Vagal AF and Bisoprolol

I'm curious about the comments I've seen mentioned in more than one thread, that beta blockers (namely bisoprolol) should not be taken if one has vagal AF.

If there is such a thing as vagal AF then I'm pretty sure I have it as all my recent episodes have started after eating a largish meal later in the evening than I usually do, or devouring a cold sugary drink such as J2O just before I go to bed. Needless to say, I do neither now.

However, I have been taking bisoprolol (2.5mg) for the last 5 years and have found it beneficial as my resting HR is high 40s to low 50s and my BP is usually below 120/80.

I am assuming this is because a beta blocker encourages a low HR and vagal tone late at night reacts to this producing AF? Is this based on any fact? I am not inclined to come off bisoprolol because overall I think it's doing a good job and I've seen no evidence that it is increasing my frequency of episodes which stands at around 2 to 3 a year. I would welcome any comments on this as one option open to me would be to drop the dosage to 1.25mg.

6 Replies

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  • Your bp is excellent but as you say the bisoprolol may be having an adverse effect on vagal af although you feel it is no worse. Certainly worth discussing with your gp to consider whether to reduce the dose and possibly pill in the pocket flecainide.

  • I'm not sure that a GP or Cardiologist would describe your af as vagal. Paroxysmal. Lone or Permanent or Persistent, yes. Vagal no. Vagal generally is an awareness of a trigger. Therefore prescribing a beta blocker to control HR would seem legitimate. I've been on Bisoprolol for 7 years but had the vagal triggers for 6 and half, no side effects at all. Thanks to a change of diet and lifestyle no AF since April 2015. My GP has tried to reduce the Bisoprolol but it failed to do the job. I'm on 5 mg daily, taken at night. My average HR is around 65.

    John

  • I had mixed AF - that is some vagal triggers - well a lot really - and some episodes with no triggers and no anxiety. I always knew when vagal as I had bodily sensations which was adrenaline like rush and what others have called a sense of doom.

    For instance I had to avoid driving down a particular hill on my way home because that would evoke a memory of a childhood nightmare and that always triggered an AF episode. Also some vagal manoeuvres would sometimes lessen or even stop AF episode.

    And sometimes I just had AF - no sensations, nothing would lessen or stop it. I was told that I had mixed vagal AF.

    I couldn't tolerate Bisoprolol, it made me very breathless and I couldn't reach a stable dose ie I needed a higher and higher dose to have any effect, I ended up on 10mg daily which made me SO breathless I said enough was enough. I had to taper very slowly and it took me about a month to come off it and I then felt SO much better. I refused to take it ever again, but I did for a short while after a successful ablation and had some very unfortunate side effects so stopped after a few weeks.

    My HR was also quite low, when not in AF, so I couldn't see rather reasoning in taking Bisoprolol every day although the one advantage was that it did help stabilise my BP.

    There is little known yet on the effect of Vagal tone on AF ans I know some doctors don't recognise it as a valid condition - I had signs of ANS dysfunction and my BP used to crash in AF so there was no doubt for me, it was my dentist who originally suggested I had a problem when she tilted me back to look into my mouth and I passed out - luckily she realised immediately what it was.

    My understanding is that the real concern for Bisoprolol is for those with asthma,

  • What I've read suggests that beta blockers are more likely to push one from paroxysmal to persistent or permanent AF. Who knows? My EP suggested I use a beta blocker ONLY when I'm in AF -- not routinely. I'm sure most doctors prescribe it for daily use.

  • I find that hard to believe. Prescribed drugs are meant to improve your situation, not make it worse, which going into permanent AF clearly is. If that was true, I wouldn't expect bisoprolol to be prescribed to anybody with AF.

  • I am not allowed to take Beta Blockers, as I have mild asthma. I took some once and I really felt breathless and horrible. I am on Diltiazem XT for my blood pressure, and it also controls my rate to keep me out of afib as much as possible. It is a calcium channel blocker. So from what I know is that if you have any breathing issues, do not take Beta Blockers; Calcium channel blockers are a better option as it does not depress breathing.

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