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AF Association
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AF and drugs

Hi all , have just joined this group. I was diagnosed with AF finally last year which I was so shocked about and feel so miserable, and have recently had an ablation , 3 weeks ago , wanted to know if this is meant to be instantaneous as, do not feel a lot different may be not quite as bad with palpitations, still cannot sleep as seems to be worse at night. I am on bisoprolol , Flecainide , and Apixaban, feel completely washed out all the time , usually very fit and lively apart from the palpitaions, and pre medications , any help??? out there please x x C x

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Hi and welcome to the forum.

No - it's not an instant fix, unfortunately. It can take 3 - 6 months, maybe longer, for your heart to recover. Take a look at the 'Recovering From An Ablation' factsheet here: healthunlocked.com/api/redi...

You should have been advised to take it really easy in the first few weeks as it's easy to overdo it; particularly if you were quite active and fit before your ablation (I know I did).

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Could it be the Bisoprolol? How much are you on?

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Hi , thanks for replying, I am on 7mg i have felt fairly groggy since I started in June last year , but I don't think anyone is willing to change it x x

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hi vernaloliver, Ian's suggestion is a good place to start as the fact sheet is very comprehensive. The other thing you need to consider is the effect that side effects from your medication may be having on your general well being. For many, there is little difference between the side effects of some drugs and the symptoms caused by AF. Fortunately, there are alternatives and it's possible that your EP may decide to reduce dosage or even stop some of them at your first review.

Side effects from apixaban for most people are minimal but this medication is very important and really must not be tinkered with without the approval of your doctor. I didn't have any major problems with Flecainide but others may. However Bisoprolol, from the comments we receive from many forum members, whilst being an effective drug for AF, is notorious for causing the side effects you describe .

You probably have an appointment scheduled to see your EP for maybe 3 or 6 months from the procedure and if possible, it would be better to be patient until then as medics prefer not to interfere with the healing process by tinkering with medication and more often than not, patients begin to feel better as the healing process kicks in. However, if it really becomes difficult to function, then contact the Arrhythmia Nurse attached to the hospital where you had the procedure or contact your EP's secretary to see if there is anything that can be done to improve your situation. Hope this helps.....

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Thank you you are very kind, it all helps x x

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What you are saying is all too familiar and Bisoprolol seems for many to make life feel an uphill struggle.

Be encouraged for there can be light at the end of the tunnel and the misery of not being who you used to be can disappear as things improve and you get the upper hand.

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Thank you I shall mention it at my review, was beginning to think that that was it really , your encouraging , thank you x x

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It is definitely not instantaneous. It can take many months for your heart to settle. Your EP will review it at your follow up appointment.

At 3 weeks you should still be taking it very easy and resting a lot, your heart has been through a lot.

To me a dose of 7mg Bisoprolol is very high. Bisoprolol is a beta blocker designed to control your heart rate. I used to feel lethargic on 1.25mg a day and it is really not uncommon for patients to feel very drained by it.

I suggest you contact your EP ir arrhythmia nurses and explain how you feel so bad, they may change the dose.

Hope you feel better soon.

Pete

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Hi Pete , thank you for your helpful advice, I think 7 is a lot too, I have learnt more on here in the 5 hours I have joined than a year pre and post op , Caroline

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Good morning. Like you I learnt most of what I know about AF from the wonderful, helpful people on this forum. I never understand why the doctors, EPs and nurses don't put us in touch with the forum. I discovered it by chance only relatively recently.

Re the drugs it seems we all tolerate them to a lesser or greater extent and in different ways. Flacainide makes my heart race and Bisoprolol makes my heart too slow for me to function so I took nothing post my 3 ablations and have been mostly good since the last one in Dec last year.

Hang in there - things will get better.

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Hi Jockstrap , did you reduce your own medication or was that doctors advice?

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I always discussed with doctor or nurse before changing my dosage. Only tried Flecainide once as it had been prescribed as a pip.

Tim

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As others have said, it may be the bisoprolol. You may have had the dosage changed a time or two. It affects people differently so there doesn’t seem to be a standard dose. I am on 7.5 mg per day and tolerate it well. Some people have difficulty with 1.25mg per day. Although it is the popular choice, alternatives are available, as indicated above. It is preferable to stick with the bisoprolol if you can but suggest an alternative to your cardiologist at your next appointment if you are still having problems.

