Persistent AF

[cicek]

HI all. I am taking 10mg Bisoprolol and Digoxin for persistent AF. I was due to have a cardioversion but as the meds seemed to be working I decided to swerve the cardioversion especially as I was told it was only a50/50 chance of success. My question is, should I take all the Bisoprolol at once? At the moment I take 5mg in the morning and 5mg at night (due to the tiredness during the day). I notice a few comments on here about it being better to take it all in the evening to overcome the sleepiness. Does this help get rid of that "flat" feeling during the day. Thanks.

[Hidden]

Hello cicek, I haven’t taken Bisoprolol for around 6 yrs now so not able to advise but was interested in your comments regarding the cardioversion. It’s obviously quite natural for folk to be apprehensive about any form of procedure on their ticker but it’s important to understand why a cardioversion is such an important part of a treatment plan for anyone with persistent AF. Apologies if you already know this but a cardioversion is the quickest and most effective way of finding out if it’s possible to return you to sinus rhythm and if it does, determine whether or not it makes you feel significantly better. It is not a cure, neither is it likely to last long but if you are lucky, it could last for a year or more. I’m not medically trained but as I understand it, if it does not work, it’s unlikely to make your AF symptoms worse because it does not alter the structure or function of the heart. Most importantly however, if it does work, even for minutes or hours, it does mean that there is a possibility that you will respond well to an ablation(s) if that’s a route both you and your Doctor decide to take.

So then you then need to decide whether or not finding this out is worth the risk involved in having it. Provided patients do not miss ANY dose of their anticoagulant in the 4 weeks prior to the procedure then the risk, according to them that know about these things, is deemed to be miniscule but it will be interesting to see what others say.

Hope this encourages you to re-consider the benefits a cardioversion offers……

[Zeinmassri in reply to Hidden]

I agree with you 100 percent my mother was diagnosed with AF and she was chemically diverted by choice and it put her back into rhythm and it’s been 10 years now and she is still in sinus rhythm I’m the unlucky one who has the stubborn Kind

[cicek in reply to Hidden]

Hi. Thanks for your response. I wasn't particularly scared of having the cardioversion and was given the choice to still go ahead with it. I did feel a little bit that the arrhythmia nurse was leaning more to me not having it when he said it was only a 50/50 chance of success. I have had PAF for about 15 years now and been in persistent for almost a year. My consultant did also say that the chances of a cardioversion working after that year is less likely to work. I did explain that `I didn't like the high dose of Bisoprolol due to how it made me feel. but nothing was suggested to me about lowering it. I have made my decision but will review it in the New Year. I don't get too many symptoms from my persistent AF and certainly don't get the awful feelings it like I did when in PAF. Thank you once again.

[pusillanimous in reply to cicek]

It's such a pity you have to mull it over, it makes you more so much more anxious. I have symptomless PAF, and on a visit to the cardio for a check, he said you are in AF at the moment, would you like me to do a cardioversion now? I had no time to think too much about it - I'm an extremely anxious person, was immediately admitted to the cardio ward, had the conversion quickly, a couple of hours later before I was able to analyse what was happening. All I recall was having the leads affixed and waking up with a tray of sandwiches and tea of the table beside me. In no time at all I was dressed and waiting for my lift home

[cicek in reply to pusillanimous]

Amazing. I'm so pleased you were able to get it done as easily as that and that it worked for you. As I am in persistent, AF when I saw the Cardiologist/EP I guess they could have done the same for me but other people are waiting for much more serious procedures especially since Covid. Obviously in the end I turned it down but had they done it on the day, it could, probably would, of course have been different. Stay well.

[Zeinmassri]

I take 10 mg of bisoporol once in the evening I feel like it helps me sleep better at night as my heart rate tends to go up at night and most of my episodes happen at night. What I don’t understand is how come you don’t want to go through a cardio version. I think it’s worth a try it would eliminate all the medication you are taking if it puts you back in rhythm even if it’s 50/50 the reward is far more greater than the risk. I’ve had over 10 cardio versions and two ablation trying stop taking meds and will continue until I hopefully beat this thing. Anyways I wish you nothing but the best but if you want my personal advice give the cardio version a try you have nothing to loose.

Good luck 🌹and I hope you feel better

[Ppiman]

I have read that bisoprolol soon reaches a "steady state" concentration in the bloodstream on a once-a-day dosage so there seems nothing to be gained by halving the dose and taking it morning and evening. 10mg is quite a high dose and it's what I had, with digoxin, when I had persistent atrial flutter in 2019. I was able to reduce it to, I think, 2.5mg and then to stop altogether after my ablation.

Steve

[cicek in reply to Ppiman]

Thank you. The trouble with a 50/50 choice is not an easy decision to take. Had they said 70/30 in favour then obviously I would have gone ahead. No suggestions of reducing my Bisoprolol but of course I can discuss this at a later date with them.

[Ppiman in reply to cicek]

I was lucky that my ablation came sooner than the planned cv. These things are all for symptom control, usually, rather than for protecting the heart. It’s tachycardia that can weaken the valve and ventricle, not AF or AFl, I was told. Is yours well controlled?

Steve

[cicek in reply to Ppiman]

Definitely AF. As I said I've had it a few years now. My rates once I went into persistent were very high and even at rest weren't coming down enough. Once I settled on the meds it seemed much more controlled i.e. doesn't spike much above 120 now even when I'm walking briskly with the dog. I've always had a very low pulse rate, particularly at night before AF and that is what they say they must keep an eye on now. Not sure how they'll do that while I'm in bed asleep without another monitor! I can still ask for a cardioversion if I change my mind but I really am feeling quite well other than the awful tired feeling (caused by the Bisoprolol) when I try to rest. Thank you for your reply.

[Ppiman]

Ah, I see. When I was on 10mg of bisoprolol I wasn’t able to separate what was causing what. I know that I felt very poorly but think a good deal of that was fear.

I wasn’t too clear in my post, I think. What I meant to say was that treatments for AF and AFl are to prevent persistent tachycardia, which is the more dangerous aspect of arrhythmias, I was told (once any clotting risk has been resolved). Treatments for the arrhythmia itself are, I gather, for symptom relief rather than because of risk to the heart.

Steve

[cicek in reply to Ppiman]

Yes, I was told that there would be no danger to my heart but that I had to be comfortable with whatever symptoms I was struggling with, which are better now than they were. Bisoprolol of course is know for causing extreme lethargy and I am on the maximum dose. Now I've been on the Digoxin for a few weeks too, I might even experiment with reducing the Bisoprolol to 7.5 mg and see how I go. Thanks again.

[seasicksurf]

I'm in US, where bisoprolol equivalent is metoprolol. When I was taking metoprolol as part of my PIP regimen for PAF (which also included flecainide), I was taking metoprolol tartrate for its "fast acting" effect. After my ablation 6 months ago I was put on metoprolol succinate for BP and heartrate control. The succinate is "extended release" so I take it only once a day.I understand the idea of each is to get the blood serum levels of the drug to the desired level in the desired time, depending on the treatment. It may be best to check with your doctor about taking your bisoprolol once a day versus what was prescribed (twice a day). You would likely not have the desired levels of the drug in your system if you are taking all the meds at once that what was supposed to be twice daily. Good luck.