Hi everyone, Had my ablation last March and was told by the cardio to come off all meds apart from apixiban. I weaned of flecanaide two mths ago and now I have finished weaning the beta blockers. My bpm was a steady 60-65 whilst weaning but the last couple of days it has gone to 75-77. A couple of tachy episodes as well. Is this normal when finishing beta blockers? Could it be the heart resetting or is it something I should be concerned about? Took my last beta blocker two days ago. Thank you
Beta blockers: Hi everyone, Had my... - Atrial Fibrillati...
Beta blockers
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stoneyrosed
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I would say it is perfectly normal the way your heart is right now. For years it's probably had its beating restrained by drugs. I always imagine it as a dog that has been let off it's lead, at first it goes mad for a while but then it calms down. Hopefully it will then find it's new normal rhythm.
Jean
Thanks Jean, Yes I was hoping that’s what it is that’s happening. Thanks for reply x
Hi Stoney.
I’m currently weaning myself off bisop after ablation as well. Haven’t had any tachy episodes yet but my heart rate has gone up almost identical amount to yours. I had my ablation in august and have been weening off for last 3-4 weeks. I’m currently on a quarter tablet of 2.5mg so basically nothing and will be coming off completely next Wednesday 😬 both looking forward to it and 💩ing myself at the same time. My heart has definitely been protesting since I’ve come off but no where near as bad as I thought it would and like I say the heart rate is almost identical to yours both before and after weening.
How long did it take you too wean off the bisop? How much were you taking originally and how did you go about it?
Hope it goes well for us both 👍
Hi Elli, I was taking 2.5 bisoprolol and I cut it in half for two weeks and stopped two days ago, bpm gone from 60-65 up to about 75-77 slightly worried it might go higher and turn into af but so far so good. We have to do this Ellie otherwise what would be the point in having the ablation. We must put our big boy pants on, and do this 😁. Good luck 👍
😂😂 that is certainly one way of putting it. I totally agree though. In my eyes there’s not much point in having an ablation if your going to continue taking meds. Unless it is going to drastically alter your frequency of episodes. But for me personally the whole point of having the ablation was to come off meds and try to get back to some resemblance of normality prior to AF.
There is one thing that concerns me though. That is that there may be an optimal time to come off the meds and maybe a person can come off them too early in the process of the hearts rehabilitation of itself. This is purely theoretical of course and I have no evidence to back it up. I just worry that maybe coming off the meds too soon will put an undue amount of strain on a heart that is still healing? I am aware of the 3 month blanking period and docs/nurses I’ve spoken to are convinced that the heart “heals” within this time frame, however I do not think this is going to be the case 100% of the time if not even 50% of the time. I think everyone heals at different speeds and many variables need to be taken into account along with this.
With that in mind I do have this in the back of my head that maybe I am coming off a little too soon. As I do feel like my heart is still healing. My stamina is not even 20% of what it was and my heart does still ache and do all sorts of stuff that my healthy heart did not do before. But who knows what and why that is? Could actually be the drugs holding back the progression of my now “electrically stable” heart.
It’s very hard to say to be honest but this is the decision I’ve made and I just hope it’s the right one for the both of us 🤞🤞
I asked ny EP this very question post ablation. Picking up on the fact that our hearts and CNS/ANS are remodeling after the ganglia reflexive structures near the PV veins are destroyed/decoupled,....I thought wow, I really need to prioritize a lifestyle where I optimize this remodeling process. That would seem to mean I might want to remodel while not under the influence of heart drugs that change how it operates. My EP would not entertain the debate but simply said for me, the drugs were for symptom control and only that. I was welcome to come off or to stay on. I actually increased their use for a bit due to flare ups but ultimately have come off entirely due to side effects. Having said this, I can see the wisdom in leveraging meds during recovery to ease the heart into it's new normal. My over riding thought is that I want to let my body heal itself and trust the natural progression to it's own set points, it fhat makes sense.
Eps/cardios/docs are very black and white to put it lightly 🤣 they seem to only be interested in their specific field and then once they’ve done their bit they move onto the next one. Which is fair enough I suppose as with any other profession but it doesn’t help us much.
Interesting point you make about letting the heart remodel whilst not under the influence or having the support of meds. Makes sense when you think about it. Problem is so does the other side of it 😂 so bloody hard to know what’s right and the so called experts are absolutely useless when it comes to this side of things, in my experience.
Even the arrhythmia nurses, who you would think would be more in touch with the patients recovery and aftercare, due to the fact that they must deal with them daily, are pretty useless once the jobs done as well.
