Beta blockers for rate control in permanent AF

Guidelines suggest a resting rate below 80, and a rate below 115 on exercise. For many who don’t exercise hard, this may well be achievable without medication. This will include those unaware they have AF, either without symptoms or who accept how they feel as normal when getting older.

The Race-2 trial from 2010 challenged these guidelines and concluded that so called “ lenient” rate control with a target resting rate below 110, was “non-inferior” to “strict” control as recommended.

I was looking in to this, because I was getting fed up with the side effects from Nebivolol which for me have been only marginally less than Bisoprolol. I weaned myself off the Nebivolol and my resting rate is between 70-80. I have more energy and nap less: my exercise tolerance is much better.

I like to exercise reasonably energetically in the gym, and often push my rate to 130 and don’t see that as a problem.

I don’t suggest anyone else in my situation should do this, but it may be worth discussing with your GP.

nejm.org/doi/full/10.1056/N...

The RATE-AF trial from Birmingham UK, revisits this and reports later this year.

[terryw]

Hi oyster, I found your information very interesting as I have over the last 18 months halved my Bisoprolol dosage causing me to be in continuous AF. The result on my quality of life has been better. I would be grateful if you could let me know of any further tests on this subject. One thing that I would find useful is how the results compared with a group that were kept in SR by higher drugs usage. TerryW

[Hidden in reply to terryw]

Hi terryw, I remember our discussion from 2 months back. I have provided a link to the NICE evidence base. It supports my impression that there is not much recent evidence in this area. If you click the link in blue in the article below you will get a long list of papers, some of which may be relevant. I have only today found this and have not read any yet. I can’t answer your second point and I too would like to know the answer to that.

cks.nice.org.uk/atrial-fibr...

[Hidden in reply to terryw]

RATE-AF linked below is a small study not yet reported, intended to facilitate and inform subsequent larger multicentre trials

clinicaltrials.gov/ct2/show...

[Hidden in reply to terryw]

My experience has been that my cardiologists aren’t interested in my permanent AF. If they had been, they would have realised how inappropriate it was to prescribe a high dose of Bisoprolol (subsequently changed to Nebivolol reluctantly by my GP) because my AF has never been significantly symptomatic. In the event, I took matters in to my own hands.

[terryw in reply to Hidden]

Hi oyster, Thank you for all the information. I will work through it. Knowledge is King! TerryW