Heart Rhythm Conditions – Welcome to the group

Gloaming, Good info. I'll add mine to the mix. In 2024 I was racked by PACs - as many as 8 in a 30 sec smartwatch trace, which I calculate to be above 26% for my 60 bpm rate. The symptoms were there; I called them AF Lite. (I use AF as i've had diagnoses of both Aflutter and Afib). I was post ablation by 6 years. My AF is paroxysmal with infrequent AF occurrences however during the high PAC episode, I noted more AF sessions. I searched Dr Google which led to articles similar to those you cite although the Japanese study seems in more detail. I recall two points from the article search: 1. Frequent PACs are a precursor to Afib and 2. Best treatment is ablation. After presenting my traces to Ep he offered another ablation or a med - deflectilide, which I understand works like a chemical ablation. i was at the time experimenting with thyroid hormone levels with some success, so I deferred on his suggestions. Since, I have been successful with adjusting the levothyroxine level - the PACs and AF episodes have ceased. https://pmc.ncbi.nlm.nih.gov/articles/PMC2680813/
I'm an engineer with no medical training but here's what i would do if I were Greg, in conjuction with my EP:
1. Chase the hyperthyroid possibility. With a lot of PACs I had low TSH(hyperthyroidism); after adjusting my TSH to around 5, which is upper limit of normal range, the PACs and AF episodes stopped.
2. If thyroid isn't it then consider an ablation. THe reason I suggest that is I've read and heard from EPs that AF gets worse with age if left untreated. My ablation was cryo; I understand the pulsed field technology now available is safer and just as effective or maybe even more so as EP has less concern about damaging adjacent heart tissue or esophagus.

@pamandgreg Whoops, I don't know what I was thinking. Yes, the official report says you DO have bradycardia. I'm happy you caught that...and are paying attention more than I. (Where's that red-faced coughing emoji?) 😀

Bradycardia is officially any sustained HR measured that has a rate under 60 BPM. Many cardiologists think that number should be revised downward at least five points. This is because of the 'fitness generation' and their penchant for racket sports, running, cycling, etc where their fit hearts routinely are running below 50 BPM, often below 40...!!! And they're perfectly fine, no syncope or shortness of breath. What is not evident in the information you provided is how low, how long. And did you, during the measuring interval, feel any symptoms that could reasonably be attributed to 'bradycardia' when your monitor recorded the lowest heart rates? Does your heart respond readily to increase demand, such as rising to your feet from a seat and maybe climbing stairs to a bedroom? These are important questions that could mean your official 'bradycardia' is really of no consequence. But............if you have a history of stumbling, fainting, wheezing and feeling unwell, swollen ankles, etc...these could be signs of an HR that is simply too slow for your needs. And you have just posted that you do indeed have some minor episodes of shortness of breath. This could be ectopy or valvular function/deterioration problems.

chickenfarmer has lots of experience and learning under his/her belt, so do have a careful read, please.

I am sorry I misread your earlier statement. Sin in haste, repent at leisure.

My name is Nancy, have had afib occasionally for two years. Am on eliquis and metoprolol tart. Have been in afib for almost 60 days now. Dr wants to put me on sotalol but Im not sure about it. Would rather have cardioversion and stay on current meds to see if that works.

@nfsandf A cardioversion might work, and I can see why you 'd want to give it a try. I have no idea why it wasn't offered to you. Your long-term AF means that you may......important....MAY...have moved through paroxysmal AF and are now in long-standing persistent which makes it trickier to treat medicinally and through catheter ablation. The best electrophysiologists can probably help, but you'd need access to them.

This is just untrained me, but I would press hard for a single cardioversion attempt, and if it just doesn't fly from the cardiologist's point of view (I'd want that carefully explained to me so that I can put it to rest/poll another cardiologist/EP), have a strong personal reason for declining Flecainide, Sotalol, Multaq, or propafenone. Note that I have no idea if you have other comorbidities or cardiomyopathy, structural problems like valves that need attention....so maybe that's why Sotalol is a best fit for you.

