Hi All - I’m wondering if the beta blockers I’m taking are doing more harm than good? I had never taken beta blockers (I’m now taking metoprolol 25 mg once a day) before my ablation, but after my ablation they were prescribed for the week following. Unfortunately I never felt comfortable not taking them after the ablation, although I was able to wean myself off of 50 mg to 25 mg about a year ago. As of late I’m experiencing a pretty severe shortness of breath partnered with a low heart rate, which I normally have a low resting HR because I exercise but I’m worried that now it’s becoming too low because of the beta blocker and my naturally low HR combined. I’ve talked to my doctor and all she says is to wean myself off by cutting it in half but the last time I tried that, I ended up in the hospital because of a rapid HR. I also suffer from ectopics because of the ablation and I believe the beta blockers help with that as well, so I’m worried about how that would be off of them. At this point I just feel lost and not sure what to do. I would rather not take the beta blocker because of the obvious symptoms, constant fatigue, shortness of breath, adverse reactions to certain things etc, and the whole point of the ablation was to cut out all of these things, and it makes me upset bc I never took beta blockers before the ablation but now I’m depending on them. I’m just scared to be off of them. Any advice is appreciated, thanks.
When to Stop Beta Blockers - Atrial Fibrillati...
When to Stop Beta Blockers
I will be very interested to hear what people say about this, because, although I’ve never had an ablation, my symptoms mirror yours. I’ve been on atenolol for forty years, and all has been well until about a year ago, when I started walking a lot more, which seems to have slowed my hr quite a bit, and I get really breathless. Haven’t been able to see a doctor, just the nurse who thought it was my asthma, but it doesn’t feel like that.
Hello, obviously we're not qualified to give medical advice so I'd say your first step is to ask for a referral to see your cardiologist or EP. Breathlessness is not normal - it means something isn't working as it should. It could be your lungs, your heart, or even the result of a virus. Insist you are sent for some tests and have some scans. As regards weaning yourself off the pills, people use different approaches and you have to find one that works for you. I don't know the strength of your BB - I think it's one of the hefty ones - others may have different insights. But one approach might be to take half a pill one day and a full pill the next day. Others here have reported good results from that and i used it myself wuth Flecainide. Do that for a month, then try a half every day.
I’m on 1.25 bisoprolol, my dose was higher than that and I found cutting it down helped with the fatigue. But yes I’m in fourth gear not sixth . My pulse on this is generally 60 to 70, it fluctuates. But I’m 68.I feel though you are young, You have a long life ahead of you and no wonder you feel lost and unable to get the advise u need. Being breathless could be something else , perhaps go back to doctor again and ask to be referred to you cardio and also ask about other things it could be.
You haven’t said how long since your ablation....now if it’s early days you will feel fatigued, ectopics .....
Chin up,
Sue
I've had 4 ablations and tried various betablockers. Im pretty intolerant to most, tried bisoprolol and made me incredibly cold/painful. Another one I think flecanide - depression. Then carvedilol - various doses and dreadful muscle aches and pains and unable to do anything. Came off them for 6 months after last ablation but then ended up having to have a further cardioversion. Went on high dose for a while until i could have this and have now slowly reduced them. I found that on a very low dose but twice a day my blood pressure was extremely low. But then after several weeks again started to get muscle aches, so reduced to one a day. Pain /ache is now more manageable on 3.25mg once a day! But blood pressure has increased but still just a top of normal. Hope that helps. I try and listen to my body and assess side effects/risk and try to minimise based on what my body needs. I still get 'breathless' due to the betablockers on walks/hills/inclines.
Definitely seek medical advice. We all react differently to all medications.
Hi Dogluvr95,
I can only sympathise and am in a similar boat. I haven’t had an ablation ( though I’d have one tomorrow if I could) I am paroxysmal and controlled now by a very small dose of Bisoprolol 1.6 mg I am down to.
This is the second time I’m tried to wean off them, as first time I failed. As soon as I did, I had palpitations and went straight into Afib.
Breathlessness is a side effect of the beta blockers, I would be pretty sure you don’t have any other issues going on. I too have issues with breathing and it’s intermittent. I’ve only ever had these problems with beta blockers.
