I just want to feel better..

I was seen two weeks ago tomorrow by my EP after my last episode. He says that I'm now having some atrial flutter and started me on 25mg Metoprolol Tartrate twice a day. He said that my atrial rate was a little over 200 and ventricular was 160. Is this common with flutter? My EP continues to be very vague. And for the medicine, I don't feel awful but don't feel great either. I'm still having times where I feel my heart is racing and feel the fluttering in my chest. Other times I feel like a total zombie. I'm trying to give it a good shot, but if I'm going to take medication when I really don't want to, I want it to make me feel better all the time. Any advice or experiences would be great!


Atrial Flutter

by Gemita - 2021-09-15 11:19:57

Mae11, your statement “but if I’m going to take medication when I really don’t want to, I want it to make me feel better all the time” causes me some difficulty.  To feel better all the time might require successfully stopping your Atrial Flutter if it is causing your symptoms.

A beta blocker like Metoprolol (low dose 25mg) will help to control the speed of Atrial Flutter when it occurs and therefore should make you feel a good deal better, but Metoprolol is not a cure for Atrial Flutter.  An anti arrhythmic medication or an ablation if Flutter causes difficult symptoms would be the next step but both would be more invasive treatment and perhaps not as safe as staying with a beta blocker like Metoprolol.  As a Flutter sufferer, I would only recommend pushing for further treatment if the Atrial Flutter became more frequent or symptomatic.  Short runs of Atrial Flutter do not usually adversely affect me, but of course we are all different and perhaps even brief infrequent runs are causing you a great deal of anxiety and difficult symptoms, so please be guided by what your body is telling you.

Unfortunately all beta blockers can cause side effects.  I can feel sluggish on mine (Bisoprolol) and very tired at times but they are good at calming us down and calming our arrhythmias down too and are usually the first line treatment, unless an atrial tachyarrhythmia gets out of control speed wise or becomes difficult to stop.  This might then require a cardioversion, anti arrhythmic medication or an ablation.  

I see you have just amended your message, but I will leave my message largely intact.  Heart rates with Flutter can vary.  The AV Node slows conduction to the ventricles, preventing dangerously high atrial rates from ever reaching the ventricles, the main pumping chambers of the heart, especially since atrial rates can go exceptionally high with an atrial tachyarrhythmia like Flutter;  hence your 200 bpm in the atrium and 160 bpm in the ventricles reading.

I hope the Metoprolol controls your 200 bpm atrial rate.  No wonder you are feeling this.  You will start to feel better when these rates are under good control dear Mae11


by Mae11 - 2021-09-15 12:09:10

Thanks Gemita! I'm going to continue with the metoprolol for the time being. I honestly don't want to be my age and having to take a medication twice a day for what, the rest of my life? But if it is needed and will help help things, of course I will!

I guess it boils down to me still being completely overwhelmed by all of this.  There has not been one day since April 14th that I have felt 100% myself the entire day. And honestly, that's a little disheartening..


It may take time

by TLee - 2021-09-15 12:17:59

I can completely relate to what you are describing, from the episodes of feeling your heart racing to the zombie-like fatigue. It is very upsetting to not feel as well as you want, and it doesn't help that the reason is sometimes hard to pin down. Having a-fib or flutter can definitely lead to fatigue--I was told not just during an episode but even for some time after, while your body recovers. Then again, side effects of some of the meds to treat it may include drowsinessl. I did find that was true when I started taking metoprolol, but after the first couple of months it was not as severe. Just to show how confusing things can become, somewhere along the way I started an anti-depressant/pain reliever (cymbalta) that had me wanting to sleep 24/7. I pretty quickly figured out that it was the main culprit (somehow the sleepiness felt "different") & decided it was not for me. I  have been 2 1/2 years now trying various procedures & medications, and only now am I beginning to feel like we have found a combination that works. My last check-in with the cardiologist was great, and I just found out today that my blood work looks good, so no adverse effects from the meds. **I also felt misgivings about some of the medications, but once I started to feel a difference--and for me that was pretty much as soon as I started the metoprolol--I felt like there was a method to the madness. I still feel groggy at times, but I can push through & enjoy a decent level of activity. I understand that you want to feel better as soon as possible, and I really believe that you will. Give it time. I was about to add somethng about accepting our limitations as well, but I saw your age (same as my daughter!) & I am hoping that eventually you feel like the sky is the limit!  

Afib /Aflutter

by Theknotguy - 2021-09-15 12:19:38

Afib and aflutter can be tricky.  I went from being knocked down for several days in a row to not being aware I have the afib/aflutter.  For you that's the good news.  The not-so-good news is that it took time for my cardiologist and EP to figure out what would work best. The good news is there are a lot of medicines like Metoprolol out there and you aren't just limited to a few options.  The not-so-good news is that it may take a  while before they find what is best for you. 

It takes the body about a month to adjust to the new medication, then a few months on it, then another month to get off it.  If the medication doesn't work you get to go through the whole cycle again with a new drug.  That takes time and trying to be patient while you go through the process is nerve wracking at best.  

