Advice needed re bisoprolol as an anti-arrythmic (instead of rate control) per cardiologist recommendation. I have recently been diagnosed with PAF, “lone Afib”. See Forum link.
He prescribed 2.5mg/day of bisoprolol, though as I’m border line bradycardia upon my insistence I got the doctor to reduce to 1.25mg as a first step. I am in favour of the medication as my episodes generally come on during the day and therefore consider myself more affected by adrenalin (than vegal), which I understand this β-Blocker will help minimise. I’m initially taking the pill at night time as recommended on this board to minimise effects. I’m in my 4th day now and “so far, so good” with no symptoms. Next week I may go to day time use per patient sheet recommendations, and may split the pill for am/pm. Guess I shall have to increase the dosage to 2.5mg/day (per initial prescription) if I get any reoccurrence of episodes.
In course of research I have read a technical paper (Ishuguro et al, 2008) who discuss the anti-arrthymic benefits of this medication.
They say bisoprolol is normally taken for its rate control but they wanted to study its use in suppression of sympathetic activity in rhythm control. Apparently in this study over 62% of the participants eliminated their episodes from a 2.5mg dose. Unless I’m missing something, I consider them good odds! So, the questions are:
Q) Has anybody been successful in eliminating episodes by taking bisoprolol? If so, at what dosage?
Q) How long did it take for the drug to take effect?
Q) Thoughts on whether I should increase the dosage to 2.5mg/day only if episodes reoccur, or just hold out to give the medication time to take effect?
Thanks in advance
Vince
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Vince1001
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Thanks for that Pete. Agree its an old study but it was all I had to go on. Hence the reason (which I didn't make clear) in posting was to understand how the Forum feel about the chances of my success...
G'day Vince,
I was originally diagnosed with paroxysmal AF in Jan 2010, at which time my Consultant put me on 5 mg Bisoprolol. Original prescription was to take in the morning, however, this gave me significant side effects ( random and violent nose bleeds). I complained to my GP at the time and she got out her Book of Magic Potions and Brews and told me to take it at night. I did this and have done so ever since, all side effects disappeared and were not replaced with any other side effects.
The last few days have seen me suffer some Vagal issues resulting in my heart chucking a wobbly 30 hours ago. I managed to capture this wobbly on my hand held ECG device - the printouts of which are now with my GP. She has now prescribed me an additional 2.5 mg Bisoprolol and to be taken as a pill in the pocket, when needed when I lurch into another wobbly.
Prior to AF hitting back in the day my HR was around 88-92 bpm. Since going onto the 5 mg of Bisoprolol it is holding steady at between 62 to 67 bpm. Prescribed as a rate control drug. So, theoretically, This is a PIP technique and should help tame my heart a bit more as and when needed. My last full blown AF event was in the early hours of 18 Feb 2018. Prior to that it was 15 April 2015.
Today my GP very, very quickly organised ECG and blood tests and am being lined up for Holter Monitor and an Echo. So far she seems to be thinking that what I experienced was perhaps Atrial Flutter.
So, for me, this is the first time anyone has prescribed a small dose of Bisoprolol to attempt to settle occasional bouts of a wobbly. My original diagnosis by the way was not just for paroxysmal AF but that I was asymptomatic and could be in AF and have no symptoms! In other words its primary aim is as rate control, with PIP support on a needs must basis with the additional 2.5mg.
Thanks for your detailed reply John, which is very informative. I'm now realising how complex this whole subject is. It's great that you have identified the issue and got your doctor to react so quickly. Hope all goes well.
I was getting my hopes up that this medication would work, so if not so then as Pete says I will need to have a detailed conversation with my EP.
Yes, it is complex but clear your brain. then open it up - as you seem to be doing - and some of the AF mysteries will be revealed then you can start working on understanding them. Don't rush, plenty of time and we are all learning something all the time. Great resources for you on AF Assoc. website and its also worth noting academic papers ( not just in UK but from around the world, as you seem to have latched onto already) on this hydra headed monster we call AF. Y'know an amusing side to this is noting my grannies sayings we often use today to illustrate something , like .... 'one mans meat is another mans poison' - so what I am alluding to is that you will see on here posts from people who claim this that and the other. It amounts to the fact we are all different and respond differently to the diagnosis of this thingy AF, but we also respond differently to symptoms, triggers, medication the whole bit ....pity the poor Cardiac consultant who has to run the gauntlet of this and give an improved quality of life to the sufferer. So often you'll read that such and such happened to one person, yet some body else will almost give a reverse point of view.
This thingy is pure mongrel and what is good for one person isn't for the other yet ....there is always something to be noted and learned, no matter how tiny a bit of information. I personally found your technical paper very interesting. Thank you for sharing.