Last point: AF is considered to be a progressive disorder. I don't know how you feel about just winging it from here and living with it, including if/when it becomes classified as 'permanent.' But, the progressive nature means it encourages what is called 'remodeling' of the substrate, the tissue below the endothelial linings of each of the four chambers. Their walls can become 'enlarged' or thickened, which tends to reduce blood volume internally. They develop fibrosis, and AF can affect the mitral valve adversely in time. I would desire to be free of that risk to the extent possible, so I would opt for either anti-arrhythmic drugs or a catheter ablation. I have had two of the latter, and have been free of AF for just over three years now.

@gloaming thanks for the feedback. Will be having more discussion with my cardiologist about my options. She did say I did not have rapid heart beat with my afib. Don't know if that makes a difference. I do not have other heart conditions.

@nfsandf Aah! So, for many/most who develop AF, their ventricles try to 'keep up' with the signals coming from the AV node, which is picking up on the spurious signals causing the left atrium to beat rapidly. When the ventricle is keeping up by beating rapidly, it is formally known as 'rapid ventricular response' or RVR. You don't have that....I'm guessing by your choice of words just above...or your cardiologist's. So, it is sometimes the case that there IS AF, but the left ventricle continues to beat at a reasonable 50-75 beats a minute...ish. For me, and for others like me, my HR was always well above 120 BPM, sometimes as high as 180, which made the electrophysiologist looking at my case blanch and immediately raise my Rx for metoprolol from 25 mg BID to 50. 🙁

@nfsandf

Have you seen an Electro-Cardiologist? (One who emphasizes work with patients who have irregular heartbeats, etc.? )
My first installed a pacemaker; did nothing; the second, did an ablation; cross my fingers, good so far one year in. I could feel my heart hammering in my chest, and I was passing out often...

Hi there,
My name is Vio, 77 years old.
Something strange happened to me in the last 6 months. In 2017 I was diagnosed with Bradycardia, my heart rate was 90% of the time less than 55bpm. Everything normal until last year. Had the annual EKG in October 2025, normal again, but I told my doctor that sometimes I have a short breath and I feel tired going up the stairs.
Had a Nuclear Stress Test in December '25 and was told I have Atrial Fibrillation. The Holter monitor worn for 7 days confirmed the diagnostic: "Afib all the time" ! Any thoughts how after years of Bradycardia my rate is now in the 80's and when exercising/fast walking goes over 100 ? Thanks in advance for any opinion or advise !

@loli My palpitations started with hypothyroidism and finally Hashimoto's. I have different kinds and agree that coughing stops the progression. I have had Holter monitors which caught Atrial Tachycardia but not Afib. I know when my TSH goes more hyper it gets extremely worse. I believe I was in my 20's but didn't know what it was and only got worse later in life.

Hello everyone !
I have asymptomatic a~fib.
I was at my primary doctors for a follow up on my change of BP meds and after taking my blood pressure 3 times , I was told I needed them to have an ambulance take me to the emergency room. Hours later after routine e ~ room tests I was s admitted into the hospital. I stayed 7 days. I was put on an IV of heparin almost the entire time and the last two days started taking metoprolol and warfarin also . Warfarin is a blood thinner to prevent clots while I’m in A~Fib. Obviously to prevent stroke or heart attack Sometimes I have shortness of breath but I also am asthmatic. I will use my rescue inhaler and that works for the shortness of breath. While in the hospital , the cardiologist was waiting a few days to see if my heart would naturally go back into rhythm but it fid not and was given a twilight drug and shocked back into rhythm. It worked, but do to me taking the Warfarin I have to go into the dr’s office to have my INR checked to make sure it’s between 2 to 3 once it stays at that rate then I will no longer have to get it checked. At present I don’t take the same dosage each day of the warfarin until it stays in that range between 2 to 3 which they test my taking a blood sample. At one of my appointments for the INR testing I had an EKE done and I was in A~Fib. It’s like a double edge sword , no symptoms but the heart is out of rhythm. Because I was shocked in the hospital two months prior th NP said that it would be too soon yo do another “shock “ procedure. I believe that there’s others out there ,that are asymptomatic and don’t have a clue what’s going on. Luckily I happened to be at the right place at the right time. I don’t think there’s any fix for this but I am actually going to see my cardiologist in 2 1/2 weeks and that is a question I will be asking him. I apologize for this long “comment” I know it’s more like a novella ! Have a blessed day !
The only thing I have a problem with is how to determine if my episodes with shortness of breath are asthma related symptom or a~fib ? In the past I have had episodes of breathing problems but not necessarily any wheezing to go along with it.