I am going to reduce, much, much slower than I did last time. I have some jewellery scales and a pill cutter. I can only suggest that if you do decide to wean, go down much slower than a GP will tell you to. Stay at a lower dose until you feel able to reduce again. Reduce as slowly as you are able and just take your time. Our bodies go into an adrenaline rush with every lower dose and anything we can do to make it more gentler should help. This is what I’m hoping. There are quite a few threads about beta blocker withdrawal and our symptoms are not unique,
Teresa
Everyone’s circumstance is different, so consult your doc before altering or changing meds or dosages, but my experience with metoprolol was horrid.I was lethargic, very low HR, and any exertion at all left me gasping.
Turns out they gave me the wrong type of blocker at the ER...a beta, when I should have been prescribed a chanel-blocker. The change was instant, and I’ve been right as rain ever since.
Again, I have no other cardiovascular issues, never converted or ablated , and am otherwise fit, so please consider that.
Beach bum, do you have any idea why the calcium blocker was preferable to the beta blocker in your case? My situation is similar to dogluvr, except I have not had an ablation. Metoprolol was prescribed for me as soon as I developed paroxysmal afib 5 months ago. I was on 50 mg a day, but I have been tapering to 25 with the same hopes as dogluver of getting off of it eventually. It saps my energy and on my Kardia the bpm regularly comes in in the high 50s. I have been augmenting my magnesium and have used some suggestions elsewhere for staving off attacks at their inception (another dose of magnesium along with low sodium V8 for the potassium; modified Valsalva maneuver with a syringe) with quite a bit of success. I began drinking hawthorne tea infusions and have a tincture at the ready, too. Obviously, I am keen on getting of the Metoprolol ...
My Doctor made the decision based on the fact that I had no other health issues, all bloodwork was normal, no cardiovascular history or issues, and the fact that Metoprolol did exactly what is described by so many on this forum...feeling like crap, zero energy, even slight exertion would have me sucking air, low BP and HR...too low for me, and I was on no other meds other than the anticoagulant Xeralto. The very day I switched, I felt normal, and the following day, went for a 6 km hike...all good ever since. It was as simple as a phone call to my Dr to explain what the ER Doc had prescribed, and how it made me feel.
Thank you so much for this added info. I am going to start research calcium blockers now ...
Thank you all so much for the advice. The consensus is that breathlessness is not normal so I will be calling my cardiologist and speaking to her about it. I wanted to clarify that I’ve had shortness of breath the entirety of being on metoprolol (since July 2020 when I had my ablation), but that just lately it’s been getting worse. I am going to try to wean myself off of it regardless because at this point I do think it’s effecting my quality of life. Again, thanks so much for the replies and advice!
Would request an appt with cardiologist at earliest possible date.
Do you have a Kardia or any device to indicate if you are in AF and monitor your heart rate ? Also, how is your blood pressure ?
Stress and worry can contribute to breathlessness. Try to relax and be positive. Good Luck
Hi mav7, I was not diagnosed with AF, only SVT. So far the SVT has been cured since the ablation. Fingers crossed it stays that way. I do not know what my blood pressure is, but never had an issue with it before. The metoprolol was purely for the ectopics after the ablation.
Hi, yes metoprolol can be a tricky drug to wean yourself off. I have had 5 ablations now and I stayed on metoprolol after the last one. It took me months to wean myself off it because I felt very insecure not taking it. I had most of the effects that you say. To get off metoprolol meant really looking after your body and taking small amounts off your daily dosage each week. I was down to just the dust of the tablet when I finally got off it. LOL.😀 Now I am good , only taking aspirin daily, and having no issues with AF.Hope you manage to solve this. Regards Greg.
I started a high dose of Atenolol at age 28 only for the purpose of controlling anxiety symptoms of palpitation related to benign PAC/PVC. Though my heart rate and blood pressure ran low, I was very active lifting weights and cycling for about 12 years and didn't really notice any side effects otherwise. Gradually the ectopics got worse despite the beta blocker. And I became less tolerant of the low HR and BP. This led to lots of experimentation with other loading regimes, types of beta blockers, including switching to Calcium Channel Blockers.
