The GP who told me I had AF (during a 2 week episode in January) prescribed Bisoprolol (1.25mg) on the spot. I haven't yet tried them despite having another AF episode (6 days early Feb), partly because I'm reluctant to become dependent on medication, but also because I don't want significantly lower BP (normally 105-115/65) or slower HR (normally around 55). I also get Reynauds which is a contraindication. When I said this to my GP he agreed but didn't suggest an alternative.
Does anyone have experience of using Bisop or similar just as a PIP to head off episodes or reduce ventricular rate and symptoms during an episode? Does it work and does it make you more prone to ectopics afterwards?
I'm still very much learning the shape of my AF - the last episode was triggered by intense exertion (I'm currently avoiding any exertion for at least a few weeks, trying to see if detraining will help) and preceded by a lot of ectopics. So I'm wondering about trying the Bisop if I get that warning again.
I do have a GP appointment next week and arrhythmia clinic at the end of March (booked in November :-)) so will hopefully get more advice then.
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1.25 mg is a low dose. Bis and I don't get to well but at that dose we would shake hands and there wouldn't be a problem.
Bis lowers your HR but is not an anticoagulant. It will drop a high HR pretty quick - however if your HR is 55 then It's not really a problem. Bis will lower it even more.
Now I am not a medic before we go any further. If your doctor has suggested you take this dose then you must do so.
I can't help any further except to suggest accept your doctors advice, They put me on 5 mg a day of it - couldn't funtion on it although my HR went right down. It works well but can have the side effect of making you feeling very tired (for me but we are all different).
You wrote
"Does anyone have experience of using Bisop or similar just as a PIP to head off episodes"
For me personally no. That doesn't mean it will be the same for you. I found Flec much more effective as a PIP. Maybe this is something to discuss with your doctor.
I have autoimmune with AF. I tried Biso when I didn’t know it was contraindicated. BIG mistake as it really messed me up.
The one thing though it did help with was my very low BP which was less than 90/60 most days at that stage - it did stabilize my BP and kept systolic above 90. Be warned though that’s it’s an adrenaline channel blocker and withdrawal can be a problem for some as it can exacerbate anxiety when you stop in some people. Men seem to tolerate it better than women and there are other drug options so do ask your arrythmia specialist.
I now have a red alert on my file to never be given Bisoprolol but had more than few arguments with more than one doctor about it so good luck.
Bisoprolol is the recommended first line of attack on AF in the UK. I think there are people here who use as a PiP. When I was in 2.5mg I've certainly been given a further 1.25 in A and E to bring me out if AF. Which tbh if I'd known would have saved me the hospital trip. But I'd never take extra meds except in advice. So, this might be something to discuss with your GP. There are other meds you can have so maybe getting referral to cardiology us your next step? Meantime, carry on with the lifestyle changes. You mention exertion- you need to exercise but moderation us the best approach for most if us AFibbers
Thanks Singwell. That's helpful. Yes, I've got my cardiology appointment at the end of March and hopefully will get good advice then. Yes, I'm walking an hour or two a day, but since I think the AF was caused by years of long-distance cycling I'm trying detraining as my first response. (plus cutting out ectopic triggers as far as I can).
In order of importance, you have to stop the AF as any episode increases the chances of another. Lifestyle changes play a key role and best not to go back to any heavy exercise until this thing is properly sorted. Turning to your BP/HR and Biso, I had similar vitals & Reynauds at 60yo with no comorbidities and an active lifestyle my cardiologist took a chance (I checked with him twice since) and prescribed Flecainide (200mgs) only; only a handful here are similar. After a couple of years of feeling not myself and after many lifestyle changes including exercise reductions and supplements, 8 years down the line I have excellent QOL/energy and to date no appreciable side effects. However, I have not gone back to hi exertion sport instead Nordic walking and walking basketball as getting sufficient enjoyment from that and an AF free life. Hope something helps in the above.
Not medically trained. However bisoprol is primarily used as a rate control drug when in AFib. It helps reduce a high heart rate. Do you have a high heart rate in AFib?
I have read that Bisoprol has some rhythm control properties but it is not classed as an anti arrhythmic.
I was put on 1.25Mg Bisoprol when I first diagnosed afib, but my rate was 165 resting in afib. It did reduce my rate - too much for me.
I did not tolerate Bisoprolol even at that low dose , but it certainly acted very quickly. I was asleep in 40 minutes after every one of the 8 tablets I took before I stopped taking it. (I believe I am an exception with my dramatic response to it. )
So I suppose you could try it as a PIP . I did have a discussion with the cardiologist who eventually became my EP about using rate control meds as a PIP but at that time I had moved off beta blockers to Verapamil ( a calcium channel blocker) for rate control. CCBs do not work very quickly and he was skeptical but was happy I tried it. However I found verapamil had no side effects for me so I took it daily.
