Sign-in to Ask A Doctor - 24x7
OR
Sign in with Google
What Causes Low Heart Rate In A Afib Patient?
Question: I'm a 58 yr old female and was diagnosed with Afib in my early 50's. I currently take Norpace. Toprol and warfarin. Since wearing my Fitbit I've keep up with my heart rate which runs mid 50's during the day and high 40's at night. Last night it was 42. Isn't that too low? Should I cut my Toprol from 50 mg to 25mg? I moved out of state and have not found a cardiologist yet. I'm am under the care of a family doctor
Brief Answer:
I would explain as follows:
Detailed Answer:
Hello!
Welcome on HCM!
I passed carefully through your medical history and would like to explain that your current heart rates (50's during the day and 40's at night) seem slightly low.
Nevertheless, it is not considered pathological as far as you have a persistent normal sinus rhythm, without any cardiac conductance impairment (heart block) and no clinical symptomatology is present (no fatigue, lightheadedness, dizziness, etc.).
Heart rate at night may slow up to 40 bpm while asleep and this is not considered abnormal.
But, I would also explain that Norpace (disopyramide) is mainly indicated for ventricular arrhythmias and its use for supraventricular arrhythmias (including Afib) is considered an off-label indication.
Furthermore, Norpace may exert several potential adverse effects (some of them dangerous, like heart block, cardiac dysrrhythmias, torsades de pointes).
Instead, alternative antiarrhythmics with a safer profile may be used (such as class IIIC drugs: flecainide, propafenone).
For the moment you may reduce Toprol to 25 mg/day, but my advice is to discuss with your prescribing doctor (when it will become possible) to see the opportunity of replacing Norpace with another more safe antiarrhythmic drug.
Hope you will find my answer of some help.
In case of any further uncertainties, feel free to ask me again.
Kind regards,
Dr. Iliri
I would explain as follows:
Detailed Answer:
Hello!
Welcome on HCM!
I passed carefully through your medical history and would like to explain that your current heart rates (50's during the day and 40's at night) seem slightly low.
Nevertheless, it is not considered pathological as far as you have a persistent normal sinus rhythm, without any cardiac conductance impairment (heart block) and no clinical symptomatology is present (no fatigue, lightheadedness, dizziness, etc.).
Heart rate at night may slow up to 40 bpm while asleep and this is not considered abnormal.
But, I would also explain that Norpace (disopyramide) is mainly indicated for ventricular arrhythmias and its use for supraventricular arrhythmias (including Afib) is considered an off-label indication.
Furthermore, Norpace may exert several potential adverse effects (some of them dangerous, like heart block, cardiac dysrrhythmias, torsades de pointes).
Instead, alternative antiarrhythmics with a safer profile may be used (such as class IIIC drugs: flecainide, propafenone).
For the moment you may reduce Toprol to 25 mg/day, but my advice is to discuss with your prescribing doctor (when it will become possible) to see the opportunity of replacing Norpace with another more safe antiarrhythmic drug.
Hope you will find my answer of some help.
In case of any further uncertainties, feel free to ask me again.
Kind regards,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
I do feel dizzy at times and become tired easily- could that be the result of my low heart rate? I've been on norpace for the past 4 year because nothing else seemed to work.s
Brief Answer:
Opinion as follows:
Detailed Answer:
Hello again!
I don't know what other therapeutic options (drugs) you have tried before, but as you are clinically symptomatic (dizzy, tired easily), then is necessary to follow the next step:
- perform an ambulatory ECG monitoring (Holter) for excluding/confirming possible cardiac conduction disorders or persistent severe sinus bradycardia,
- Cardiac ultrasound (ECHO) for reviewing your overall cardiac performance,
and discuss with your attending cardiologist on the possibility of replacing the above combination (Norpace and Toprol) with another alternative 9with less adverse effects).
Regards,
Dr. Iliri
Opinion as follows:
Detailed Answer:
Hello again!
I don't know what other therapeutic options (drugs) you have tried before, but as you are clinically symptomatic (dizzy, tired easily), then is necessary to follow the next step:
- perform an ambulatory ECG monitoring (Holter) for excluding/confirming possible cardiac conduction disorders or persistent severe sinus bradycardia,
- Cardiac ultrasound (ECHO) for reviewing your overall cardiac performance,
and discuss with your attending cardiologist on the possibility of replacing the above combination (Norpace and Toprol) with another alternative 9with less adverse effects).
Regards,
Dr. Iliri
Note: For further queries related to coronary artery disease and prevention, click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
Get personalised answers from verified doctor in minutes across 80+ specialties
