Bradycardia

I had one fainting event upon standing three years ago, but this was before having a catheter ablation to rid my heart of the arrhythmia called atrial fibrillation. I had been on a rate control medication called 'metoprolol', widely prescribed and used, but sometimes it puts patients into bradycardia territory. Happened to me.

Depending on your ability/motivation to make some lifestyle changes that may help, and it's always worth a trial to see if yes/no before resorting to drugs, there are drugs and there is the pacemaker. Those two can help to put you back into a rate that keeps your blood pressure sufficiently high to stave off any syncope.

@gloaming

Thanks for the info. Cardiologist told me he is currently not concerned about it due to my healthy lifestyle and told me to see him in a year. We’ll see what the future holds.

@robert66
same here, swimming etc. Holter shows daytime 45-55. nighttime 39(!). can get dizzy standing up (orthostatic hypotension) so I stand up slowly. Otherwise, nothing. Docs can't find reason. keeping an eye on it. no effect on qol. see other previous posts.

It sounds like a conservative approach is completely reasonable. If symptoms progress to the point where you feel like you’re about to faint, are fainting, or they become lifestyle-limiting, the traditional approach has been the use of a pacemaker. Medications are not particularly effective for slow heartbeats, although some medications can cause slow heart rates as a side effect and could be discontinued.

There is a newer therapy called cardioneural ablation, for which there is a program at Mayo Clinic that has been very successful in treating patients—often younger individuals—with recurrent fainting spells and symptomatic slow heartbeats. In this approach, the ablation focuses on modifying the nerves to the heart rather than the cardiac tissue itself in order to prevent slow heart rates.

Best of luck to you.

@gloaming You have been helpful to me (and many others) in the past.

Amiodarone 200mg, once a day, was stopped October 1, 2025. Ablation was done October 8, 2025. Metoprolol was reduced that same day from 25mg twice a day to 12.5mg twice a day. Metoprolol was again reduced to 12.5mg once a day on January 7, 2026 and stopped on January 13, 2026. On January 7, I had an ECG which, among other things, had an interpretive statement: "Sinus Bradycardia with First Degree AV Block and Frequent PACs". I can attest that my sleeping HR now, having stopped Metoprolol, is higher (from high 40's to mid 50's) and resting HR is likewise higher (from low/mid 50's to low/mid 60's). All of that background for the following question: Since reducing and stopping Metoprolol 17 days ago, PACs have started and are quite noticeable at night once in bed (and make it difficult to get to sleep) and also noticeable when I wakeup in the mornings. Do you have experience or knowledge with these PACs? When I brought the topic up with my cardiologist, he dismissed it, saying the PACs were not "life-threatening". Not the response I was looking for. Thanks in advance for any information you can share.

Pump your legs before rising from bed. Get up slowly form sitting,

@vaughandodd Aw, shucks. I really feel badly when I see stories like this. Why, you ask? Because it's my story. Very briefly, I was sliding into nastier AF just weeks before my first ablation. Had it, and in six days I was in the local ER flat on my back with leads all over my chest and legs. AF had returned, but this time it was reeeallllly pissed off. I had to go on amiodarone for seven weeks. Told to stop it over a two week taper, which I did, but the AF came back. ER attendant said let's do another two weeks and then another taper. This was at 400 mg per day, 200 BID, and then a taper on 200 per day, or only the one tablet. This time, it actually worked. Then about a month later, I was walking holding my toddler grandson's hand in Calgary, visiting, which is at 3500 feet ASL I felt my heart go, used my Samsung Galaxy watch to take an ECG, and it reported, 'AF detected. See your cardiologist.' I got the results of my earlier Holter when I returned home two days later, and the nurse said, 'You have a LOT of PACs, but no AF.' She emphasised the word 'LOT'' and I heard it.

With that little personal story, I have since done some reading (I always try to learn more about each experience). It turns out that if one has AF in the blanking period, but only in the first three/four weeks, even out to Week 6, and then it stops, and the Holter shows no AF, that's a very positive sign. On the other hand, if you seem clear of AF until much later in the blanking period, if your Holter assessment near Week 12 shows either AF or many PACs, that's usually not a great prognosis for the weeks and months ahead. Later onset of ectopy and AF usually means you're headed for a touch-up ablation in the not-too-distant future. My frequent ectopy in the Holter suggested that my ablation had not succeeded, and a month later came the proof while holding my wee grandson's little hand.*

I don't like saying negative things. They can be hurtful, and they can cause a lot of anxiety. But ethically, with what I 'think' I understand about these things, I can't blow smoke on you. I think you should make sure your EP knows exactly what your ECG shows, and that the two of you should have a discussion about it. I think he/she should/might/would very much like to...offer you a redo. If nothing has changed about your heart's physiology, no knew information about the state of deposition in your cardiac arteries, no niggling worries about your mitral vale....then I don't see why you can't agree to try again. That, too, is my history. Second ablation has worked like a charm. In two weeks, today, I am three years free of AF.

* Just a caution about what I have posted. First, I have no medical training. I don't know you. We are two individuals who have widely different backgrounds and genetics. This is important because I have read posts by people claiming they had serious ectopy or AF for weeks after an index ablation, but here they are five years later and haven't experienced a single blip for the past four years. That means that eventually their heart settled down after....AFTER...their blanking period and all has been good. So, I may be flat out wrong about what I said about late onset ectopy....in your case. Time will tell. Please keep that in mind.

@gloaming Many thanks for extensive reply, including personal history. And yes, I fully realize you're not medically trained, but you have more knowledge on the topic(s) than I do, hence I reached out. A couple of additional pieces of information I should have included.

First, I had atrial flutter, not AF (but related), and my EP told me after the ablation that once he had dealt with my atrial flutter tissue, he tried to stimulate AF several times, with no success (bad wording on my part, I know), which he seemed quite happy about.

Second, in November 2025, I had a TRANSTHORACIC ECHO (TTE) COMPLETE which indicated an ascending aorta aneurism had grown from 4.3cm in September 2024 to 4.7cm.

Third, my cariologist is putting me in touch with a thoracic surgeon (but no appointment has been scheduled yet). Thus, the reason he appeared to be less concerned about the PACs. My opinion only.

Lastly, before I sent the message to you and Mayo CC this morning, I sent a message via portal to my EP group about the PACs. Unsure if they were aware of the aneurism, but they are now.

Thanks again.

@vaughandodd Whew, that's quite bit of bother there. But, it sounds like you have an informed and concerned team pulling for you.

I know that flutter is often the result of an ablation for AF, but I haven't looked to see if it also works the other way around. [Just did, and it does.] That kind of flutter is usually relatively easy to ablate.
https://www.aerjournal.com/articles/atrial-flutter-typical-and-atypical-review
I wish you the very best of luck in the treatment of both your flutter/AF, whatever it turns out to be when they ablate (if they ablate) and the repair of your aorta. I would love it if you would return and give us all an update in time. 🙂

I’ve had atrial fibrillation for about ten years now, well controlled with Flecainide, but this past spring began having episodes of being lightheaded. The episodes were only on standing at first, but quickly progressed to being present with any activity. A three day recording of my heart activity showed braydicardia and a junctional heart rhythm - with my heart rate dropping into the 30’s bpm. After 6 months my cardiologists determined that I needed a pacemaker. Since it was implanted I have been doing much better.