Managing Atrial Fibrillation: Concerns About Heart Rate Variability and Medication

Arrhythmia, specifically supraventricular tachycardia?

Hello, Director: I have been experiencing arrhythmia for many years.
In March, I underwent an echocardiogram and a 24-hour Holter monitor, which indicated paroxysmal atrial fibrillation.
The doctor prescribed Rhythmol (propafenone) and advised me to start with one tablet; if there was no improvement, I could take an additional tablet.
After taking one tablet, my arrhythmia persisted, with my heart rate sometimes exceeding 120 beats per minute and at other times dropping below 40, along with irregular beats or missed beats.
While Rhythmol may help with tachycardia, if I take an additional tablet when my heart rate is too slow, will it cause my heart rate to drop even further? Could this be dangerous?

Liu Xiansheng, 60~69 year old female. Ask Date: 2022/06/11

Dr. He Dongjin reply Cardiology

Hello, a slow heart rate combined with medication that lowers heart rate may further decrease cardiac output, which could be dangerous.
Conversely, a rapid heart rate can be managed with medication.
Changhua Hospital cares about your well-being.

Reply Date: 2022/06/11

More Info

Managing atrial fibrillation (AF) can be a complex process, especially when considering the variability in heart rate and the effects of medications. Based on your description, it seems you have been diagnosed with paroxysmal atrial fibrillation and have been prescribed a medication called Rhythmol (propafenone), which is used to help control heart rhythm and rate. Your concerns about the fluctuations in your heart rate, ranging from 120 beats per minute (bpm) to as low as 40 bpm, are valid and warrant careful consideration.

Understanding Atrial Fibrillation and Heart Rate Variability
Atrial fibrillation is characterized by an irregular and often rapid heart rate that can lead to various symptoms, including palpitations, fatigue, and sometimes more severe complications like stroke. The heart rate variability you are experiencing—where your heart rate can be both excessively fast and excessively slow—can be concerning. It is not uncommon for patients with AF to experience episodes of tachycardia (rapid heart rate) followed by bradycardia (slow heart rate), especially when medications are involved.

The Role of Rhythmol
Rhythmol works by blocking certain electrical signals in the heart that can cause an irregular heartbeat. While it can help reduce episodes of rapid heart rates, it may also lead to bradycardia in some patients, particularly if the dosage is increased. If you take an additional dose of Rhythmol when your heart rate is already low, it could potentially exacerbate the bradycardia, leading to heart rates that are dangerously low.

Monitoring and Adjusting Medication
Given your experience of fluctuating heart rates, it is crucial to monitor your heart rate regularly. If you notice that your heart rate drops significantly (for example, below 60 bpm), or if you experience symptoms such as dizziness, fainting, or extreme fatigue, you should seek medical attention immediately.
Your healthcare provider may need to adjust your medication regimen based on your symptoms and heart rate readings. It is essential to communicate openly with your doctor about your experiences with the medication, including any episodes of rapid or slow heart rates. They may consider alternative medications or adjust the dosage of Rhythmol to better manage your symptoms without causing excessive bradycardia.

Potential Risks and Considerations
1. Risk of Bradycardia: If you are experiencing significant bradycardia, this can lead to inadequate blood flow to your organs, which can be dangerous. Symptoms of bradycardia can include fatigue, dizziness, and fainting spells.

2. Medication Interactions: If you are taking other medications, it is important to discuss these with your doctor, as they may interact with Rhythmol and affect your heart rate.

3. Lifestyle Modifications: In addition to medication management, lifestyle changes can also help manage AF. This includes maintaining a healthy diet, regular exercise, managing stress, and avoiding stimulants such as caffeine and alcohol, which can exacerbate AF episodes.

Conclusion
In summary, managing atrial fibrillation requires a careful balance of medication, monitoring, and lifestyle adjustments. Your concerns about the effects of Rhythmol on your heart rate are valid, and it is crucial to work closely with your healthcare provider to find the right approach for your situation. If you are unsure about the dosage or experience concerning symptoms, do not hesitate to reach out to your doctor for guidance. Regular follow-ups and open communication are key to effectively managing your condition and ensuring your safety.

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