However as Bisoprolol is a rate controlling medication not a rhythm controlling medication I would certainly recommend you ask the question of your EP if you have one.
As a lay person I find it very strange that "1 doc say take 5mg a day and 1 doc say take 1.25mg". If your HR is below 60 at rest 5 mg seems a high dose although I can't speak as a doctor.
"I would certainly recommend you ask the question of your EP if you have one" seems a good suggestion to me.
Paul
Edit - just read your first post Matt.
"i was in AF at the time , my heart raced to circa 145bpm but i had no symptom's and even whilst in AF felt fine , ive had 2 further episodes both lasting 12 hours. i was told pill to pocket , which works when i take 5mg but since ive had 3 episodes in 2 weeks im now going with the advice of taking 1.25mg daily".
As above - I'm not a doctor but can understand the logic a little more now. I suggest you get the echogram under your belt on Thursday and move from there. There's nothing to an echogram by the way - totally painless and easy to have done. I'm sure you'll find out more soon and get some answers
Bad luck, eh? And join the club! Oh, and welcome to this little band of sufferers.
Beta-blockers can help keep a heart in normal rhythm, and, indeed, return a fibrillating heart back to normal sinus rhythm. They did me (5mg bisoprolol). As a "pill in the pocket", well, they take about 30 minutes to become absorbed and active, so that won't be a very effective way to use them (even though my GP recommended it, my cardiologist disagreed).
By keeping both rate and blood pressure down a little, they can help with anxiety as, for some people (me included!), this can be a major aspect of suffering with arrhythmias and, indeed, can itself be arrhythmogenic.
As you say, your echo-cardiogram will be very useful and, even more so if you can push for it, would be the gold-standard test, a stress MRI. You do need to know that your heart is in good shape and this latter test will help your doctors know just that, and better than any other.
In terms of dosage, bisoprolol is not linear in its effect, so even 1.25mg can be a significant and useful dose, and in a few people, it can be a high dosage if the body metabolises it differently from most.
You'll read a great deal about altering your diet and not drinking alcohol and coffee, no doubt, as you read around this. Keep in mind that no one knows fully why some heart muscles develop arrhythmias and that for many caffeine seems fine (indeed there have been studies that show that drinking coffee has no effect). Alcohol has been shown to be a possible cause of arrhythmias but, again, often isn't. It doesn't affect me or two friends but we do all drink very moderately.
What is less commonly investigated but which I think might be a cause of many arrhythmias is the physical pressing of organs against the heart. In many people, the oesophagus presses tightly against the top of the heart, and in others, the diaphragm is easily lifted up by a bloated stomach or a constipated bowel. These causes haven't been studied a great deal, but if you feel there's a digestive link to your arrhythmia, you'll find evidence for it.
Thank you ... makes sense to me. I often wonder whether my surgery caused aFIB issues for me as I later developed hiatus hernia, then surgical induced erosive gastritis and “high” constipation due to adhesions. Which specialist will consider that though as gastroenterologist says see surgeon, cardiologist (who I see for mild mitral valve stenosis) says see neurologist (dizzy/fainting episodes/atypical fugax) or in my case oncologist (Neuroendocrine tumours of the ileum) and EP (murmur/intermittent aFIB) also says see neurologist after explained felt intestines “rolling”. GP just thinks I have health anxiety as a cancer survivor. I think they are all Drs Don’t Know! You end up giving up on getting to the bottom of your symptoms so I guess I was lucky to get any dx on all my complaints which by the way were all incidental findings
Well - poor you, I say. You’ve been through t’mill, lad!
I think many symptoms elude doctors - partly because the body’s systems are so massively complex, I suppose. And the way doctors specialise in the UK knowing lots but only about certain parts of us is not always very helpful to us “whole” human beings. I’m currently seeing a cardio and a gastro and struggling to find what’s wrong.
Wife was also concerned over low resting BPM and had had no AF episodes in a year. Gp decided to cut her Bisoprolol from 3.75 to 1.25...result was 6 AF episodes in 5 months. Now up to 2.5mg and seeing if that reduces AF episodes but keeps BPM up.
All advice here is very good. Have the echocardiogram, discuss options and have a list of questions for when you get an appointment. As second try said - don't be shut down! Treatments for AFvin any case vary considerably because the condition itself is so variable. Ultimately, it's about patient quality of life. You're on a fact finding mission at present!
Best advice EVER. Don’t be shut down. LOL. You get 15 mins with specialists who are masters at evading answering! We can but try hence this forum is essential
Again no training in medicine. You dont say much about your general health and fitness levels. What I have learned from those well medically trained is if you have trained hard and have a naturally low heart rate. As you seem to have. You are more at risk. Seems unfair. But it seems to correlate with the large number of ex runners and especially cyclists. Just like me.
I was diagnosed in April, take rivaroxaban, and 5mg bisaprolol daily. Resting rate 48-51 ultrasound in 4 weeks! I’m high risk for stroke, hence the 5mg dose, so far only side effect is fatigue!
If the Bisoprolol is giving you side effects and is not preventing the afib then it seems to me to be counterproductive to take it every day. Especially as you have had so many divergent opinions. After the echo you will have more info as to what sort of state your heart is in. If all is well I would be inclined to question the usefulness of Bisoprolol every day and say you prefer to take it to lower the heart rate during an episode. Beta blockers do not just act on the heart but on all systems of the body. They can cause breathlessness due to acting on the lungs , slow the metabolism and cause weight gain and constipation. But they do help with anxiety!
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If you take the pill in the pocket only, what frequency and duration are your AF episodes?
Constant Ectopics. How to live.
Fear
AF and now coronary artery disease at 47. I recently had a CT angiogram and the results aren’t great. Back to being scared and worried.
Pride comes before a fall! Anticoagulant thoughts. 