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Just had another thought. As has been said, 7mgs is a high dose for Bisoprolol and this could cause changes to both your pulse rate and possibly your blood pressure since your ablation. They may now be too low. Certainly worth having them checked ASAP....

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It will get better, given time. I had a double ablation 3 years ago, I still have AF but it’s manageable, which it wasn’t before the ablation.

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Just to say hang in there! I had ablation in November 2013 (first and only). For 5 months I had lots of arrhythmias and bumps in the night but gradually settled. 5 years later I am still AF free and have my life back. No meds except apixaban.

My EP stopped bisoprolol on day of ablation but I think that’s unusual. However worth asking for a review of this.

Good luck and stay positive 🍀

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Have not yet had an ablation, but have changed from Bisoprolol to Nebivolol and hope to change the Flecainide as the higher the dose I take the stronger my AF becomes.

Di

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Hi - did the change from Bisop to Benivolol work for you ? And why do you want to move onto Flecainide if Benivolol is working for you ? I’m exhausted on 1.25mg Bisop and am trying to understand and considering changing to something else if appropriate!!! Thanks

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Nebivolol stopped the tiredness I felt with Bisoprolol but it is a rate control drug. Flecainide is for rhythm- hope I have that the right way round. I already take both Nebivolol and Flecainide but want to change the later as I feel I am having an adverse reaction to it.

D

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Thank you for that - I think I will try for a change to Nebivolol as I feel exhausted most of the time on Bisop- 🙌

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Recommended it to my brother in law and he hasn’t looked back

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I was taken off 1.25 of Bisoprolol after a few days as it brought my heart rate down dangerously low. It just does that- and does not stop the irregularity- get off it and try a bit of meditation or breathing techniques. We are all different and the B stuff is cheap so they seem to dole it out to everyone! It actually costs less the higher the dose!

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Thanks for taking the time to reply - I agree with you - it has my HR too low !!! It’s hard to walk away from conventional medicine - best wishes

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interesting topic. I started off on 5mg Bisoprolol, but my heart rate was in the high 40's. My GP lowered it to 3.75mg and it's now in the mid 50's. Still feeling tired though.I'm seeing the GP in a couple of weeks and wondered if I should ask for a change of drug or lowering the dose again?

Is mid 50's still too low?

Any advice appreciated.

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GP knows best- but my resting HR is currently mid 50s and I personally think it’s too low and has me exhausted!!! I try to walk vigorously for 30-40 minutes every 2nd day to get my heart working at higher levels!! You’re right - this is an interesting topic !!! I think you might try 2.5mg for a while to see how you get on / but I’m a surveyor not a GP or EP 😂

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I was taken off 1.25mg of Bisoprolol daily for the same reason as you. 45bpm during the day and 34bpm at night. Felt like a zombie. Not on any heart medication now and feel all the better for it. It makes you wonder...………….

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Gosh- your results trump mine though not sure exactly what mine was when the pharmacist took my pulse, told me to see the doc and get off the stuff immediately! I only took them for a few days but they still said they were useful as a PIP which they weren't! How are you managing on no meds at all if you have AF? I have paroxysmal and just have flecainide to take as a PIP when/if needed and it stops the episodes fairly quickly- I can spot it myself but check with a Kardia. I still get tired though - perhaps it's age (74) but am to have yet another blood test to try to find what might be causing that.

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Hello, We seem very similar. I am 70 and have PAF too. I was on Flecainide but my cardiologist took me off it because of my age. Nobody, including my GP, has been able to understand why he did this. He put me on Bisoprolol at that point and straight away I felt tired and I was still getting the missed beats and episodes of racing, irregular beats. I knew my day time heart rate was lower but had no idea just how low it dipped at night until I had a 24 hour tape done. He didn't bother to contact me or my doctor with the results but left me for a further 9 months until a follow-up appointment to tell me to stop taking Bisoprolol straight away as it was reducing my heart rate to dangerously low levels. I was disappointed with him about that. He has not replaced Bisoprolol with anything else. I have had a 24 hour tape done recently and my average heart rate throughout that 24 hours was 62 which is more like it and probably the reason why I feel I have more energy. He is muttering about a pacemaker but I shan't be putting myself through that without very good reasons why. I have missed beats most days but I haven't had an episode of rapid, irregular beats for hours on end since I stopped medication. I have had PAF for 29 years and I have seen so many medics in that time. They all have their opinions and favourite medications. You feel like a guinea pig sometimes...………………..

