Is it possible to live with symptoms without beta blockers and just have anticoagulent?

Hi there I have PAF and can live with it, other than the fear of stroke or heart attack.  I am seeing consultant next week and want to be clued up so I'm not fobbed off. 

In a nutshell I want to know if I can not bother with beta blockers and just mitigate stroke risk with anticoagulant? Or is there a clinical reason for the beta blockers other than symptom control?

Thank you


19 Replies

  • PS I don't want anything at all other than anticoagulant - ie also don't want ablation etc.  Currently having sporadic attacks most days for a few minutes to a few hours duration. Thanks again 

  • My understanding is that uncontrolled AF can result in cardiomyopathy and eventually heart failure. Beta blockers are the first port of call by doctors before rhythm control drugs are tried but it is generally considered a BAD THING to leave the heart uncontrolled. You must also understand that AF is almost always progressive so will increase in frequency  over time until it becomes permanent in most cases. Nobody can force you to take drugs  but do work from a position of knowledge  rather than fear or prejudice.

  • I agree with Bob - personally I'd try to keep it under control if you can. However, for certain types of AF beta blockers aren't a good solution and it may be better to take rhythm control. Ask your cardiologist. 

    You also need to consult with your cardiologist re anticoagulation. A cost-benefit analysis needs to be done based on your CHAD2VAS2 score. 

    Stay well

  • Look at SRMgrandma's posts on diet and lifestyle as it sounds like it might be possible to control it in this way. It might be worth trying for a while  if you are determined to avoid drugs and ablation.

     I would worry if I was having AF every day and wonder what it might do to my heart long term.

  • I don't know my way around this site very well, so just wonder if you could tell me how to find the posts you mention.  Thanks.

  • When reading a post, click on posts in top left.  Then click on community - again top left.

    Then click on followers box and you will see a search area where you can search for a particular member.  Type in SRM and her posts etc will come up. 

    You can then read through her old posts and she has a lot of stuff about diet and lifestyle.

    Good luck

  • Thank you.

  • Having suffered supposedly with PAF for 6 years and having been prescribed Beta Blockers for some 5-6 years prior to the onset of the PAF I have exactly the same thoughts.  In my case I can say that the increased use of beta blockers coincided my the increase in both the frequency and length of AF episodes.  Indeed in November last year I was switched to a Calcium Channel Blocker and my condition became intolerable with episodes every day for most of the day.  Since stopping the calcium channel blocker I personally have been noticeably better with relatively few episodes which last for fairly short periods.  I would therefor entirely concur with your thoughts, further there is increasingly opinion to suggest that the intake of these cocktails of drugs are more harmful than the condition, save other than the anticoagulant.  As recently as two days ago I consulted a cardiologist whilst abroad merely for another opinion. He pointed out that the biggest risk with AF was blood clots which when negated through the use of anticoagulants left the condition itself which is non life threatening.  Moreover, his conclusion being; if I maintain a relatively healthy life style and avoid triggers, stress, alcohol, caffeine etc it is entirely possible to live without aggressive drugs and ablation which is in its self an extremely invasive process which in a number of cases needs to be repeated 3, 4 or 5 times.  

    I would stress this is entirely my take on PAF and is not offered as an expert opinion. 

  • Cypbill I'm on the same page as you.  Anticoagulants are a no brainer but I am a relatively young woman with very young twins and a and the prospect of wading through it with the fatigue and depression and general brain fog potential of BBs is not appealing.   I would far rather try yoga deep breathing further improving my already good all round health and generally getting myself into a better place to really understand my condition and it's triggers.  Good luck to you 

  • I am interested that you readily accept the idea of anticoagulants BUT as  you say you are a relatively young woman does your CHADS2VAS2 score actually say you need them? If you have no co-morbidities and are under 65 your stroke risk is VERY low.

    I do , however, agree that changes to life style such as reducing stress, alcohol, reduction in reliance on meat products and an increase in plant based foods have been shown to be beneficial in reducing  AF in some people. Usual caveat, we are all different.

