Atrial Fibrillation and long-term management with medication

@Maryamm22 Regarding switching to the "newer oral anticoagulants but worry that the latter cannot be stopped in the event of a bleed as quickly as warfarin can" - this used to be a problem and I held off switching from Coumadin for a long time, however, my doctors assured me that this is no longer an issue, so I switched to Pradaxa at the beginning of this year. It's nice not to have to test for my levels every month, but Pradaxa is significantly more expensive than Coumadin.

I am 72 and also in chronic AFIB. I am on Diltiazem and carvedilol and the blood thinner Xarelto. I switched from Coumadin to Xarelto about 7 months ago . I was also told that bleeding on the new blood thinners can now be controlled so I agreed to take it. I like Xarelto so much better.

I have mild afib for 7mo now...which I understand my heartrate is irregular (2 beats then a pause & repeats that) But my pulse & b/p are normal? The ER Dr said I didnt need blood thinner but the cardiologist thinks I do & put me on low dose of Eliquis. I see a bit of blood when I blow my nose tho.
I use kardia mobile to check if I'm in afib & I am 90% of the time! I worry its damaging my heart?

I have afib. Had it for a couple years. I am 77. I did not like the tired I felt with it. Was shocked twice but still had it, so had an ablation. Feel better. Have afib but only occasionally. Metropolol helps to keep heart in rhythm and Eliquis helps prevent stroke.

Hi @sassysally and welcome to Mayo Clinic Connect. I am actually on the same medication. How long ago was your ablation and how often is your Afib?

I had an ablation in July of 2018. After that had a-fib again starting in January 2021 six to max 10 times over the course of a year usually lasting no more than an hour. Now in 2022 I have had a-fib six times still lasting no more than an hour.

@kevkat73 -- If your pulse and HR are in the normal range; you're on an anticoagulant; you're getting check-ups every six months with an EP; and following your EP's recommendations, your heart will NOT be damaged.

Also suggest you make any appropriate lifestyle changes (quit smoking, exercise, watch out for stress, use a reasonable diet, sleep, etc... you know the rest).

Enjoy life!

/LarryG

I recently went through a frightening period of constant tachycardia (sleeping and at rest) for three weeks. Started out of a clear blue sky. Monitored in the ER for three hours (regular cardio sent me there after I called his office), I was told the readings showed constant tachycardia, but mostly in normal sinus rhythm!

The ER doctor told me I needed to follow up with my cardiologist as he didn't know what to do. I had no accompanying symptoms (breathlessness, dizziness, syncope - only the BP reading on my Apple watch, which failed to report AFIB. It said it couldn't check for AFIB while my pulse was in tachycardia).

In response to my query after returning home, my cardiologist said, yes, I could return to the gym and didn't need to come in - could wait over a month until my pre-scheduled appt with him for follow-up. A week's "event monitor" (requested by me) reported tachycardia (sinus tachycardia) and paroxysmal AFIB.

The tachycardia stopped after those three weeks, reverting to my usual rates during waking, sleeping and exercise. I kept a prior appointment at the Cleveland Clinic (after my tachycardia had stopped) - I'd wanted to discuss the Watchman Procedure with that doctor but also raised the issue of the strange tachycardia episode. That doctor wanted me to start with metoprolol (.25 mg) supposedly for the tachycardia and high blood pressure.

Only I do NOT have high blood pressure!! (He seemed to just assume it was a problem for me owing to my age, 76). I told him I had never been told I had high BP by other physicians, so seemingly reluctantly, he dropped it from my CHADD score. He still wanted me to use the metoprolol and see how it worked.

Answer - it was a complete nightmare. It dropped my pulse to 50 (without the new med, my normal had been ~ 70 BPM going about my normal business, and 50-60 at night when sleeping. No more AFIB than before the tachycardic episode (paroxysmal).

What was most terrifying was that the metoprolol made all exercise impossible. I've been exercising almost daily since I was 25 and it's of great help for my physical and mental health (my cardiologist said I was exceptionally fit for my age). As soon as I swallowed that single metoprolol, though, my pulse dropped to 50 in the day, with a blood pressure of 95/47. (Most often previously ~110-120/60). At the gym, I was on the point of passing out merely walking, while I felt dizzy and nauseated. Worst, all attempts at aerobic exercise were impossible.

I was gasping for breath, while barely managing to exercise at a fraction of my previous exertions (HIIT on treadmill and stairstepper). My pulse only went up to 80 at absolute most dropping rapidly when I stopped. Previously, it had risen to 150 - 160 at my "high intensity" point from a starting rate of baseline 70, repeated at my usual HIIT intervals of ten minutes.

I felt like I was dying - completely unable to exercise and even at a standstill, my pulse dropping to the 50s.

I have heard such great things about the Cleveland Clinic, but this medicine outcome was terrifying and if this physician insists on my taking a beta blocker, I will not return to him or this medication or anything resembling either one. Waiting to hear the results of my echocardiogram he ordered.

I had hoped to learn the origin of that period of tachycardia, but especially since it had already stopped on its own, I am frightened at his insistence on the Metoprolol. My greatest source of stress (and slightly elevated BPM and BP) is the use of that medication and the sense that the physician I saw was not paying attention to my history - especially, my past success at aerobic exercise (also weight lifting), and absence of high BP.

I guess I should attend to my son's reassurance - he was there - that "you don't HAVE to take it"!

I felt pressured and also anxious at the combination of his expertise (the Cleveland Clinic, after all!) and his inattention to my history, BP especially. I will never forget my terror at not being able to catch my breath, and complete inability to exert myself.

Waiting to get ahold of his assistant to discuss my experience, ask about the echocardiogram, and a few other issues. Meanwhile, I take some comfort from sharing this frightening experience to my peers here. Don't know where to go, but I'm holding decisions in reserve until I hear his response to the concerns I report here.

Thanks Larry for your reply.
I Am doing All that my (GP)Dr & Cardio require.
I appreciate your reply! 🙂

@realitytest this happens to me with beta blockers. My bp and heart rate drop and I am weak, can't feel my arms, feel strange.

I will tell you two things. I use diltiazem (calcium channel blocker) but ONLY when needed. This is called the "pill in a pocket" approach.

You could also try the beta blocker ONLY when you have tachycardia.

I read once on another forum- sorry cannot cite- that beta blockers are sometimes not good for certain types of afib. Diltiazem also lowers blood pressure so when I have afib with heart rate of 180, the ER does a diltiazem drip and watches my vitals. I have only taken diltiazem three times n 5 years-while I wait for the ambulance!