I have been very lucky since I moved to Cornwall, my first GP was almost a double of Doc Martin on TV and we got on so well and my consultations were almost a laugh a minute. His replacement is a woman I'd say in her mid /late 30's ........ much more academic. So in terms of my AF she was probably only just coming out of med school, so my real life AF experience is as long as she has been in practice. I haven't had many dealings with her in the past usually, my annual Bus Drivers medical .... but we have struck up a good working relationship and now she knows if I yelp, she knows to take notice. and that's what happened the other day and why she moved so fast - even surprised me given these challenging times we are in.
Anyway, good luck with the learning curve - there are some fine people on this forum with much more experience than me and their posts are worth following.
Bisoprolol caused me a lot more problems than helped. I fought taking it and should have trusted my own instincts.
Short answer - I very much doubt that Biso will have any affect in preventing your AF but good luck with trying.
I think AF is such a complex and mongrel condition that there is no easy answer but there is always hope. After 12 years of AF and doing the gamut of treatments - Lifestyle changes, drugs, ablation and Af always returned - I had a pacemaker inserted in Oct 2018, barely a flutter since after years of very symptomatic AF.
You just need to find something that works for you and maybe Bisoprolol will for you.
I take Bisoprolol for my PAF, prescribed 2.5 which I take at night, I also have spells of Bradycardia so I had a pacemaker fitted to allow me to take the Bisoprolol and avoid the associated low heart rate. I did find 2.5 taken in the morning to much at first so I went down to 1.25 at night then after a couple of weeks increased to 2.5 at night and I've had no problems since. My Cardiologist and arrhythmia team do say Bisoprolol is the best drug for the job as alternatives done work quite so well, previously when I tried it I couldn't tolerate it but this time round and with the pacemaker I'm doing really well. My brother in law who is in persistent Afib is also on it and he's had no problems since starting it.
My wife was finally diagnosed in hospital with PAF in December 2018 but had been reporting symptoms to her GP for the preceding 15 years which were brushed aside as panic attacks. She was started on 2.5mg Bisoprolol but felt her heart laboured so GP lowered this to 1.25. She was also put on blood thinners at this time. This seemed to reduce incidents of PAF but not altogether. As her hypertension was thought to be a trigger she was also put on blood pressure tablets. In August 2019 she was in AF for 7 days and started having chest pains so went back to the hospital. Eventually she self reverted and they upped her dose of Bisoprolol to 3.75mg and shes had no further noticable episodes of AF since.
So, in her case, getting the right dose of Bisoprolol does seem to have decreased the incidence of AF for now.
I think it depends upon the cause of the fibrillation. It didn't stop my atrial flutter, but it did, within an hour, put a stop to the attack of fibrillation I had following my ablation last June.
Re cause of my AF. It is most likely caused by stress/ stimulants hence I see adrenalin as the culprit. I've cut out coffee, alcohol and reduced my hill walking. In trying to decipher the triggers I've surmised it could have been the anxiety as to whether an episode would start from something rather than the trigger itself. (hope that makes sense).
Episodes generally start in the daytime. I have been able to clear episodes by entrainment (listening to heat beats) and slow breathing.
The AF is not caused by heavy meals etc and I've never had an episode start at night. None of the vagal methods (Valsava etc) seem to work in stopping an episode.
Note that I use a handheld ECG in conjuction with a oximeter that displays a plethograph to identify abnormal heart rates.
The high Mg diet has helped a lot in reducing frequency and strength of episodes, but obviously still a long way to go.
I'm personally rather dubious about the use of magnesium on the basis that it did nothing for me and no controlled studies seem to show anything meaningful, either - but, I suppose, everything safe is worth trying, even if it's a placebo and isn't a rip-off!
In my case, I have a feeling that the cause might be related to my anxious disposition along with the hiatus hernia / reflux issues I suffer from, with both combining to push the stomach high against the diaphragm and then pushing that into physical contact with the base of the heart. My GP felt this was the cause, but the cardiologist simply disregarded the idea.
Luckily since my ablation, the flutter is now a thing of the past and although I have plenty of ectopics, all seems well with my heart. The one issue that never has gone away is the lack of energy that marked the period when I had all this trouble, although my insomnia and age (66) might be at the root of that.
Hi I was diagnosed with paf early 2017 although I knew I had it long before. Two ablations later I still get episodes. After trial and error I found that bisoprolol definitely helped to reduce the fast heart rate and I returned to nsr within a couple of hours. I am now on 1.25 per day taken in the morning and have noticed a definite reduction in episodes. Not had one now for 3 months. If I do have an episode I take 2.5 bisoprolol as a pip. I know everyone is different but for me bisoprolol definitely has anti arrhythmia properties.
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