Replying to Grinch2 I realised how little I know about the med I've been taking for so long.
I went into AF about 8 years ago and have been dutifully taking bisoprolol ever since. I had a successful cardioverion shortly afterwards and stayed in NSR until last year. Had a second cardioversion and have been back in NSR since.
The only difference is my pulse rate is slower, about 49bpm, on a dose of 3.75mg. That's technically considered bradycardia which leaves me wondering why I need a drug that reduces my heart rate to that level? Does bisoprolol have other benefits? As I remember pulse was about 54-ish on 3.75mg after the first AF and about 69-ish before AF.
I'm back to the cardiology department, to see a nurse I think, in six weeks, so was wondering if there are any sensible questions I should be asking?
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It may be doing nothing but giving you a slower pulse rate and why would you want that?
Like yourself, my first cardioversion lasted a long time -- 10 years. Other than taking something like bisoprolol for the first few weeks after the cardioversion, the rest of the time I was drug free.
They may try and tell you that it's the bisoprolol that's been keeping you out of afib. Simply a guess and btw bisoprolol is a very weak anti-arrythmic anyway.
Beta blockers like bisoprolol are often given out like candy to afib patients. Maybe the doctors feel they have to do something. But personally, I'd ask for a trial off the drug and see how you do. If you go this route you will have to be weaned gradually, Good luck.
Thanks, Jim. Good to hear of others for whom cardioversion has been very successful. If you've had a second, I hope that lasts for at least as long.
I need to admit that I was prescribed 5mg and took the decision to reduce to 3.75mg myself, the dose I'd been on for years (but would never encourage others to do the same). I'll learn if nurse approves when I next see her. In the event, reducing the dose slightly has barely moved my resting rate - just from 48 to 49.
The slow heart rate has been a bigger concern to them than to me. I'm fine with it and the high dosage doesn't have any ill effect on me either. It's just that I don't understand the purpose of the higher dose if they feel the PR is already too slow.
That's my thought exactly, especially when they are so concerned about the slow pulse. I like to assume they know what they're doing and know something that I don't.
They've booked me in for another Holter a few weeks before seeing the AF nurse and I don't fully follow the logic of that either. I know I'm not in AF and know my resting rate is steady at 49 bpm when I check. (Had an old Kardia till it died a few weeks back.) So I'd guess it's to make sure the HR isn't diving down further during sleep. Which seems to make prescribing 5mg of bisoprolol even stranger.
Hope all will become clear when I see the AF nurse.
I started on one dosage, then it was reduced as I couldn't hack the lethargy, and then again. Finally a different GP suggested it was pointless (for me). Go ask the question
It might be worth asking about whether you have any valve regurgitation or atrial enlargement seen on your echo. These are common findings in AF though not applicable to everyone. Cardiologists see these reports differently from patients, though. They’ll only tell you verbally if they’re actually concerned about something that needs attention in the near future. Otherwise they’ll say it’s “fine” but that doesn’t mean everything is 100%. It just means there’s nothing urgent to address, and TBH some findings are common as people age. However, they don’t want anything to progress too quickly if you have AF as it’s a vicious cycle as your heart tries to compensate. Whether beta blockers are actually protective of anything progressing is debatable, so this is a conversation worth having with the AF nurse. There may well be no reason to stay on a beta blocker if your HR is quite low to begin with. Remember, nobody else here has your heart, your metabolism, your DNA or your medical history. You can’t necessarily choose someone else’s experience and apply it to yourself. It’s your body and your life after all. Good luck with the Holter.
Well, shortly after the first time around, I had bigeminy for a few months and the consultant used every type of imaging available without finding anything of interest. That eventually went by itself. This time I had an echo before the cardioversion and that was it, apart from about half a dozen ecgs and this will be the third Holter recording.
I haven't seen a consultant this time either, just a specialist nurse. So I doubt that anything has been noticed this time round that wasn't spotted before.
