I’m 70 years old, 8 weeks post AVR with an Edwards Inspiris Resilia and am currently in cardiac rehab. I’m blessed with a cardiologist and rehab nurses who understand my desire to get back to my avid cycling hobby and have geared a moderately progressive rehab approach toward that end. Because I had minor post op aFib, I left the hospital with metoprolol. Elliquis, and an amiodarone taper. After my 5 week follow up, they took me off everything but metoprolol. My cardiologist ordered a seven day Body Guardian Mini Plus event monitor which I’m now wearing to determine if my aFib has resolved so that I can come off of the metoprolol in order to allow my heart rate to respond normally to my rehab efforts. My questions are: 1) what are others experiences with post op aFib and how long it lasted; 2) any experiences with event monitors and the types of abnormalities they track; 3) the experience people have had with endurance activities like running and cycling if they needed long-term metoprolol use. The monitor company called me this morning and said they noticed an anomaly at 11 pm last night and wanted to know if I had any symptoms (I didn’t) before they forward the info to my cardiologist. Not yet knowing what it was is concerning but I’ll wait to hear from the doctor. In my monitored rehab over the last three weeks they’ve noticed no aFib or abnormalities while my heart is under load. Anyway, would love to hear anyone’s thoughts…..
Post Op AFib, Body Guardian Mini Plus Event Monitor and Metoprolol
- Thread starter morellib
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I came home from AVR with a pacemaker, an armload of meds (including amiodarone and metoprolol) and paroxysmal afib. I am now 12 years post-op. Prior to surgery (at age 63) I was running 3-4 miles daily, 5 days a week. Now, at 75, I still exercise 5 days a week, but at lesser intensity.
My initial metoprolol dosage was 100 mg/day of the timed-release version of the drug. It made me feel like I was pulling a sled full of boulders all the time. Over the first few post-op months, I negotiated step-wise reductions in dosage to my present 25 mg/day. (This was done about 4-5 months post-op.) Amiodarone was stopped about 30 days post-op, IIRC.
Since my pacemaker is radio-linked to the device clinic, it acts as a halfway event monitor. It tattles on me whenever I experience afib. If an afib episode is too long, the clinic emails me to start Xarelto anticoagulation therapy to prevent stroke. Year 11 after the valve surgery was the worst for afib, but it has settled down over the past year or so.
I hope you're different than I, but I haven't been able to run in years. Even with "just" 25 mg/day of metoprolol, I can't get my max heart rate up beyond the 140's, which is not sufficient for me to run. (When I was running, my max HR would be in the mid to upper 160's.) I still exercise 5 days a week, but have had to drop the intensity from running to speed walking. I have heard that some athletes have success with holding their daily metoprolol dose until after their morning exercise periods, but I never wanted to risk it. Also, I imagine that after having taken the drug for over 10 years, there is enough built up in my system that even if I were to skip a dose, there would still be enough there to suppress my heart rate.
My initial metoprolol dosage was 100 mg/day of the timed-release version of the drug. It made me feel like I was pulling a sled full of boulders all the time. Over the first few post-op months, I negotiated step-wise reductions in dosage to my present 25 mg/day. (This was done about 4-5 months post-op.) Amiodarone was stopped about 30 days post-op, IIRC.
Since my pacemaker is radio-linked to the device clinic, it acts as a halfway event monitor. It tattles on me whenever I experience afib. If an afib episode is too long, the clinic emails me to start Xarelto anticoagulation therapy to prevent stroke. Year 11 after the valve surgery was the worst for afib, but it has settled down over the past year or so.
I hope you're different than I, but I haven't been able to run in years. Even with "just" 25 mg/day of metoprolol, I can't get my max heart rate up beyond the 140's, which is not sufficient for me to run. (When I was running, my max HR would be in the mid to upper 160's.) I still exercise 5 days a week, but have had to drop the intensity from running to speed walking. I have heard that some athletes have success with holding their daily metoprolol dose until after their morning exercise periods, but I never wanted to risk it. Also, I imagine that after having taken the drug for over 10 years, there is enough built up in my system that even if I were to skip a dose, there would still be enough there to suppress my heart rate.
Thanks so much for your response! I see my cardiologist tomorrow to discuss all this so we’ll see where it leads. Day 22 of my event monitor and haven’t had any other episodes reported….
I am 64 and 1 1/2 yrs post avr with Resilia. I had persistent afib in the hospital which resolved completely but I did develop premature atrial contractions (like a extra half beat, usually 2 or so per minute that felt like my heart wanted to jump out of my chest). Wore a 48 hour monitor which confirmed the PAC's but showed no afib. I had Surgery in April and by Oct or so my heart settled down to a regular rate and rhythm. I was on 25 mg metoprolol before surgery for BP control, which was upped to 100 mg after surgery, which I continue, plus Eliquis, which was discontinued. I have no issues. I play squash and regularly get my heart rate over 150 and don't feel sluggish, etc. When I wear my iwatch I occasionally get an alert my HR goes below 50 (48-9), but no dizziness, etc. Otherwise all good. The heart needs 6 months to a year to settle after surgery.
pellicle
Professional Dingbat, Guru and Merkintologist
post surgery I didn't need metoprolol long term (prior OHS was late 2011), until May 2022 when for whatever reason (I speculate a dose of COVID that I was only mildly effected by, and only knew about it because my friend called me to say he'd tested positive) left me with (at first) very frequent ectopic beats which led to tachycardia (like starting a 2 stroke chainsaw that eventually runs fast like it should) to eventually just running fast all the time (fast is 140).
So in discussion I went onto metoprolol tartrate. I was asked (and engaged by the Dr because I wasn't just a turnip but engaged meaningfully) and said that I'd been on the tartrate before and tolerated it well. I also liked the effects created by the shorter half life (see below).
That graph takes a moment to get your head around because it has dose and reduction of HR in the same image to show the effect on HR of the dose load.
Further I've read that being on metoprolol (probably other beta blockers too) facilitates healing of the myelin sheath. I can report that some months in to this process that when (for whatever reason) I forget to take my morning pill, and am away for the day (thus unable to take it) that the resulting tachycardia is far less pronounced than when I did the same months ago.
I am presently taking 25mg twice daily (my pills are 50mg and I split them). This has resulted in meaning my mornings and afternoons can be my exersize times and in my warm downs (where previously sometimes my HR would never come back from 100 and would often then ramp back up again). This also means it is at a minimum drug load at the times I exercise and I can get to 160 if I choose (but I burn out fast when I go over 155).
HTH
Best Wishes