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Well, we are not that similar after all! I was only diagnosed just coming up to a year ago and have never been offered any monitoring except for the worst night of my life on ECG and blood pressure monitoring and different medics coming to talk throughout the night just after having been diagnosed by the lovely paramedics in the ambulance they insisted I be transported in from A&E in the nice local hospital to the nasty larger one (with a dreadful reputation!). I have only ever seen my "consultant" once for about 5 minutes and otherwise twice by one of his cardiologist minions who was not interested in me as an individual at all after I declined to have a test involving a radioactive tracer etc and they appear to have abandoned me now to my local bunch of GPs where one is fortunate to get an appointment in under a fortnight. An echocardiogram showed my hear performing just fine. I had to go to a lovely private EP who I found through this site in order to get flecainide which I only take if/when I get an episode of AF - he told me to get a Kardia which meant I had to get a smarter phone to use it with to check it was AF and not just irregular and slow etc)- but I don't take any anticoagulants which tends to annoy the cardiologists. If you have managed to live for 29 years with it, I should be more positive about my situation. It appears that a cousin of mine now over 80 has had it for 18 or more years with medication (including flecainide) and without problems but then he is male and drug doses are based on the average male! You could try some meditation or breathing techniques which are supposed to work as well as beta blockers for blood pressure which they are really for. I am interested to know why your consultant took you off the flecainide because of age? Were you taking it regularly? Bisoprolol is considerably cheaper!

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You may have hit the nail on the head mentioning the cost! I asked my GP why the cardiologist had taken me off Flecainide and he didn't have a clue and said lots of people older than me take it without any problems, so who knows? Having your first episode of PAF or AF is a shock and downright scary and the 'treatment' you received fell short of what you could reasonably expect. All the medics I have seen tell me that AF & PAF aren't life-threatening, which may explain why medics seem unconcerned when we pitch up at A&E. You will have had raised eyebrows over anti-coagulants because it is thought to reduce the risk of a stroke. I was on aspirin for donkey's years and then told it was being replaced with the 'new' anti-coagulants. I was put on Rivaroxaban which seems ok but the docs tell me not to cut myself badly as there is no way to stop the bleeding!!! I won't answer any adverts for a knife throwers assistant. There is an excellent cardiologist called Sanjay Gupta who works at York Hospital. He has several short videos on YouTube covering all aspects of heart conditions and some very useful tips. He is worth a try. Keep well.

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Yes, bisoprolol is cheaper the higher the dose- look it up! Rivaroxiban gave me dreadful diaorhea (?sp) which is a known side effect and I didn't get on with apixaban either. The 2.2% risk of stroke means a 97.8% chance of not having one! I'd rather not have bruising and/or nose bleeds which I got when I took that! I know about Sanjay Gupta but he failed to respond the time I tried to contact him. I have always had a healthy diet and been fit until a bout of shingles around 18 months ago. You keep well too!

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I am awaiting ablation but was having a bad time on Bisopropol. Insist on a change to Nebivolol. I did and I feel much better.

Good luck.

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Post ablation I only felt a lot better AFTER I stopped the drugs. Particularly the rate control which was 200mg diltiazem daily. As for bisoprol, I was on 1.25mg daily when I first was diagnosed AF, and after every tablet I was asleep in 40 minutes and felt dreadful when I woke up, so I cannot imagine 7.5mg! I only took them for 7 days before changing.

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7mg of Bisoporol - cant believe thats right - I would ask for that to be checked pronto - whats you pulse rate ?

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Hi it can be as low as 40 , but then when I am having an AF moment obviously more, I am only doing what the docs have told me to do , and to be honest when this all started I was on 1.25 , they just kept putting it up because it wouldn't improve but to be honest it got worse as soon as they started increasing it , I am usually very lively fit , have fun , now I am totally miserable and have no energy for anything , always falling asleep at the wrong time , when it comes to bed time I am agitated and cannot sleep at all , surely my consultant would question it if not right ? I have given up with GP , they don't listen to me tell me I'm depressed and want to give me more drugs to help that which is not really the case x

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Pulse rate of 40 is fine if you feel ok , but it could be that its the Bisoporol thats causing it - if its the AF thats not improving maybe they will up the Flec - you need to press this home so you feel better again !