During this period I always returned to Atenolol as it was a 'known'. But I discovered it just was no longer effective at dosages I could tolerate. I believe the long term use led to some metabolic dysfunction as well as some depression. I always feel like a bubble rising to the surface when I would wean down/off. Like others, I've gone through some elaborate weaning schedules. That last jump to zero is the worst for me....takes several tension filled weeks to adjust and I've probably weaned entirely off at least 5 times in the past 10 years. I'm 53 now!
Well, the ectopics continued to get worse and I developed Afib. I was in denial for about 3 years until the situation became unbearable and I proceeded with an ablation. I'm 4 months post procedure now and entirely off all medications. I clung to the Atenolol afterwards as I had the worst storms of PAC's I had ever experienced. At that stage with twice daily loading I developed heart pauses caused by the Atenolol. With EP's approval I came off entirely and simply learned to deal with the ectopic storms. Luckily they passed, though will kick off again if I overdo things.
They have their place for sure, but in my case if I had it to do over again I would have opted for lower or no beta blockers, especially once my resting heart rate began to settle into the high forties while watching TV on the couch. Having said all this I can see jumping on them again if I experience high rate afib again, and or go through a nervous spell with high blood pressure and very fast rate. For this, they are very effective.
Hi Bennera, thanks so much for sharing your experience. Do you think the beta blockers worsened the symptoms of your ectopics? Now that you mention heart pauses, I think I have been experiencing those too.. I couldn’t put a name on it because I’d never experienced it until recently.. ugh, this stresses me out lol.
I don't think they made the ectopics worse in a direct way. Though I did experience that with Verapamil, seemingly. But I have noticed that my ectopics are, many times, a function of heart rate. Like if I'm manifesting bradycardia then I may be more prone to more PAC's. Though this isn't always the case.
Oddly I have noticed that in the early going, I liked beta blockers because they softened the palpitations associated with ectopics....so I couldn't feel them as severely. But like everything else, I've come around on this to prefer the way palpitations feel when heart rate is a bit higher and I think I know why. The compensatory pause (or sometimes non-compensatory) pause is longer if my heart rate is slower, so there is more time for the blood to pool in the Atria, etc. and when the next normal beat kicks off it's a jolt and rather uncomfortable as the extra volume pushes through. An ectopic at higher rate softens that blow and the quicker premature beat is softer and over before I have a chance to get too excited about it. I believe this feeling is also predicated on blood pressure so if yours is higher you'd likely be more symptomatic.
For me, the biggest benefit of the blockers is how it reduces the body's reaction to stress. Anxiety and stress are big precursor's AND result of my ectopics. Sinister cycle this is. I can send both my rate and pressure up significantly just by thinking about premature beats. Blockers blunted this reaction....But, too much of a good thing. After years and years I really feel my entire system had been down regulated to such a degree that I was no longer adapting biophysically. Like, the constant freezing and shivering, depression, fatigue. You get used to it, but there's no denying you are operating at a reduced capacity. If beta's are taken due to a cardiac structure issue or post M.I. then the trade-off is of little concern, but if taken long term simply to quell concern over a 'benign' condition then maybe it's wise to cycle off every few years or rotate to something that works just as well.....?
If you had implied when I was 28 that I would need to 'harden' up and just deal with the ectopics I would have thought you were nuts. But after being forced to weather many more ectopics and, finally, afib,...I feel differently. It is very possible to live with ectopics, accept them, and simply look the other way. Every cardiologist I ever had recommended just ignoring them but I found that impossible until I found the tools and training to be mindful about them. No real secret, just a mindset and awareness that what often brings on the concern and anxiety is an unhealthy focus on and attempt to evade them. Easy to say now as I only have 50-100 on most days. In the midst of a 1000-2000 PAC day you'd likely get a different manifesto, but right now I'm thinking PiP could work as well for beta blocker as for flecainide when in afib. Mileage may vary of course depending on what your EP allows. Sorry for the book,....this has been my life for past many years!
I have had atrial flutter for about 2 years. Initially prescribed Metoprolol. Had all kinds of bad side effects but stayed with it for almost a year because it did lower my heart rate. Finally, it was so terrible I requested a change. Now on time release Diltiazem which controls the heart rate just as well and has almost no side effects. I should have made this request much earlier. It is up to your doctor though whether Channel Blockers would be appropriate for you.It was a hugely beneficial change for me.
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