What they finally had to do with me was to give me a dosage large enough to slow my heart down below what would be a livable level, then use the pacemaker to bring my heart up into "normal" levels.  Like you I didn't want to take the medication at first, but going into an afib/aflutter session that would leave me flat on my back for three to five days while gasping for breath wasn't any fun at all.  Then I went into a session of afib with  RVR.  All I could do with that was gasp for air, try to keep my heart from bursting out of my chest, and pray for a quick death.  Absolutely no fun at all. Between afib with RVR and taking a pill, I'll take the pill.  

The even better news is they have my afib/aflutter under control and I lead a "normal" life.  It just took them a while to come up with the correct combination.  I feel they can do the same for you but it may take a little time.  

Otherwise, I hope your adjustment to your pacemaker goes well.

Atrial Rates

by Marybird - 2021-09-15 12:36:12

Not an expert here, but according to the available sources on afib/ atrial tachycardias, including the pacemaker, and programmer manuals available on the manufacturer's websites ( Abbott/St. Jude specifically), atrial rates indeed can and do go well above 200 during aflutter and afib incidents. These rates, thank goodness, don't generally make it to the ventricles thanks to the " governor" action of the AV node, so the ventricular heart rate ( which is the " heart rate you feel, measure with a pulse ox, watch, blood pressure monitor, whatever you use may be half, a third, or a fraction of the atrial rate.

From what I've read from those manuals, pacemakers can detect atrial rates, and these are documented in the pacemaker monitor reports your doctor gets, along with the number and length of time for these "AT/AF incidents. So that is how your EP knows what your atrial, and ventricular ( those are reported too). 

The metoprolol acts as an AV node blocker, helping it to keep those high atrial rates from getting to the venticles, that's how it keeps your heart rate down. Sounds like your doctor started you on a low dose ( 50mg/ day) as is appropriate, Mae, but if you are still feeling those flutters it may be a higher dose of metoprolol would work better. But there are the side effects of the metoprolol, feeling like a zombie is a good description, which many people experience. Those feelings may decrease or disappear over time, but about the only way you'll know is to give it a chance to work, and if you need a higher dose to mitigate the flutters, you can see about that over time. 

I also have recently been diagnosed with afib, ( long history of SVT, atrial tachycardia, even a-flutter- ahhhhhh, these multi-talented hearts we have!l,, and I also take metoprolol at a daily dose of 150mg, along with diltiazem ( 360/day to control that along with controlling the blood pressure. I also still feel the flutters at times, but otherwise feel well. I've taken these drugs so long the side effects are minimal, limited to a couple hours of tiredness at times. 

Anyway, you will feel better. 

Thanks guys!

by Mae11 - 2021-09-15 13:24:01

Thanks guys! I'm prepared to wait it out and see what it is that I need. Waiting feels like quite a blow as a mom of three kids under 10 though. I'm trying my best to adjust and wait it out, but it has been tough.


by AgentX86 - 2021-09-15 18:23:33

AFL is a real pain in the butt.  As far as I'm concerned, it's far worse than AF.  An atrial rate of 200 is on the low side for AFL.  Mine would (does) range from 240 to the high 300s.  I had an odd problem in that my AV node was slow, so I'd go from a 4:1, to a 5:1, to 3:1, to 2:1, at random so it would feel something like AF and the "average" rate was closer to 80 or 90bpm. It was always in integer sub-multiples of of the atrial rate.  Yours isn't slow so you're seeing a much higher ventricular rate.  Mine was a PITA, yours needs to be taken care of ASAP.  The rate has to be taken down below 100bpm.

Metoptolol is usually the go-to drug to lower the heart rate.  Its purpose is to slow the nervous system down.  In fact snipers often take metoprolol to remove the "shakes" so their aim is much better.  Metoptolol is one of the safer drugs, which is why it's the go-to drug.  I can make one lethargic, particularly in larrge doses.  If this is the case, other beta blocker can be used (beta blockers end in "lol" just so you know what you're getting). 

I'm surprised they have you taking metoprolol tartrate rather than metoprolol succinate.  The latter is the slow acting form so usually only needs to be taken once a day.  If accurate dosing is needed, it can be taken twice. Both are "almost free" so I'm not sure why they prefer the tartrate.

Feel Better Soon

by MinimeJer05 - 2021-09-15 18:51:33

I'm sorry for your current discomforts and the pain and lowsy days that you have been having. I too haven't felt great and am trying to find "comfort" or "reassurance" in the fact that I have a great team of doctors, but it will just take time for them to figure everything out for me to return to normal.


I hope the meds start to have a positive effect on you and I encourage you to try your best to keep spirits high and remain patient. Nothing is worse for the body than anxiety and depression, which causes everything else to work harder. I know it's easier said than done (I'm currently a mess), but in good time you will recover and get back to your version of normal. 

best of luck 


Thank you guys

by Mae11 - 2021-09-16 10:56:30

I go back to see his NP on October 7th (the anniversary of my brother's passing) . I plan to just wait it out as far as the meds unless something drastically changes by then. Maybe as you suggested Agent, Metoprolol Succinate would be better. The fluttering does seem to be most often in the late afternoon early evening, between doses.

My atrial pacing was only 7% at my post op appointment. I would assume with this number being so low, most of the time it had to pace was when I would be having the pauses I was before. I just wonder if my heart rate dropping as quickly as he said it was on the event monitor could also be causing some symptoms. 

Maybe I am just grasping at straws. I just need to feel like myself again. 

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