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I would disagree with a heart rate of 40 being fine. It is if you are a world class athlete which the vast majority of us on here are not, I shouldn't think. A heart rate should be between 60-100 bpm so my cardiologist told me. I would be querying 40.

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I am only repeating what my cardiologist told me - it is low but as long as you feel fine with it you are ok.

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And as I said he should get it checked as maybe the Bisoporol

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My husband was put on Bisoporol felt terrible asked the doctor to change medication was told to persevere, changed doctor and cardiologist. Is on Sotalol now and can sleep more energy. Its your body keeping asking till you find what suits you everyone is different.

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I was on 2.5 mg bisoprolol after ablation and back to normal could hardly walk a few blocks had to keep stopping taxi back to A &E . They found nothing wrong except HR 33 and asked what med I was on .Told to reduce it by half 1.25 . My HR was 23 at rest so I stopped taking it altogether after a week or two HR back to normal 42 and above at rest and 10 times better .

Flex on large amounts pip felt groggy up to 24 hrs later.

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Hello, you don't say what your pulse rate is, I suspect quite low. It seems most cardiologists prescribe bisoprolol with Flecainide but mine said because my pulse was under 60 it would make me feel unwell dropping it even lower, so I am just on Flecainide. The downside with just Flec is that there is a chance you could get Flutter and a very high pulse, no one can say whether that is 1 in a 100 or 1 in 5! Good luck.

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Honestly, I'm horrified sometimes by the number of drugs the doctors flush into our systems, most of them with dire side-effects which in turn need more drugs to counteract them. A highly lucrative cycle of course but I don't get how many conflicting medications can help heal/stabilise/purify.

When I had my ablation four years ago, after four years of 24-hour AF, it was a four hour operation, fully conscious, excruciatingly painful at times, and concluding with an (unconscious) electric shock to the heart. There was immediate quietness in my chest. I could have cried with relief. I think I probably did.

After-op treatment consisted of 36 hours rest in hospital, followed the next day by a ten hour international flight. 48 hours after that I was back at my desk - the doctors said I'd be fine, and I was. They said 'stop Warfarin (which I'd been on for years) in 3 months', and 'stop Diltiazem (slows the heartbeat) immediately', 'gradually increase your exercise to normal levels in the next month (swimming 4-5 times a week)' and 'eat plenty of low-fat hi-fibre foods long term'. Sensible, simple self help really. That's ALL. And it's worked. Thank the angels I didn't put myself into the hands of a typical western medic who'd almost certainly have afflicted my system with the bio-stresses brought on by Bisoprolol, Flecainide etc. I guess I was lucky.

For those on a cocktail of drugs, I can only urge you to keep exercising the most important muscle in your body - the heart. Yes, even if your AF persists. A sedentary heart long term, almost certainly becomes a weaker, sicker heart. Ultimately the aim should be to free yourself of the drugs. The option is to submit to a lifelong sentence of medication.

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I’d love to know where you had this ablation experience. It sounds so different from what I experienced here in the US.

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I sent a message. Kindly confirm receipt.

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Yes, I received your message. Thanks!

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Hi. I had my ablation just over 2 weeks ago and I’m getting all sorts of side effects, all of which I’ve learned through this forum are normal. Sometimes wish I could reach out and cuddle everyone on here as the anxiety of being diagnosed with AF would’ve been horrendous without them. I’m on 1.25mg of bisoprolol and I’m tired most days, so 7 sounds high. Wishing you well and please stay in touch x

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My experience with a beta blocker (metoprolol) has been limited. I was prescribed PIP flecainide and metoprolol as a combined remedy. The flecainide for rhythm and the 25mg metoprolol to slow the heart rate ONLY during the PAF episode. I recall once taking a second metoprolol 4 hrs after the first when PAF has still not stopped. I felt the washed out feeling you describe. I’m no expert, but taking too high a dose of beta blockers washes me out. I don’t trust any doctor to prescribe the right dose for heart medication. To me both beta blockers and flecainide dosages seem to be patient-specific, which means the prescribed dose may be wrong.

