Question about using Flecanide and Bisoprolol. Currently I am taking 100mg Flec and 1.25 Bis in the AM and 150 mg Flec and 1.25 Bis in the PM. I have been taking both meds for 4 years. When it was originally prescribed I was taking the Bisoprolol as a 2.5 mg dose in the AM but it made me feel horrible - felt like I had lead boots on and I was short of breath. My cardio agreed to have me separate it into 2 doses of 1.25.
My current problem is that in the last 2 months I have felt incredibly fatigued, dizzy when I stand up ( have almost fainted twice) and my resting HR is sometimes as low as 45. I wore a Holter monitor recently which showed that my sleeping HR is as low as 40. During the day my HR varies from 47-90 depending on what I am doing. My cardiologist does not see any of this as an issue . I do as it is hard to function during the day with these symptoms. I feel it is a med issue. ( I forgot my AM meds one day recently and had the best day I have had in the last 4 years- tons of energy, not dizzy. I didn't realize I had forgotten till the next day. I did unfortunately have a 4 hour bout of AFib that night which shows that I do need the Flec) I went to the Emergency Room a few weeks ago as my heart was feeling very odd. I was in NSR but had a low heart rate and the cardiologist on call said it the ECG showed a First degree heart block . He told me to lower the Bisoprolol to 1.25 mg daily as he felt that this was the issue.
The problem is my regular cardiologist does not agree and said I can fiddle around with my dose of Flecanide but not my Bisoprolol. He suggested that I should get to my family doctor to see what is wrong with me as it is not my heart. My family doctor agrees with the on-call Cardiologist and feels that I should lower the dose of Bisoprolol to 1.25mg. ( She is running a laundry list of blood tests to make sure.) My cardiologist had sent a note to my family doctor saying that I was neurotic and stressed and that there is nothing wrong with me. Luckily she has been my doctor forever and knows me well enough to know that I am not a neurotic or anxious person. She knows and respects the cardiologist who was on-call in the emergency room and said I should switch to him.
Now my question- is anyone here only taking 1.25 mg of Bisoprolol while taking 200 or more mg of Flecanide. I know that we have to take a betablocker when on Flecanide to avoid a proarrthymia. It is confusing when 2 cardiologists give different information so I wanted to hear your experiences and pick your brains about this. Sorry for the long post but I wanted you to have the background for my question.
Thanks Pam
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PamH75
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Hi Pam, definitely change your cardiologist, I had to and pleased I did. Suggest you discuss with the new cardio the risk factor (proarrthymia) in your circumstances of taking just Flecainide at 250gms without the Biso as the latter is very likely causing the problems.
My story: When diagnosed with Lone paroxysmal AF I was 60yo, because I had HR under 60 and lowish BP 110/65 my cardio said the usual accompanying drug would make me feel ill. I have checked twice with him that Flecainide on its own is not a dangerous issue for me. So 6 years in, he has been right as my energy/QOL just gets better, albeit with many lifestyle changes as well.
Thanks for your reply. It is so helpful to hear the stories of others and how they managed their AFib. I have always tended to low blood pressure and low heart rate but most doctors here prescribe a betablocker when the dosage of Flec is over 150mg a day. I am taking 250 mg so they worry about proarrthymias. I just am hoping that a slightly lessened dose would be helpful. My frustration lies in the fact that the cardiologist is ignoring my symptoms and awareness of my own body. I have seen him once a year since he became my cardiologist ( previous one retired) until now and have called him 3 times in the last 6 months due to change in my QOL/energy trying to see if we can figure it out. Each time his response has been it must be stress. Today I requested that my GP refer me to a new cardiologist so I will see what happens.
A 3rd vote for change your cardiologist. No doctor in this day and age should be dismissing a patient’s report of symptoms as being ‘anxious and neurotic’ but should be taking the symptoms you report seriously. You are the expert on you.
Any medication that is not improving your QOL or prolonging your life, in my view is redundant. I had stand up rows with cardiologists on taking Bisoprolol, thankfully with the full support of my family doctor who sees you as a person and more than a ‘heart issue’.
I also took Flecainide without Bisoprolol but I have to say there is a small risk of consequences but with regular monitoring they can be picked up. 4 years is a long time to be on those medications for. Have you considered other treatments or have they been suggested?
