Beta Blockers and Vagal Afib

So in a small comment on a blog a year or two ago I saw a doctor state that beta blockers can actually irritate vagal afib. As I was coming up to my colonoscopy last week, I started taking 1 atenolol in the morning again just as a safety thing because I was worried all the digestive uproar would cause me issues(Prior to this I was nearly weaned off of it and hadn’t had any afib and very little ectopics for 3 months) . I didn't have any issues with the colonoscopy -seems an empty digestive system is a happy heart for me -but after the fact as soon as I started eating, I was again getting frequent ectopics. I am now stepping down the atenolol again because I took it 5 days in a row but I'm still taking it daily atm at about 75% of a pill, I'm still getting some ectopics. I hadn't had them for months other than when my GI had me try miralax and Prilosec.

When I took atenolol as I was prescribed (25mg twice daily) I had daily ectopics.

I'm starting to wonder if blog doctor was onto something. I also just found a page saying that beta blockers are not recommended for vagal afib on afibbers.org. Makes me even more cynical about my previous EP - he is the one who told me I have vagally mediated afib. He left me on Atenolol for 2 years despite this, and upped my dose of it during my last appointment, meanwhile marketing an ablation. Hoping it would worsen so I'd agree?? Maybe. :/

afibbers.org/atrial_fibrill...

This says flecainide could be prescribed with alternatives such as verapamil and diltiazem instead of a beta blocker. My former EP had suggested he wanted to do beta blocker + flecainide - it's certainly seeming that was wrong for me.

[Teresa156]

Hi Aoxomoxoa,

I’m not sure how true that the blog statement is - and I think I’ve seen posts about this sort of thing before as I’ve come across that in the past. I have paroxysmal vagal Afib and have been taking Bisoprolol since last Autumn (now 1.25 mg) it’s all I currently take for it and I’ve (fortunately and touching wood everywhere) been in NSR since November - and I only had an afib attack back then, because I came off it too quickly 😳 I currently don’t get ectopics either but I don’t think I used to get many, if any before the Bisoprolol. So, I just wouldn’t necessarily jump to the conclusion that beta blockers aren’t right for vagal Afib, based on that post alone.

I’m not medically trained of course but it could be that you just need to change your meds as perhaps atenolol just isn’t right for you any more and this is something you might need to discuss with the professionals and change. As we always say, we are certainly all very different when it comes to this condition.

Good luck,

Teresa

[Hidden in reply to Teresa156]

I'm actually thinking bringing the atenolol back is what's worsening my ectopics. I was nearly weaned off of it prior to a week and a half ago. (updated the top post to be clearer)

[Teresa156 in reply to Hidden]

Hi Aoxomoxoa,

I see what you are saying - I think whatever is happening, you need to either discuss with an EP/cardiologist who you trust, or go with your gut and instincts.

I am purely saying that I am not sure if beta blockers are not to be used with vagal Afib, as they seem to be ok with me, for now, but I’m only one person of course.

My HR can go to early 50s occasionally during the day, but my cardiologist didn’t want to switch me to a calcium channel blocker of any type.

Do what you think is best for you.

Teresa

[CDreamer]

Blog was absolutely spot on. Beta blockers can be an issue for vagal AF and those with Asthma and whole lot of other conditions as they are an adrenaline blocker as well.

You may find this blog useful - Dr Bogle spoke at one of the Patient Support Group Meetings that Rosie G organises.

richardbogle.com/blog/vagal...

[Hidden in reply to CDreamer]

This is definitely the one I ran into before! I couldn’t remember the name and didn’t come up with it for some reason yesterday.

[Palpman]

A low heart rate can precipitate arrhythmias. Mine certainly do.

[Singwell]

Have a look at the York Cardiologist YouTube channel and search for visual on vagal AF. I think he may give more useful perspective on vagal AF but if I recall confirms BBs not the best. However, BBs in tandem with an anti arrhythmic such as Flecainide might be a more nuanced approach. Get some different viewpoints from reliable sources.

[secondtry]

I have lowish HR 55, BP 115/65 and vagally mediated AF, no co morbidities and when first prescribed I was 60yo. My cardiologist put me on just 200mgs Flecainide and said any BB would make me feel unwell.

[Jajarunner]

My EP took me off beta blockers as my HR was low anyway and he felt all they did was make me feel unwell! My Afib comes in with sleep so probably vagal.

[JOY2THEWORLD49]

HiI'm CONTROLLED ON 120mg Diltiazem a.m and Bisoprolol 2.5 pm.

I was no where controlled on Metroprolol or Bisoprolol. Bisoprolol is best for AF and as a beta blocker doesn't interfere with breath.

I saw a city Auckland Cardiac sp. 2 weeks ago who said he diagnosed a soft systolic murmur.

I had a high systolic rate well before the stroke.

But it was more likely to be the undiagnosed thyroid cancer Papillary type.

All out, my heart did not return to normal.

A rapid, persistent H/R day . The symptoms before stroke was excessive sweating on any exertion and fatigue. So I had it prior.

I heard that the vagil artery runs past the heart so overeating/too much fat and drinking alcohol can produce AF.

But is AF more connected to thyroid problems? It was certainly a throid-A.F-stroke. Mild but a left frontal lobe embollic stroke.

cheers JOY. 73 (NZ)

[healingharpist]

Hello, Aoxomoxoa, I also saw that on afibbers.org--generally love that site--but what he said isn't true for me. After avoiding beta blockers for a long time because I also believed they were contraindicated, I have now been on 25 mg metoprolol daily, and it stopped all of my MANY ectopics immediately and has also lengthened time between afib episodes (if I'm careful to eat small meals, and not after 6:30 or 7 pm, and avoid indigestion). Metoprolol seems to have calmed my heart generally (it does block stress hormones so some use it for anxiety). I only take 150 mg flecainide to stop an episode in 1-2 hrs, but don't take it daily.

While I think I am mainly vagally mediated, I suspect many of us are a mix of vagal & adrenergic. Thinking I needed vagal stimulation, I had treatments with the Dolphin Stim device, and twice they actually PUT me into afib... although I never rule out anxiety or, in my case, over-thinking. I also had acupuncture treatments, and sometimes they trigger ectopics, and sometimes they stop them. God, give me patience! It's a tricky balance for some of us.

10 yrs ago when I started w/ afib, I was given diltiazem and it did absolutely nothing for me. So trial & error has helped me sort out what I need--even though I still don't know exactly if I'm more vagal or more adrenergic. But this beta blocker is really helping me now so, I'm swinging with that! Wishing you very good health and good rhythm... Diane S

[iris1205]

There is a trend here.... there is no one solution for us all... trial and error.

Unfortunately those errors can restart issues. For example in 2017 I had an ADR placed in my spine L5-S1, it was a moving disc, hence they did not want the anterior longitudinal ligament to grow back thus allowing my disc to be mobile. I was required to take strong COX2 inhibitors (everything I'd avoided for two years). The Afib returned.

We can only read, listen, try and then judge for ourselves what works... two snowflakes - or Afib, never the same!

In my case, I don't take any BB anymore (especially since they don't help ME), just flecainide PIP!

Good luck and we all just keep sharing, reading and enjoying what does work ( and what does not ) , in whatever capacity! Take care!