Don’t like to put anyone down and I’m sure there are many knowledgeable and decent ones but in my experience so far, anytime you pose any sort of question that’s even remotely in depth, you just get a very generic answer that defies logic or you pretty much just get told to get on with it 🙄
When did you have your ablation? How long after did you start to wean and how did you go about it? Which beta blockers were you taking and what dose?
My PVI Cryo-Ablation was Oct 6 (so 8 weeks ago). I had to come off for the procedure so I did a quick 'wean' in the week prior and then off for three days before ablation. Afterwards I tried to continue but my HR was easily 30 bpm higher than normal AND I went into PAC ectopic 'storms' that were unlike anything I'd experienced in my previous 20 year struggle with them. Funny how the trial by fire puts you in a place where what you thought was bad, in reality, is not...:). Those buggers finally resolved mostly by week 5 and I was under terrible fatigue and dizziness and metabolic down regulation as well as some depression and anxiety. I was on Atenolol (Tenormin) and at one point was on 25mg twice daily. A moderate amount. I demonstrated cardiac pauses which were not of concern but I was advised to bring it back to 25mg per day. I reduced this of my own accord to 12mg/day but even that was an issue, so I went to 6.25mg/day for a week and then quit. On previous weaning cycles it might have taken 2 months to get off a 50mg/day dose. Other than slowly reducing the amount, I have read in many places that it is wise to also alternate days....this rings true since my rebounds tend to happen squarely on the 2nd or 3rd day, so I think the ideal approach is to reduce by a quarter for two weeks, then another quarter for two weeks, then alternate days only, then reduce by another quarter on alternate days, and repeat until you are off. To entirely over think this I think if I ever do it again I'd reduce by a fraction for two weeks at a time and then when at smallest does I'd go every other day then every second day and then quit.....Either way I think there's still going to be that leap of faith at the end...
Sounds like you’ve had a hell of a time of it! good job getting through it though 👍 how long were you on the meds for before having to wean? I’ve heard that the longer your on them consistently the harder it’ll be too come off? I’ve been taking 2.5mg bisop daily for best part of a year yet? Not sure this can be considered a considerable amount of time when compared to some others on here who have been taking their tabs for 10+ years
I so resonate with what you said here about not having experience of how bad things can be ...till they are . And I like your alternate day approach. I think I'll try that on my next step of weaning.
Have to say my Arrythmia Nurse has been great. Had my ablation in April and we knew from the start it was only partially successful. I've reduced my 100mg Flecainide to 75 by cutting up my evening pill. I'm intending to try the morning pill at some point too. Takes much longer than you think. I'd even be prepared to take a 3/4 dose to start the process.
To be fair my arrythmia nurse is a lovely lady. Friendly and tries to be helpful without doubt. Just disappointed in the level of knowledge when you ask questions that, in my opinion, they should be able to give the answers too or atleast give a decent opinion on.
Glad you’ve got a good one. As I said there are obviously decent ones out there. I’ve just been disappointed with the level of medic staff in general that I’ve dealt with thus far on my AF”journey”.
Hope your weaning goes well 🤞 I’m currently down to a 1/4 dose of my bisop now over 3 week period. So far so good 🤞 couple fo hiccups but nothing I’d consider major. Coming off completely on Wednesday 😬 or may do 1/4 dose every other day. Can’t make my mind up 🤔
I have been so disappointed by the communication I have received since my ablation which was now nearly 9 mths ago, I have not spoken to anyone at the hospital since. I brought this up with my GP and finally got an email from cardio nurse saying “Come off all meds”. That was it. I replied back I shall wean off them if that’s ok? He replied “ Has you wish” 😳. Anyway I finally got an appointment next week with the EP so hopefully get a few things clarified. Regarding weaning Ellie I think one every other day for a couple of weeks sounds ok, Sanjay Gupta recommended that way so sounds good to me. I just halved mine from 2.5 to 1.5 for two week then stopped. Now the journey begins.
Sanjay Gupta is where I got the idea from funny enough 🤣 he knows his bacon that man! I was just gonna come off completely Tuesday morning and hope for the best. Think I might come off and see how goes Wednesday and then if it’s really bad I might continue to take every other day for a further week 🤔
In terms of your experience with your cardio, that sounds like the general experience 😂 mines not been great to be honest. They told me to stay on in a rather rushed phone call, I then said my plan is too come off entirely eventually but I’m happy to stay on for the time being if that’s what they think is best. He couldn’t give me any viable reason why that would be, even after I gave him a few possibility’s to which he had no answer. He then phoned me back 20 minutes later telling me to come off entirely. I said ok fine but what are the reasons for the change? He didn’t have any. I said right ok I want to taper off then…..he said he would phone back. Phoned back telling me too taper. I said great I’ll do that. Any suggestions? 🤐 nothing! I then pushed him on it and he said take half for a few days and then come off completely. Will there be any possible side effects to this? According to him none what so ever 🙄 I then suggested the way I’m doing it now to him and he said that sounds great! 🤦♂️🤦♂️🤦♂️ Pointless conversation to say the least!