In the UK if your HR continues to drop on Biso then a pacemaker is suggested to compensate so that you can continue to take Bisoprolol to control a high rate in AF. Biso is a rate control rather than antiarrythmic drug and my understanding is that it is given to stabilise the high rate and BP, it will not affect AF directly but does stop tachycardia which triggers AF, unfortunately - so can a low HR.
I have tried other meds and have had 2 ablations (2011, 2013) which tamed my AFib to some degree but I need meds to keep it at bay. I don't feel the antiarrythmia med is the issue but that it is the betablocker. Working on getting a new cardiologist. I really appreciated everyone's feedback on this as I wanted to make sure that I wasn't over-reacting to his response and treatment.
PS - if a doctor wrote on notes or a letter to another doctor an opinion such as ‘neurotic and anxious’ then it would be cause for complaint here. Notes and letter should reflect facts and report what you say - not offer opinion of your psychological health.
Anxious and neurotic indeed, then he/she should try dealing ongoing with this condition, they would then quickly review their opinions.
Time for a change of cardiologist to someone who understands the human condition alongside their medical expertise. Please don’t waste time trying to work to their direction and find someone who you can feel confidence in. Best wishes.
I respect the professional and doctors who treat and advise us but unless they have in fact had Afib themselves they truly don't understand the huge impact it has on so many levels of our lives. I have had many doctors shake their heads at my attempts to use homeopathic remedies in conjunction with medical care and my search for 'my" triggers as we are all different in what might set it off.
My first response is to change your cardiologist as soon as possible. I'm quietly seething for you!
Secondly,yes I am on 100 mg flec twice a day and 1.25 biso at night. I have had a few weeks of breakthrough some kind of arrthymias recently ( under investigation ) but usually this regime works well for me. Any higher dose of biso drops my hr too low.
My breakthroughs tend to be in the evening or night so I want to take the 1.25 biso at night. My heart rate is definitely too low and is impacting my quality of life.
I really do hope it is within your power to change your cardiologist; I would be incandescent with such a description. I understand that the Canadian healthcare system is first-class but obviously not in your case. Is it still the case that in Canada it is almost impossible to get any form of private consultation? Some forum members do that to speed things along but then revert to our NHS. Hopefully your GP has more say in the matter and can refer you to the second cardiologist. Best of luck.
I have had great care over the years. I have had two ablations (2011, 2013) but my AFib is stubborn and can pop up for a few minutes to hours a couple of times a week especially if I am overtired. My previous cardiologist retired and I have an excellent EP but not considered high needs at the moment and he is pushing Amiodarone which I do NOT want to take. I have only been with this one for 4 years and until the last six months have only seen him twice. I am working on changing my cardiologist now that those who truly understand AFib ( us) confirmed that my reaction to his response is valid.
The Canadian healthcare system is first-class for life-threatening heart issues. Since AF is non-life threatening, it is downgraded, and in my opinion, somewhat neglected. I do not quite know if Ontario has some small avenue of private consultation, but in British Columbia, the courts have recently ruled to outlaw private clinics. We are the only country in the world that do that according to my research. The case is under appeal. I was a victim of the system being kept dangling while in persistent as the clock ticked away and my heart kept being remodeled. Finally at six months persistent, I packed it in and went to Bordeaux for a total of three ablations to get back to sinus. If I had not gone at six months persistent, I would never have been able to return to sinus because I was one of the most complicated cases at the six month persistent stage. All the aggravation , strain, and deterioration could have been avoided had I had an ablation at the paroxysmal stage. I strongly feel that our great Canadian health system which is notorious for waiting time accelerated my AF deterioration big time. I was capable of researching and solving the problem. But, there are hundreds of AF Canadian healthcare system victims walking around. I can only hope that either the technology greatly improves quickly to negate waiting time issues or the governments wake up or both. There is no room for substandard care for AF.
You have confirmed what I thought about (the lack of) private medical care in Canada. You picked one of the best places to go for your ablations, though. The French healthcare, both public and private is renowned for its excellence. My mother needed a hip replacement and in Scotland was left so long she was totally housebound. Our French friends investigated the cost of having the procedure done in France and it was remarkably reasonable. She ended up having it done in the UK but France was the next option.
Hi, can’t remember the doses I was on but I had them morning and night for years and years.... I then consented to an ablation which I had been frightened of having, now I am completely off all meds after 18 years.