  • Obviously it's your body and you have to decide what's best for it in the short and long term. 

    But not taking beta-blockers could mean that the uncontrolled AF does progressively damage the heart to the point of no return.

    Your call.

  • Hi again Ahab,

    I'm trying to figure out the reasoning behind your question. Is it due to some sort of fear of being on beta blockers?

    When you speak to your consultant, there are different types of drugs that can be used to control the heart rate. Beta blockers are just one type. Different people get on better with different drugs - personally I found the side effects I had from the beta blocker Bisoprolol unacceptable so my consultant put me onto a calcium channel blocker instead. I immediately felt a lot better and have been on it ever since. Other people find it goes the other way round - they experience side effects with the calcium channel blocker and find the beta blocker better for them.

    Incidentally, in some competitive sports e.g. archery, beta blockers are banned because they can potentially improve steadiness of aim. Calcium channel blockers appear to be ok, but if you do compete, you would need to check.

    Re anticoagulants, my CHADSVAC score is 1 - just for being female. As a result, my consultant has not suggested putting me onto anticoagulants. I'm on Tildiem Retard (calcium channel blocker) for rate control and Flecainide for rhythm control. At the rate that your episodes are currently occurring, I would really recommend that you use some form of medication to control your heart if your consultant suggests it - you need something to increase the time between episodes and allow your heart space to rest and recover.


  • Hi and thanks to everyone for taking the time to reply.

    I am obviously still coming to terms with having a life long condition which carries considerable risks.  As a person who was never ill and never took meds I am trying to limit the amount and impact of them now and going forward. 

    The side effects of BBs strike me as potentially horrendous and those of ACs less so.  Obviously if the Dr tells me they're necessary then I guess I will have to suck it up but I'm not going down without a fight 😆. 

    My score for strokes is 1 but as my treatment is private I am aware that I can have them if I want and my Dr doesn't see any clinical reason not to. My bleed risk is tiny.  There is however family history of strokes.

    All this is new and horrid and I'm doing my best and I hugely appreciate any help or advice.  Have a good day all 

  • I feel that same regarding being blindsided by a lifelong condition, when I'm otherwise very healthy.  I am 69 & a 3 on the CHADS scale, so anti coagulants are definitely indicated.  It scares me.  I also have been on Veraprimil (a calcium channel blocker) for many years for "PVCs" which I now suspect was PAF.  I do have a prescription for Flecinide, but my EP says that managing my heart rate is more important, & that the occasional arrhythmia is not harmful if I can tolerate them.  I have not had a noticible AFib event for almost a month, although I do have some ectopic beats. 

  • Not everybody gets bad side-effects from beta blockers and there is no harm in giving them a try – and move on to an alternative if they don't suit you. One of the causes of AF is a slow natural (sinus) rate and beta blockers (as well as calcium antagonists and digoxin) make this worse. Flecainide does not slow the sinus rate and can be very effective in preventing AF – you can also take it just when required (the "pill in the pocket" or "pip" approach), if necessary together with a short-acting beta blocker. That way you take control of the problem yourself which a lot of people find very helpful.

    On anticoagulants, there is minimal risk unless the attacks of AF continue for more than 6 hours so if you only have short attacks you are probably safer without. If you are using a new-type (not warfarin) anticoagulant (NOAC) they kick in within a few hours so you could also keep them handy and start taking them only if you do have a longer attack.

  • Thank you, that was a very informative reply.

  • BBs are to control the rate. I have had PAF and was told to take 25mg metoprolol with 100mg Flecainide if I had an AF episode. Didn't take BB when not having an episode. Sometimes took Flecainide daily to prevent PAF from occurring.

  • Short answer YES - you will live.  

  • Absolutely you can.  My EP (who also afib and does not take any regular drugs for it) recommended using the beta blocker ONLY when I have an AF episode, so that's what I do.  Daily use of beta blockers can lead to persistent AF, or so I've been told.

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