Yeah it all sounds a bit hazy, probably good that they are not too concerned , sounds like it doesn’t matter if you taper or if you just go cold turkey, I know what I would rather do 😁
Yeah it’s got to be taper all the way for me! Don’t want to risk upsetting my ticker more than it already is.
Your wise to taper off your drugs. I was prescribed Atenalol 50 in 1993 for high blood pressure. For 20 years it worked fine and then for no particular reason except for him saying it was an old fashioned drug he decided to stop it and put me on a calcium channel blocker. No weaning just stop the BB Atenalol and take this. Like a fool I did this and consequently that was the start of my PAF which has dogged me now for the past 10 years and made life intolerable at times. Keep doing it the way your body is happy with it.
Sorry to hear that rein. Doctors seem so out of touch with patients and it shouldn’t be that way. They should know as much about recovery and side effects of drugs as they do about ailments in my opinion. I think the whole medical system needs an upgrade to be honest. Hopefully new technology can make big changes 🤞 hope it gets better for you 👍
Thanks for your thoughts Ellie.. Not much left for me now except pace and a late which I am hesitant to take cause you can't undo if it doesn't work😘
ablate
Are you permanent af now then?
Interesting re Dr Gupta. I didn't know that about taking every other day. I shall do that when I next attempt to cut down. This business of no side effects during withdrawal is absolute b#ll. If drugs don't have an impact then why are we taking.them.in the first place?.
If I were you I would do every other day for a couple of weeks. When I weaned off Bisoprolol the first time I did this then went to every two days but often forgot where I was and missed it! So stopped altogether then. I had no problems at all. But I had only been taking it 6 months. Now I am weaning off Nebivolol and have got down to . 65mg but finding myself reluctant to go to the next stage. But this time I have been on a beta blocker since April 2018.
Thanks for advice. Think that’s the way I’m leaning to be honest. I’ve been on beta blocker solid daily for over a year now I think. So far so good. Gonna see how my ticker reacts on Wednesday and if it’s really bad I’ll take one every other day 👍
I've just weaned off of beta blockers post ablation myself. Wild ride that is. Not the first time doing it either. First comment is how much better I feel overall. Same for you? The other thing I'm convinced of is that the last step of the weaning cycle (going from crumbs essentially to absolutely nothing) is the biggest leap in terms of rebound. It doesn't matter how slowly and carefully I reduce, even if going to the smallest sliver I can manage for a couple months,.....going to nothing will have my HR and anxiety and agitation going through the roof. I suppose this makes sense as you are still enabling down regulation of your adrenergic receptors until you aren't. It seems 2 weeks is needed to acclimate somewhat and then another 2 weeks depending on how long you've been on them to get back to 'normal'.
That’s interesting that the last step is the hardest and again makes perfect sense. I’m looking forward to it even more now 🤣 was thinking maybe taking 1/4 dose for a further week but every other day instead of stopping completely next Wednesday? Do you think this would make any difference to the last step or not?
I’ve had the agitation and it’s bloody horrible. I got it when I cut down to half tablet. Literally did not sleep all night but luckily it was only for the one night 😁👍 didn’t get any real change when I dropped down to 1/4 tab on Wednesday but am expecting fireworks when I come off completely 🤦♂️🧨
Couple things to consider.....maybe sub in some magnesium towards the end of your wean, to offset that sharp busy feeling in the heart of the rebound. Also I note that some symptoms get worse before they get better....i.e, sleep, digestion, breathlessness, ectopics, etc. But the light at the end of the tunnel starts to emerge as the body fully rids itself of the compounds and related physiologic responses....I also try to rearrange my day in anticipation of rebound symptoms,....like I really feel a surge in the mornings so I take it easy and lay in bed sitting upright for 30 mins reading or such,....then walk downstairs and bundle under a blanket on the couch while meditating or checking morning emails. Then a hot cup of tea to soothe, etc. Maybe a warm shower. You know, be nice to yourself and don't challenge during this time. Good Luck, I'm sure you'll be fine.