I always think you know you own body, why don’t you for peace of mind go private just for one consultation to see if you can get it sorted. It’s awful when you get conflicting answers. I was told by one I needed a pacemaker then was told by another I needed an ablation. I went private and an ablation it was and the time he took explaining it to me was well worth the money.
Thanks for your advice Ursula. I have had AFib for over 20 years and have been on a variety of different meds. I have had 2 ablations , 2011 and 2013 and got some relief but my AFib is stubborn and though abated it is not gone without meds. I think it is the betablocker that is causing my symptoms. Glad to know that you had such success with your journey. It gives hope to all.
Verapamil is in the same class as Diltiazem. They are both dihydropyridine calcium channel blockers. Some EP's get used to one and prescribe only it. I have been on both, and, in my case, Diltiazem had more side effects for me.
I used Propafenone prior to my ablations and did have some success with it but eventually got break through AF. Haven't tried it since my ablations- are you AF free now?
Yes, luckily. I had one breakthrough for 5 hours at the nine month stage when I stopped , for 6 days, Propafenone which I went back on and have stayed. However the dosage is reduced from 3000mg x 2 to 150 mg x 2.
Hi Pam
I take 150 flec per day but with 1.25 nebevolol, bisoprolol sent my heart rate to low 50s but nebevolol is better low 60s usually and less fatigue so maybe ask for a different blocker.
I’ve was on flecainide 50mg twice a day and bisoprolol 5mg a day until my successful cardioversion in August. Was asked to maintain the same meds after it but my heart rate was in the 30s and I could hardly function. On cardiologist advice I halved and quartered the dose of bisoprolol for a few days but it made no difference. Cardiologist said to stop the bisoprolol and continue my other meds. Have done this and feel back to my pre AF self.
Congrats on your successful cardioversion and maintaining of NSR. I have had so many cardioversions over the years and two ablations in the last 10 years but only got a few years of no AF. For the longest time I had AF a few times a year which was not a problem. Currently it isn't the AF that is the issue, I have it but it is manageable it is the side effects from the betablocker that are impacting my life so much so I will need to figure something out. Thanks for the response. It is so helpful getting hear the experiences of others. It always me to go to the doctors with a plan that I know has been successful for others and that my experience with the betablocker is not in my head but one that many others have also had.
I was put on bisoprolol in hospital at 2.5mg daily. I could barely function and felt ill all the time. My go reduced it to 1.25mg but it made little difference. I was taking flecanide 50mg twice daily. In the end I had to stop taking the bisoprolol and was able to increase the flecanide to 100mg twice a day and have felt so much better. I can also take another 100mg pip if necessary. My normal heart rate is below 60 and the holter monitor recorded a resting heart rate over a period of time at 38bpm and that was before meds when I was under investigation for heart problems. My Afib is more stable without the beta blocker and I can function far better without it.
Thanks for the reply. I don't think I will be allowed to get off it completely as I take a much larger dose of Flecanide than you do and with the risk of pro-arrhythmias they won't consider it safe. I am hoping I can at lease reduce it to 1.25 mg of Biso taken in the evening. Hoping that might make a difference.
How condescending! I know you have had issues with the institution you're under. I do hope the situation gets resolved. It seems the doctors there do not want to be questioned about their treatment at all.
Hi In May I had a AF of 180 compound by SVT which took it up to 240. After this they put me on bisoparol 2.5 a day on top of my regular 200 mg of flec. I felt terrible depressed, fatigue , heavy arms and slow heart rate of 45 which made doing anything hard work. I talked imy GP into weaning me off it and immediately felt better. Had good three months of no AF until Weds when I went into fast SVT again. Lots of interventions until bisoparol stop it. But no way going back on it. Happy to self adninister if go in SVT again ....my EP won't be happy but need quality of life and take the risk . X
Thanks I know that the big concern is using Flecanide without some form of betablocker specifically due to the chance of pro-arrhythmias so I highly doubt I will be allowed to be off of it completely as I take 250 mgs of Flecanide daily. I am hoping to change to 1.25 of Bisoprolol and take it in the evening as it has a 10-12 hour half-life so by the time my day begins there will be less in my body and perhaps the fatigue will not be as bad. Should I have any AF with high rate I could take the other 1.25 of Biso as a PIP. I will see if I can convince the doctors to let me try this. I take Magnesium glycinate which helps with blood pressure even though my BP has always tended to be lower than average.
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