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I tried to "like" what you had written but when I clicked on the "likes" it went from 3 to 2 - perhaps the powers that be have decided 3 is the maximum "likes" allowed! So I pressed again and then thought I'd just reply to agree wholeheartedly with you over us all being different and requiring patient specific dosages. I just take flecainide if/when required which gets my heart back to normal in an hour or so.

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Thanks!😀

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Hi and welcome. I had my ablation a month ago and felt the same way - that it wasn't working. I have to say that I feel much better now and the AFib episodes are much more brief. I'm on Amiodarone and Eliquis and metropolol (sp?) And feel tired from those on top of feeling miserable with afib. Give it some time, I know it's hard to stay positive, and remember that your body is dealing with the procedure and needs to just heal. And stress as we know doesn't help.

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Your very sweet Beady girl for taking the time to reply to me, I have felt so traumatised as I was told, my ablation took longer than most and had to have a GA , typical me , but I am a severe stress head which doesn't help , and being an ex nurse really doesn't help at all , so all your help and advice is so appreciated, no one can see our illness which also makes matters worse as people , unless you tell them which gets very boring , and I am sure the majority doesn't want to hear any way, so we all tend to suffer in silence , I have learnt so much over the past 2 days, and now don't feel I am the only one thank you , and I also hope your recovery continues in a positive manner x

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Glad to hear you are feeling better. How long have you been on Amio and at what dosage (if you dont mind me asking ). Can initially make you tired (especially in the evenings in my case) but once established symptoms may leave. I am on 200mg daily and suffer no significant side effects. Happy Bank Hol and good luck.

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Hi, I'm on 200 mg of Amiodarone. I've been on it since November, starting after my first failed cardioversion. I've noticed my hr these days is mostly in the 50s, which I'm not sure also makes me tired? I hope to be off of it permanently at the end of October.

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Fatigue is a listed side-effect and, as I'm sure you are aware used to slow heart rate, Amio for rhythm. I'm on Bisoporol and once again took me about a month for body to adjust. My HR similar to yours, get it to late sixties on brisk walk. Hope that all goes well in October and although it's of little comfort we are both on a small maintenance dose of Amiodarone. Good luck.

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If you are feeling tired and breathless on Amiodarone I would come of it as soon as possible Amiodarone is full of Iodine look up Amiodarone Induced pulmonary toxicity. See Stop Amiodarone.

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Unfortunately still the best med for rhythm. Side effects are lower on lower dosage.

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There are other drugs, do your research get a 2nd opinion, should only be used if life threatening. It has black box warning. Look up everdayhealth.com. Nearly killed my husband on a low dose.

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I felt exactly the same on Bisoprolol.As soon as the Doctor took me off this drug my health improved dramatically,ask for an alternative!!

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I omitted to mention the drug i was prescribed was Slozem 180 inplace of bisoprolol.Best of luck!

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Pulmonary vein ablation works by ring-fencing the base of the pulmonary veins with scar tissue to prevent the erratic beats that originate within those veins from getting out into the atrium and triggering afib. Ablation surgery creates a "burn" around the base of those veins that turns into scar tissue over 3-6 months. So until the scar tissue forms, you're still going to get afib. While ablation has a high success rate, it takes time to work. So try to be patient because you're going to be stuck in neutral for a while. I too was diagnosed about a year ago with paroxysmal afib. I have good days and bad days. On bad days, I get a lot of episodes and feel VERY fatigued by it. So you're not alone. Hang in there. Things will almost certainly get better soon.

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Hi and welcome. I just joined myself and am so grateful to have discovered this forum. I’ve been through that same adjustment, of being active, fit, and then feeling bad when I overdid it & went into AF post-ablation. Right out of the hospital, I rested a lot, curled up with my cat and immersed myself in coloring. Yes, one of those adult coloring books that is a craze here in the States. It was so soothing. Hope you feel better soon!