We are all different with drugs, and our personal reaction to them. I am aware there are people on this forum who have been on 10Mg bisoprol daily and appear to tolerate it. I think you will not know it's effect on you until you try it. Whether that is as a PIP or just anytime.
Have you spoken with a cardiologist/ EP about your AFIB? How many attacks have you had? Are you classed as paroxysmal?
I've had three episodes that I know about. The first was three days, I went to A&E but they didn't identify it as AF. The second was two weeks and my GP surgery did an ECG which they said showed AF. And the third was six days. So I suppose I'd be classed as persistent already.
Part of my uncertainty has been that I don't know my HR in Afib. I think standing/sitting it's probably around 80-100, but I woke up in the middle of the night a couple of times with a very rapid tapping in my chest and negligible pulse. A friend suggested sleeping propped up and that seemed to help. - I guess gravity helps the blood get into the ventricles. My Kardia arrived yesterday so I'll be able to find out next time.
Wow - so you had a 3 day long episode to start, but was not clear it was Afib, a 14 day episode showing AFib, and then a 6 day long which you are unsure about? How long since your first know episode?
My longest episode was 8 days but that did not stop on its own, I had to be cardioverted by flecainide infusion in my local HOSPITAL CCU. My previous 11 were all only 24 to 40 hours although most were terminated in some way.
I don't know how you take your pulse but the best method is left side of neck 1 inch ish below the back corner of your jaw . It is very clear there. Use your finger NOT your thumb. If you are in AFib you will tell as the beats are clearly not evenly spaced. You mentioned ectopics, these show as "missing" beats in your pulse but regular beats between the "missed" will still be fairly even. Be aware the missing beats are actually extra beats but not caused by the normal sinus rhythm nervous system but from somewhere else inside or outside the heart. If the extra beat is close to the next normal beat it empties your left ventrical, which does not have time to refill, so little blood is pumpedon the next sinus beat, so you don't feel the flow/ pulse in your neck / wrist. I understand that the "fluttery " feeling you may get in your upper chest lower neck is also caused by this mechanism. I am sure you will be able to distinguish AFib from ectopics as their is little/no consistency in the time between any of your heart beats in AFib. Not an expert at this as 8 to 10 seconds after the start of my afib, my heart was doing 165bpm sat still which when also random is just completely uncountable . I used to get my heart rate from a garmin running watch/ hr monitor which worked from a chest belt which measured electrical activity, not blood flow via optical checking. ( my wifes fit bit could not count my high rate) . The Garmin was actually how I discovered I had afib, as apart from the fast rate I was otherwise asymptomatic.
I do not have a cardia so can't advise but it's worth getting used to using your fingers as you may be somewhere with no kardia or battery but usually you still have fingers.
A note on heart rate/ blood pressure: certainly early on recognising an episode is likely to cause a bit of stress which will release adrenaline to your system,( your body is dealing with the threat like it would to fight a wolf). This will raise your heart rate and blood pressure a bit so if you measure these then expect this, as otherwise the fact that either or both have risen will stress you further ( vicious circle). So don't stress, easy to say but more difficult to do.
Incidentally beta blockers like bisoprolol actually work by blocking the effects of adrenaline on your heart to slow the rate.
The three days was in November last year. I may have had brief ones earlier. I've had ectopics for over 20 years - thought I'd found the cause a few years ago but they started up again early last year.
I did talk to a GP whom I totally trust during the 2 week episode who said not to worry if it goes on a long time, cardioversion can just take longer.
And yes, I'm sure it can be stressful but to be honest I've been doing so much mindful breathing during episodes that I've mostly felt quite serene. And it really helps with the symptoms.
Out of interest what did you think was the cause of your ectopics? I get loads of them, started from a few months my ablation , but only from time to time. They have not done me any harm ( so far as I can tell) over the last 3.5 years so I just ignore them mostly or focus on something else, but IMO any knowledge is power!
They started just after I began working from home in 1999, and I think I was having more hot drinks to stay warm without much heating. Plus being vegan and generally cooking from scratch I was getting less than 2g/day of salt, with a very high potassium and magnesium intake. The ectopics stopped when I started making sure I got 6g salt a day and cut back on the fluids - around 2015. And whenever they've come back, a little extra salt has seemed to stop them, up to last year.
Wow interesting. Unfortunately I don't think it will apply to me . I dont add salt to cooking and use non salt butter, but I eat quite a bit of bread which is loaded with salt!
