Your description of how afib often starts certainly fits my Mom’s history. Hers started when she was about 80? Initially controlled with cardioversion and medication. Gradually became more frequent until she was in it most of the time. She was on warfarin (early anticoagulant) for years. She eventually died from stroke at 93, but it was from vascular disease, not from throwing a clot from her heart.
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In my experience my heart will respond to exertion even with a beta blocker holding down the rate. It’s as if the drug and the body’s signals are in a “tug of war”.
I’m in afib all of the time and take metoprolol at a dosage that brings my resting ventricular rate down to the 60’s or lower. Here’s what my Polar monitor showed during one treadmill session:
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@x475aws. Perhaps it’s just me perusing web info on possible side effects of metoprolol, but some of the possible side effects are fatigue, drowsiness, etc., which is also part of what scares me off, too. Most of the time, my heart rate is fairly normal (72 bpm right now after a light cup (1/3 tsp) of Folger’s freeze-dried coffee). I had left exercise out of my doctor-recommended lifestyle list for dealing with Afib, but I’ll add it to that prev. post now. But I think I’ll wait to see if I get into all-the-time Afib before taking a beta-blocker. My PCP is keen on trying ablation - but that seems silly if 99.9% of the time I have nothing to monitor.
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Sorry to say that Afib tends to be progressive about 97% of the time. People look for lifestyle changes and triggers to stop it, but…it usually becomes more and more frequent and severe over years. No matter what. Early intervention through drugs or an ablation has the best chance of success. You don’t want this condition to develop! It’s horrible.
It’s not about your heart muscles or valves or blocked arteries or anything like that. It’s about the electrical impulses controlling your heart rhythms. Olympic athletes get afib. You can’t muscle your way out of in any more than you muscle or diet your way out of your poor eyesight. So think of it like that.
And by the way, yes afib can cause strokes. You REALLY don’t want that. I suggest being aggressive as this condition first rears its ugly head.
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I think it’s similar to the fact that a good body weight can’t keep you from dying. However, controlling your body weight can help prolong your life and help control various medical conditions. Whatever propensity you have to have Afib, controlling various factors can help minimize the chances of having an attack. You’re more prone to Afib attacks if you drink heavily and gulp your booze down in a few swigs, if you’re dehydrated, if your potassium levels are low, if you’re very sleep-deprived, etc. My wife is a board-certified internist who, by her practice, is essentially a geriatrician. She said when I asked her just now that control of lifestyle factors can moderate the propensity of your heart to engage in episodes of atrial fibrillation. Just do an Internet search, for example, on whether alcoholics are more prone to suffer atrial fibrillation. That’s a lifestyle factor that damages your heart… I only drank in moderation (45 ml of 80-proof vodka a day), but both an RN practitioner and my cardiologist advised me to give up drinking, saying alcohol is a cardiac poison. So I did.
Edit_Update (from UCSF Medical Center): Alcohol Can Cause Immediate Risk of Atrial Fibrillation | UC San Francisco (ucsf.edu)
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I imagine your doctor wants you to do something because of the ventricular response to your 2nd noted AFib episode. It isn’t so far from there to dying. Or getting in the paper as a driver who lost control because of a medical condition.
Metoprolol is a very benign drug. You might have no trouble with it, or any side effects might go away as you adapt. If it doesn’t work out, stop taking it and it’s gone. And it’s cardio-selective, so doesn’t mess up sexual function like non-selective beta blockers.
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Although I think it’s generally better to follow doctor’s advice, I don’t think Jim’s choice is particularly unwise. It’s quite possible that the dose of metoprolol that Jim would tolerate when he was in sinus rhythm wouldn’t be enough to keep him out of atrial fibrillation or keep his rate low enough if he did go into atrial fibrillation. My Mom ended up needing a pacemaker to tolerate an adequate dose of metoprolol. Her rate in atrial fibrillation was fine but if she would convert to sinus her rate would drop into the 30’s and she’d be lightheaded. A pacemaker was a good fix, but since Jim is basically fine more than 99% of the time, not taking metoprolol seems like a reasonable decision. Ablation can be useful, but in my opinion has been oversold. It often doesn’t last and people still end up on medication.
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Fooling around with self medication or worse taking advise from internet ‘experts’ is a disaster waiting to happen.
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Yeah @Morgan1946 I very much appreciate your concern, but some of us have little or no choice in the matter, and self medication might possibly be my only option… I use Propranolol 40mg twice daily, as proscribed by the doctor, my problem is with this medication, if I take 2 tablets a day, my heart will be around 44 bpm, that’s way too low, so I monitor my heart rate frequently, and try to stay between 65 & 70 bpm, this means cutting the dose to suit, I take 1/2 a tablet, if my sitting heart rate climbs to say over 90 bpm, if I leave it, it will climb to around 144 bpm, and too high! The list of side effects associated with Propranolol is horrendous, and I feel highly fortunate that I don’t appear to have many, perhaps my constant tiredness is a side effect? My body is more often than not, highly susceptible to side effects & allergies, even the likes of a simple drug like Aspirin will reek havoc with me, any longterm medication benefits, are usually curtailed by severe side effects… Now I am a double Sepsis Survivor, I had Post Sepsis Syndrome after the first bout, Sepsis left me with extreme anxiety, a legacy, I would wish on no one, and doctors here in the UK tend to keep you in the dark, and tell you very little! I have no idea, if I have Atrial Fibrillation, perhaps I do, perhaps I don’t? All I was told was, I would be on Beta Blockers indefinitely, because of my anxiety… Cheers Kev 
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@kevels55
My wife’s on 40mg for depression/anxiety. I’m on 10mg on demand, up to twice a day, basically to counter the negative effects I get from adrenaline. My blood pressure medication just isn’t enough for me right now, and need re-assessing. I have terrible white coat syndrome, which doesn’t help.