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Thank you for that , my advice that was given was take it easy for a few days then get on with it, don't fly for a week other than that? and when you are given stories by the professionals , about someone played squash after a week , and so on , resumed there football career, ? which I am not doubting at all, and I don't wish to continue with any of those but I do have 3 horses of which I ride 2 and have not felt the energy for that , but as everyone says, now, don't rush it , which I won't now I have a different perspective on it, but initially was led to believe , that s soon as you have it done are back to normal which I certainly have not been , a long way off in fact, and as I have said before , you look OK to others , a broken leg gets a lot more sympathy, thank you Nella, good luck with your recovery x

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The only advice I can give is to cut out alcohol altogether with AF. If I ever have an alcoholic drink I always get palpations ions. Don't worry too much just be aware of your lifestyle. My mother had AF for 40 years and died at 97.

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I had my first bout of AF when I was 30. I felt completely normal just with an irregular heartbeat (still the same 60 beat per minute-- but just irregular). It was cardio averted and I decided never to go through that again.

The next time it happened I left well alone and it reverted. Since then I have had many bouts and am in AF at the moment (and have been for 10 days now). Most of the time when in AF I don't know it is happening (although if I focus I can tell my heartbeat is irregular and some of the time I do get an unpleasant feeling -- palpitations I guess). I am very fit an healthy and over the years through a gradual, careful, process have found that I can live perfectly normally -- I don't modify behaviour at all because of AF.

Despite the fact that it makes no meaningful difference to me I have found it deeply upsetting - depression, anger, -- you name it. Plus at first I found it hard to sleep. Thanks to some of the comments on this site I have done better at managing the emotional side of this. Two things helped -- rather than "why me" ask "why not me" and also of the things you can get when old(er) AF ain't too bad?

I take nothing. Taking medication trades one benefit for a downside. For example I was told by two cardiologists to go home and leave well alone as the risks of taking an anticoagulant outweighed the benefit (some of the local GPs would have had me straight on the stuff). So if you have "silent AF" You may find it better to avoid medication. But each person must look carefully and thoughtfully at their own situation. For some people AF is severely disabling in which case medication is needed. If you don't have symptoms maybe you are best off it? The medical profession is still learning about AF and doesn't have the answers yet.

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Do you take Magnesium can help with AF very good for the heart worth looking up as our food now lacks this mineral in the ground but dark chocolate has magnesium some good news. I agree in what you say about GPs always pays to listen to your own body and get a second opinion. Stay Well.

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I took a look at my diet and decided I was getting enough -- I grow my own vegetables for example which includes spinach. Thanks for the tip -- good advice for everyone

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Dear Whiteface That is such a helpful comment, I have felt every emotion, from 0 to really wanting it all to go away , and as I said in one of my replies to someone, we look fine from the outside , I hate taking drugs, have felt worse since, and what started off as an innocent anxiety bout, through one way or another stress, management, drugs , I am where I am today , its just having the confidence, and not the well, perhaps I should have feeling, my days are better my nightimes are still rubbish x x Thank you x x

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Did a GP change the Bisoprolol to Nebivicol or a cardiologist? I'm on 1.25mg Bisoprolol and feel crap most days. I'd like to try Nebivicol but have no upcoming appointments with cardiologist.

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Check your pulse, ask a pharmacist to do it if unsure and get off the stuff if it is bringing your heart rate down very low as was the case with me on 1.25mg of Bispoprolol (and others above)- it's cheap stuff so docs keen to prescribe it!

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Welcome to the forum. I have certainly found it very helpful and comforting to message others. The medics may know the facts and figures but only another person with AF and all it covers really knows what it's like. Do you have any idea of your heart rate? I was on Bisoprolol, 1.25mg daily, so a really low dose but that still managed to reduce my daytime heart rate to around 45 and my night time heart rate to a low of 34. I felt under the weather most of the time and lethargic, which isn't me at all. My cardiologist took me off Bisoprolol and hasn't replaced it with anything else. I still have the occasional ectopics and fleeting episodes of rapid heartbeats but not as many as when I was on medication. Since coming off Bisoprolol I have much more energy and feel generally more like my old self. Don't sit and worry about any concerns. Get some answers for them. One good site on You Tube is Dr. Sanjay Gupta, a cardiologist at York Hospital. He has short videos for all manner of things under the AF umbrella and he is certainly worth a look. Look after yourself and good luck.

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