to NSR within 24 hours so I was lucky. Plus the Flecainide really kept it in check for well over a year.
You could consider switching drugs before you go to the ablation too. With your low HR and BP I suggest you stay away from beta blockers though. They tend to drop you even further.
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