Peter
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Kev thanks for posting
What should minimum heart rate be?
Mine is low at night.
(My iWatch 6 will do ecg. That’s why I bought it. And heart rate. And blood O two)
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Yeah Peter, I’m not too keen on most doctors myself, I tend to avoid, or save up my various medical ailments, then hit them with a long list, all at once 
it’s been about nearly 3 years since I saw a cardiologist, she detected some sort of murmur, promised a follow up appointment, I’m still waiting… TBVH, you lose trust in the system, because of government cut backs on health spending, the whole Health System isn’t fit for purpose, it’s overwhelmed & understaffed, trying to just see a doctor, is a major problem, face to face, where I live, is almost impossible… And yes, I can go to a hospital A&E, and be seen fairly quickly, but I prefer to leave that for actual medical emergencies… For instance , approximately 6 weeks ago, I had a very large boil on the back of my neck, it was very painful, and creating sleep disturbance, could I get a referral to get it lanced, no chance, and after about a week of trying, I gave up, and did the hot compresses myself, thankfully it eventually burst, and I got it drained over a 2 week period… I reiterate, sometimes we have no other choice but to self medicate!!! my apologies for waffling on 
Cheers Kev
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Hi Dave, from what I have read, 70 to 75 bpm, is a good rested heart rate, for an auld codger like yourself 
Take care, Cheers Kev
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I agree with @Morgan1946 that the getting medical advice from people one doesn’t know on the internet is not a great idea but feel like I ought to comment. Regarding minimum heart rate: It’s a little bit like the old joke about how long should one’s legs be? Long enough to reach the ground. The heart rate should be fast enough to get enough blood to the brain to keep one from feeling lightheaded. For some it might be as low as 40, but 50 on up is more typical. Under 60 is officially “bradycardia” but many people do just fine with heart rates that are lower.
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On seeing a doctor, I listened to a podcast the other day that said that in the U.S., the average female lifespan is six years longer than the average male lifespan. Various reasons were given, but one of them is that males are more reluctant than females to see a doctor about a medical condition. (to relate this thread to the overall forum purpose, I wonder if the same applies to hearing problems, too!).
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Apparently females live longer in all mammal species. The article I read thought it might be related to having two X chromosomes (reduncdany) instead of an XY. My personal anecdotal experience was that women heart patients did less well than men at changing their lifestyles. My kidding on the square analysis was that it was because they didn’t have wives. With the men, their wives were always there asking how they should change their cooking, how much exercise their husband should do, etc. It was very rare to have a similarly concerned husband. In our society women are used to taking care of others, but not themselves. There is lots of discussion of why things are different but I haven’t run accross anything convincing to me.
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I’ve heard that hypothesized before. And then there is this recent article: Sex Chromosomes Hold the Secret to Female Longevity | UC San Francisco (ucsf.edu). Would that be similar to what you read?
Although mammalian females have two X chromosomes, during early development, one or the other is randomly inactivated, so each female cell will get the same “gene expression dosage” that a male cell with only one X to begin with would provide. If a male has a “bad” gene on his X, he’s screwed, as there is no X with a good copy. With females, it’s a crap shoot. If one X has a good copy, the other X a bad copy, there’s always a chance that in the tissue that gene is needed, (some of) the cells will be able to express the gene because it happened to be the X with the bad copy that was inactivated. X Marks the Spot: How X Chromosome Inactivation Gives Females an Advantage · Frontiers for Young Minds (frontiersin.org).
Calico cats are caused by this X-chromsome inactivation mosaicism of coat color in female cats. Only 1 in 3,000 calico cats is a male. Calico cat - Wikipedia.
X chromosome content cannot exclusively explain the longer female lifespan in the U.S. Besides males being less prone to go to a doctor early enough in a disease onset, another factor mentioned was that males tend to engage in more violent and more risk-taking activities. Men were more susceptible to COVID-19 than women, perhaps because women’s two Xs gave them a stronger immune system. Scientists may have finally figured out why women live longer than men (msn.com) (not the podcast I listened to but a similar explanation).
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I hope to see family doc soon
I’ve started taking BP again and heart rate
So I have talked about resting heart rate 4 times in the last year. Since I’ve fallen onto the treatment treadmill my resting heartrate has been 40 to 50 regularly.
She got me to take a stress test that eventually be came a recommendation for open heart surgery. I refused. Instead I accepted stents and have 3 my cardiologist is haopy
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That’s good you have now got stents Dave, my wife had a couple of stents fitted, after a heart attack, approximately 5 years back, she now does cardiac training 5 days a week… As @MDB says, heart rate, is such a variable, I guess it all depends on age, health and overall fitness levels, I am basically learning the ropes, but I am planning to do some basic improvements on my own fitness levels, like swimming, walking & outdoor bowls, going out and about on my e-Bike, nothing too strenuous, but enough to improve my overall fitness, fingers crossed 
Cheers Kev 
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