So it's not something that affects me, as far as I'm aware, but I can't help being curious of the reasoning. May just come down to some consultants believing that bisoprolol is a better anti-arrhythmia than others.
Bisoprolol isn't an anti arrhythmic it's a rate controller. So it slows the heart down. That's why your HR is rather low. Sounds like you've adapted to it. My HR was lowish on Bisoprolol too and - for me -I much preferred a higher HR because I had more energy for walking up hill. Bisoprolol just slowed me down - which is what it's designed for.I hope you get some answers as to your level of dose and the thinking behind it.
If you find out let me know! So far as I have read, no one knows it’s exact mode of action but much detail is understood in that it affects the electrolyte transport into the heart cells (of things like potassium, calcium and sodium).
In doing this, it slows the resting heart rate and slightly lowers the blood pressure and seems to be very safe even in the long term. In major studies, this class of drugs has been shown to extend life and to delay things like heart failure and similar, but that isn’t fully understood or fully accepted. A slower heart seems to go into atrial fibrillation less often than a far greater (as I seem to be finding since starting it full time a fortnight ago , previously I took it as needed).
For me, I feel the drug is something like a “friend” as it’s helped me out of a few messes more than once.
Hi, personal experience is Biso lowers my pulse and to some extent my BP. When I've had cardioversions I have stopped Biso cos my pulse goes too low, about 40, and I feel rubbish. Your dose seems high if your cardio is working and as others have said talk to doc about reducing/coming off. My consultant is weaning me off Biso and said if my BP is problem there's better BP medication.
Side effects of Biso, I get cold feet and hands and tiredness
gps here seem to use bisoprolol for high blood pressure. I was only on it for a short time and was veery indignant when someone inn the o pharmacy assumed it was for bp - i gfelt i was MUCH iller than that!
I wish I knew what the impact of bisoprolol is. It appears to have different effects on different people. I was prescribed it after being diagnosed with afib. My dose has been increased by the gp and then reduced by the cardio. I have been advised to take in the morning, then take it in the evening, then half and half with no specific results. Does it increase my fatigue or is that purely down to AFIB? Obviously you can't change the dose without taking advice, but the medicos are very busy and you can't keep on pestering them.
My heart rate is fine and has been ever since I went into afib. Long term who knows what it does to you.? Likewise the various other medications I take.
I have also been told that bisoprolol is necessary with flecainide but does anyone here just have flecainide? I believe the bisoprolol is responsible fir horrible tiredness and extremely cold hands and feet.
Thanks, Annie. That’s very informative. I seem to remember an arrhythmia nurse talking about beta blockers “protecting the heart”, and that was long before I developed AF. My understanding is that AF can be both cause and consequence of these changes. Your explanation makes sense.
Rely on what your doctors advise. All medical advice is that nobody should reduce or stop taking Bisoprolol without first checking with your doctor. I was started on it after being admitted to the Emergency Room with AF and it stopped the 198 pulse rate within 30 minutes and so it obviously provides a needed remedy. Bisroprolol also can't be weaned unless this is done very very gradually. I'll be asking to have mine adjusted as well in some way as it appears this is what has caused me excessive tiredness over the last 18 months.
When I still had paroxysmal AFib, Bisoprolol would bring down those high spikes of HR, but I only took 1.25mg as my resting heart rate was going down to about 47.
Now I have permanent AFib and I’m on 2 x 2.25mg. Following a failed ablation my heart rate in general is a bit higher. Not sure how accurate my watch is, but my resting rate is usually in the 50s. What it does do is prevent my active heart rate going too high. My average HR through the day is in the 80s, but walking or climbing stairs puts it up to 120 at times. So when active it does run higher than it did when I was in sinus rhythm.
I think of the Bisoprolol just keeping a lid on it. I am getting used to it now really and just try to push on through any fatigue. It does lower BP too as others have said. I have to stand up slowly, particularly at night. I get low normal readings on my home BP monitor, but they’re not accurate in AF. Often around 87/65
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