Thanks for the advice. Good to hear from someone who’s been and done it and got the t-shirt. I will bare that all in mind during the firework show next week 🤣 think I might go for the every other day method on Wednesday for another week and see how that goes. See how I react when I don’t take anything Tuesday evening and work off that I think 😬
Thanks again 👍
As others have said, this sounds pretty much to be expected. The BBs reduce the heart rate so when you reduce the BBs that process will be reversed. Took me months to get used to an average HR of low 80s during the day with normal activity. Previously I rarely went above 70 and typically was in the 50s in the morning. Tell you what though - my circulation has really improved - nothing like as cold!
I had my ablation at the start of September. I’m off the Apixaban and started to reduce the carvedilol a few weeks ago. Currently on 6.25 mg twice a day.
I halved one of the tablets with the intention of reducing gradually over four weeks. The first night I halved the tablet I ended up having ectopics in the middle of the night.
I’m currently back on the full dose.
Not sure how to proceed?
Your heart will not be happy with the reduction kalgs. Mine isn’t atleast. Don’t think there’s ever a good time to come off though so just got to push through it. Have your docs told you too come off?
Yes discussed with EP and agreed the method to come off them . The first reduction was ok it was the next reduction. I had one episode of ectopics.
Interesting you have come off the Apixiban so soon. I have chad score of 0 but told to continue with them. Hoping EP tell me next week I can come off them.
It’s risk v benefit . If the AFIB has stopped why continue is my view . Had the discussion with the EP
They took me off edoxaban fairly quickly as well. My chadvasc score is zero as well. I was having issues with blood in my eye though and in my nasal passage.
Try 3/4 dose next time. Might make a difference. You can cut a pill in half and then half again or - in my case - I bite it in half. Expect ectopics and a bit of lethargy. Give it a week of you can to see if you stabilise. Then wait a couple of weeks or even a month before progressing. Just my experience
It's not only normal, but according to this paper is predictive of the long term success of the ablation. Dr John Mandrola writes : "6. Resting heart rate changes:The resting heart rate can increase in the weeks or months after ablation. The increase is usually 10-20 beats per minute more than pre-procedure levels.. This phenomenon usually resolves.We do not fully understand the way in which AF ablation works. It’s not as simple as just building an electrical fence around pulmonary veins. One effect of ablation in the region of pulmonary veins is changing neural input to the heart. Bundles of nerves, called ganglia, reside close to the origin of the veins. Ablation at these sites can alter neural control of the heart. Some experts believe this is a positive effect in that it may predict ablation success."
This paper suggests it is indicative of long-term success: ahajournals.org/doi/10.1161...
Elli86 in reply to
That’s a very interesting study Sam and very positive 👍
stoneyrosed in reply to
Thanks that is interesting and explains a few things. Wish I could stop the anxiety though when my heart plays up for a few secs, the palps etc.. scare me as much now as they did when I first got them 10 yrs ago. Always remember the GP calling me a hyperchondriac when I first visited his office. 😳
😡 I didn’t get told I’m a hypercondriact but Almost. I was told it was all anxiety and basically all in my head. Took me around 6 months to convince them I had something wrong with my heart. Everytime I got the mobile ecg unit my heart decided to play ball 🙄 If I’d had my watch back then then it would have taken a matter of days/weeks
Singwell in reply to
Thank you - that's fascinating - my evening read then. I've always felt that it's essentially a neurological problem
I would say it is perfectly normal, my rate post ablation and meds is about 8 bpm faster than before ( 1 year on) but now after exercise / weekends doing stuff for a couple of days my resting rate is nearly where it was.
Exactly what they said to me. Strange how it is the general consensus when patients first go to their gp that they are disregarded of their symptoms. You think they would err on caution and send you straight for a heart monitor. What do we know. 🤷♂️
That’s what you’d think. They were saying to me that due to my age they can’t see it being heart related 🙄 I had a row with the first cardio as he told me i was anxious! I said I’ve never suffered with anxiety in my life and I’ve got nothing to be anxious about 🤦♂️ They just don’t listen until they have stone cold evidence in front of them. Everyone needs a watch to stop them going through the same thing.
Hi I am so glad to hear that you are progressing so well. Of course we are all different but I distinctly Remember my cardiologist telling me ( 5 years ago ) that my heart rate post ablation would be approx 10 beats higher that its ‘normal’ rate beforehand ( Ie when I wasn’t in AF ) . So if yours has been artificially depressed by beta blocker it may well be that yours will now stabilise at a little higher than before . My resting rate is now around 72 whereas before it used to be around 60. Good luck with your continuing recovery
My doctor took me off all heart meds immediately after other then Eliquis. It took a couple months for my heart to settle in. I also had severe SVT but a 15 months now and all is great. I had the cyroablation done
That’s brilliant. Thanks for that positive post, most welcome 😊
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