Are beta blockers still regarded as (always) bad for Vagal Afib?

[BigArnie]

So, I am 10 days or so into daily Flecainide medication for the first time after 16 months of PIP and it has been a rollercoaster to say they least. 4 clear days and then 7 episodes in 72 hours followed by 1 a day three days. (This from my 'usual' 1-2 per week)

I discussed with my cardiologist today and he recommended going from 50mg x 2 to 100mg x 2. I actually agree with this as there have been a few positives such as fast termination of the (many ) episodes that have occurred and feeling more refreshed in the morning after sleep.

Reason for the question is that he remarked that if the 100mg bd doesn't reduce the frequency of episodes then he might add a beta blocker. I mentioned that I had read this might be an issue with vagal Afib, but he said this was not always the case.

[Reena09]

Interesting point. My EP tells me that bisoprolol is beneficial for Vagal AF and more importantly beta blockers are recommended with flec. My concern is that my AF kicks off at night and whether that is down to Vagal AFib so would be interesting to hear comments.

[Hidden in reply to Reena09]

My cardiologist seemed of the opinion that night triggers were depressants ie vagal and care needed with beta blockers, and flecainide only after a scan showed if there were any risks that flecainide would cause problems.

[BigArnie in reply to Hidden]

Hi Maddiegran, actually that is interesting. My cardiologist did say that he would need to run a full range of ECGs fairly soon, perhaps to see if the Flec was causing any issues that would warrant either stopping it or adding the BB.

[wilsond]

Hello

I was put on flecanide and taken off bisoprolol ( beta blocker,)when I was taken to A and E with a very debilitating episode of AFib. Stopped it dead

After a week I was knocked off my feet with what turned out to be flecanide induced Flutter!

So for me it was necessary to have both drugs. It seems quite common so you may be advised to . I'm not sure about the effect on vagal Afib but will read replies with interest as I suspect I get this .

Look after yourself

[BigArnie in reply to wilsond]

Thanks Wilsond, yes still no specific response on BBs and VF, but the inference of my question was based around various threads on this forum and elsewhere. Trusting my cardiologist that I don’t need it for the time being.

[Hidden]

I am sure he is right - follow his advice. I was told not appropriate in my case at the moment but all hearts are different, and in your case it is alongside flecainide. Good luck! Sounds so stressful

[BigArnie in reply to Hidden]

Thanks Maddiegran, yes it is stressful, but I am determined not to be beaten!

[Tricia239]

Well, I am not a newbie and so I feel acutely embarrassed to ask - what is Vagal AF? I have been

prescribed and taken various drugs from bisoprolol to flecainide to currently Sotolol and no one has ever mentioned vagal AF as opposed to whatever. I would be interested to know.

[BigArnie in reply to Tricia239]

Hi Tricia, Vagal Afib is one type of Afib believed to be caused by a misfunctioning of the Vagus nerve. It tends to be identified by the range of triggers that cause the episodes. This is an interesting article (read the comments too!) richardbogle.com/blog/vagal...

You could also just use the search function on this forum.

[Tricia239 in reply to BigArnie]

Thanks

[doodle68]

Hi Arnie 😊 I would defiantly take a BB with Flecainide if you can to help avoid other arrhythmias.

This video below explains things well ,,,

I am about to start taking Flecainide daily, just waiting for the right moment ,

youtu.be/0nEvNIAHIJA(Not working as expected?)

[BigArnie in reply to doodle68]

Thanks Doodle68. I had all the echo and MRI tests that said my heart was structurally sound, so I guess my only worry without the beta blocker, is if the Flec causes Atrial Flutter and then if that subsequently causes the ventricular problem mentioned in the video. For now I am not getting any flutter, but will definitely bear that in mind. I’ll trust my cardiologist on this one for now. I guess there is also the question of weighing up the benefits and potential risks of taking the BB as an additional drug and the potential issue with BBs and Vagal Afib in particular.

[Hidden]

Not suitable for ablation?

[BigArnie in reply to Hidden]

Honestly I just don’t feel comfortable with that option at this time. I am reasonably fit and healthy other than Afib, so I imagine it would be an option, but the cardiologist has not suggested it and based on the balance of my reading around the subject, I am preferring the medicating route - for the time being anyway.

[Hidden]

Such different approaches, it makes me very confused. Local cardiology department now doing ablations very early. I have only had 6 episodes in 4 years - 2 four years ago, 4 since June, not on any meds - triggers alcohol / night - saw cardiologist end August, told not good to take BB and hold off flecainide. My cryo ablation is this Friday - I turned down two earlier dates as I panicked! Wish me luck.

[djmnet in reply to Hidden]

Good luck. Let us know how you're doing after awhile.

[cuore in reply to Hidden]

Wow! Only 6 episodes and straight to ablation. Where do you live? Must be the States, certainly not Canada or the United Kingdom. My GP got me to persistent, and the one -visit cardiologist was leaving me in persistent, as has happened to two friends of mine.

[Hidden in reply to cuore]

Brighton, UK. My Af is paroxysmal, very fierce, only a few hours each time.

[cuore in reply to Hidden]

Yes. You would be paroxysmal if you had only 6 episodes total and they were only a few hours each time. I guess the "very fierce" got you fast tracked even though you are in the United Kingdom where it takes months for an ablation and many, many more episodes.

[Hidden in reply to cuore]

I dont think you can generalise about the UK, it seems to depend on your local cardiology department and I am lucky - there are long waits but they prioritise AF (much to the surprise of my GP!) and it is an excellent centre in a teaching hospital. Also, it seems advice about ablation has been changing with new research emphasising early ablation, which is a change in practice. I think three years ago I would have had a different outcome. I had two episodes in the context of a chest infection then none for three years so I took no meds. At the time I only had a quick private appointment (about to go to India so I couldn't wait!), told to take bisoprolol and anti coagulants should it recur, but it didn't and I wasn't keen to take anything.

This time around I assumed a long wait and rushed to a different private doctor who prescribed meds but said maybe an ablation soon, then three weeks later a 45 minute NHS appointment, that consultant said no meds apart from anticoagulants and early ablation. I turned down two earlier dates because I hate the thought but here goes...

[cuore in reply to Hidden]

You are absolutely right. I do not live in the UK, so I should not generalize about it. I also agree with your conclusion " it seems advice about ablation has been changing with new research emphasising early ablation, which is a change in practice." This new attitude of health professionals should help a lot of newly diagnosed patients. Good luck in your ablation.

[wilsond]

I had an echocardiogram to check heart was structurally sound prior to flecanide . All was well,and I did not have Flutter until a week after starting Flec. without BBs.

Sure your consultant has taken your circumstances on board but might be worth a double check

[BigArnie in reply to wilsond]

Hi Wilsond, out of interest did you also have an MRI or something else that was looking at the blood vessels? (I did have that in addition to the echocardiogram, but no idea if that would make a difference!)