Yes,i was put on bisoprolol. After 4 days id had enough. Felt so rotten and so tired i just stopped,couldnt stand it. Straight away things started picking up. I decided to cut out all excersise. Then palpitations started but arrhythmia stopped. Gradually the palps stopped just before having a scheduled pm fitted. Its 10 months now since then and i havent so good for 3 years. I started back on gym work 2 weeks ago and intend to get back on the bike in another 2 weeks, so the detraining has worked for me and the pacemaker seems to have helped with sleeping and i consider that is a huge plus.
I am not a doctor, or any kind of medic. However, I really don't think taking Bisoprolol at random is a good idea. First, it's effect is a cumulative process, and takes a few weeks for the body to adjust to it, or to get used to stopping it later. Second, it does little to prevent AF, it is a rate control drug to stop the AF causing excessively high heart rates that could do you harm. Flecaidinde is a rhythm control drug, which _might_ prevent or stop AF. The biggest danger of AF is your five times greater susceptibility to a stroke, and you should have been consulted about being put on an anticoagulant for that.
I was given this as PIP but didn't use it in the end. I'd had a very bad experience with propranolol so I was concerned about having the same again - there isn't usually any help available when you're in the middle of a bad reaction to a medication, is my experience. And unless it's a full-blown medically documented allergy response it doesn't seem to go on record as being a problem.
However, more pertinently, I was told later by the cardiologist that there was little point in using it as a PIP, something I'd been wondering about, as by the time it gets into your system, if you've got episodic Afib, it's too late for that attack. He said I'd need to take it all the time if I was going to take it. So that's something to ask about.
I kept it 'in my pocket' for a long time though, on the basis that I might have an attack that went on for several days (I'd had this once before but it was already stopping by the time I had ECG) and might not be able to get a medical opinion/help during that time.
Thanks Frodo. I think it's probably worth trying for me since my episodes have been quite long, and looking back I may have had a day or two of warning ectopics beforehand.
When I was on Bisoprolol 5mg I would get a headache come on ( not a person who gets headaches usually) every day 2 hours after taking the pill. Robbo said it put him to sleep after 40 mins. It seems logjcal that if the med is getting into the system enough to cause side effects it should be doing it's job. I take extra beta blocker during an attack as the very low dose I take daily does not stop my heartrate increasing at the beginning of an attack. It lowers it gradually. I can see if episodes onlh last 2/3 hours this would not be of much use but if they last longer it reduces the length of time of high heartbeat.
Interesting, and how soon does the extra does take to kick in?
And my propranolol experience was of one of my worst headaches ever - and I do have really severe chronic migraine generally. It was even worse than that.
I don't know. My attacks usually start between 10 and midnight. I go to sleep and as my Kardia will not work in the bedroom I don't get up to go through to the dining room where it does work! I cannot take my pulse properly by feel. The beta blocker does not bring it down a lot on the few occasions when I have checked 2/3 hours later . Usually by the time I get up I have gone back into NSR.
Given your naturally excellent BP and HR (probably due to all your exercise) you should ask your GP why you need to take a HR/BP drug at all. If your GP saw AF on your ECG I would have expected that you would have been prescribed an anticoagulant, such as Apixaban, to help prevent a stroke.
With persistent or permanent AF your HR will be irregular (more correctly "irregularly irregular", which means no repeating pattern) but may be within the normal resting range of 50-100. You may be symptom free, but your atria will still be fibrillating at a high rate that you will not feel. This can cause blood to stagnate in the atria and potentially lead to a clot and a stroke. Hence the usual advice is to take an anticoagulant.
If you were to take Bisoprolol or similar HR/BP reducing drugs, you would probably find that hard exercise would become more difficult, as they tend to limit your maximum HR.
Thanks Engineer46. I think the point of the Bisoprolol is that it is effective in preventing AF episodes. But I'm reluctant to take it continually to prevent occasional episodes, if it can work as a PIP or I can find a solution without medication. At the moment I have no other risk factors for stroke, but they may want me to start anticoagulants when I'm 65, 5 years away.
I was diagnosed with paroxsysmal AF in 2020 and have had a few episodes since then. I take Bisoprolol as a PIP and, touch wood, they have worked at the time of the episode. I have usually had to take 2.5mg for it to work (having started at 1.25mg). Touch wood, episodes so far have lasted hours rather than days and have been few and far between, so hoping it stays that way! Like yourself, my BP tends to be on the low side and my heart rate can be quite slow at times, so I'd be nervous of taking the Bisoprolol regularly. All the best.
I take a single tablet of bisoprolol, 1.25mg, like yours, if I feel a speeding up of my heart that's for no reason and when it becomes uncomfortable (or if I've got something important on that day). With me, a faster heart rate can precipitate either AF or a very similar arrhythmia with runs of ectopics ("AF like activity" my cardiologist called it) and that one tablet seems able to stop this happening. It's a version of a "pill in the pocket", I suppose, although the effect takes a good while to work, maybe an hour.
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