Heart Rhythm Conditions – Welcome to the group

@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. 🙁

@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 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.

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.

@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.

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.

Thank you for your insight and quick response. I do have one point that I don't understand; you said that the "results do say no bradycardia, evening with that one low reading"

That is how the results were communicated to me from my Cardiologist.

NSR 61.79% - meaning I was in "normal sinus rhythm" 61.79% of the time while wearing the heart monitor (1 month).

SBrady 33.40% - meaning my heart rate was below the target rate of 60bpm for 33.40% of the time during that same month time frame.

SVE 4.80% - meaning, I assume, that my heart was pausing as you described 4.8% of the time during the month.

I have experienced the pausing with both high and low heart rates but the occasions when my heart is slow tends to result in some degree of shortness of breath.

@pamandgreg First, I am NOT an expert in this...no training. None. However, I believe that SVE stands for 'supraventricular ectopy', meaning.....probably.....PACs, or premature atrial complexes. You get a pause, then a catch-up beat that is especially powerful and feels like a surge or a thump in the chest.

Those results do say no bradycardia, even with that one low reading. It depends on what you reported was going on at the time. When they read the data, they also try to match any recorded events of note. If you were asleep, or seated, slouched, relaxed, hadn't eaten in three hours or had a coffee or a soda with caffeine....a reading of 36 for a fit heart is not out of the ordinary. My HR would often fall to 38 after bounding up two flights of stairs to a washroom. Climb, sit on the john, waited 30 seconds or more, then took my pulse. 38. I call that a great recovery, not bradycardia. And when physicians took my pulse for some reason, they'd raise an eyebrow and ask, 'Are you a runner?'

Your 'burden' of SVE, if it is PACs, is not dangerous. Everyone has them, some more than others, and for some, who find them rising in both number and frequency, it often means a slow slide toward atrial fibrillation. I hasten to add that the burden can rise to a point where it becomes consequential if not treated, and this is where an electrophysiologist would want to take a look at your heart. Mostly, it is what you tell that person...how you sense the events, how they make you feel, and how much you'd really prefer to be rid of them, or at least to have their number strictly controlled. IOW, your symptoms matter....a lot. To most patients, THAT....is the real burden...not how many ectopic beats you get in a 24 hr period, which is how they decide when your burden is getting onerous.
https://biologyinsights.com/what-pac-burden-percentage-means-for-your-heart-health/
https://www.jstage.jst.go.jp/article/circj/85/8/85_CJ-20-1277/_pdf/-char/en

Hello,

I am a 63 year old white male whose Father had many heart related issues. I stay fairly active despite my age but have been experiencing more frequent periods of low pulse rate with usually "pausing" every 10 beats or so. Accompanied with those periods my breathing is more labored. Yesterday I had a nuclear stress test and was told I had no blockages. However prior to the stress test I wore a heart monitor for one month. I have attached the results from the monitoring below:

FINDINGS: 30 DAY EM (24 days) 12/18/2025-1/17/2026 AVG HR 61, MIN HR 36, MAX HR 143 NSR 61.79% SBrady 33.40% SVE 4.80% VE 0.01% Pause/Block < 0.01% 7 pt triggered events-no symptoms associated with Bradycardia NO AFib Minimal Ventricular ectopy SVT longest 12 beat sequence; fastest @213bpm 9 beat sequence both in the afternoon No new meds and no additional meds.

I understand that 33.4% of the time my heart was beating at less than 60 bpm. But I am not extremely clear on the SVE for 4.8% of the time. Is this the actual "pausing" I'm experiencing? If so what causes it and what if anything can be done to minimize / correct to the problem, and do these results WARRANT anything being done. I do exercise, (treadmill), pretty frequently so the max HR of 143 is understandable. Also are the 2 episodes of SVT of concern? I do not see my cardiologist until late May.

I appreciate any insight.

Sincerely,
Greg

@robbarts THere is significant correlation between sleep apnea and AF. If you haven't been tested I recommned that you have sleep test. I found a pulse oximeter that would record continuously during sleep and the resultant traces were quite intersting. everytime I hade a breathing spell my heart rate became erratic. UNfortunately the traces were only rate and not rhythm. My EP said that the results of the sleep study which showed mild apnea when I slept on my back was not significant enough to be the source of my AF episodes. I now sleep on my side and no more issues. My wife is also happier because I don't snore.
My EP took me off Elliquis after the ablation. There have been some recent studies which show that anticoagulats aren't needed for those post ablation. Not sure of your situation but recommend you read the studies OCEAN, ALONE-AF and ARTESIA and discuss with your EP.