Bisoprolol and AF episode

[Fight-the-good-fight]

Due to side effects GP reduced my Bisoprolol from 2.5mg to 1’25mg to be taken at night.

I woke up at 4.30 am this morning with an AF episode. My heart rate was 54’

Do you think this is because of reduction, or taking BB at night?

Very worrying’

[CDreamer]

HR of 54 sounds OK but obviously the AF isn’t. How were you recording your HR? If you were in AF unless you were attached to a medical device it would be very difficult to get an accurate reading. My iWatch regularly records low HR in the 40’s but I know that cannot be as I have a Pacemaker which kicks in at 59 which is tracked by another app. Nocturnal AF can be caused by various reasons, HR dropping during sleep is one, posture and in some people the vagus nerve connection, Autonomic Nervous System dysfunction ie: signals to your heart when in Rest and Digest triggers AF - in some people the opposite happens and AF starts when in Fight or Flight and so is triggered by stress or exercise; a drop or rise in BP; gastric issues or a host of other triggers such as consumption of alcohol the evening before which will enhance the efficacy of the BB.

You could feedback to your GP but I doubt if they would worry unless your HR drops into low 40’s and stays there if this happens frequently and you can see a pattern and ask to be changed to another med.

What were the side effects you experienced?

[Fight-the-good-fight in reply to CDreamer]

Hi there, many thanks for your response.

I check my heart rate on my FibriCheck app.

AF episode started with HR of 54 but climbed to 136, dropped to 95 a couple of hours later, but still in AF.

My side effects were the usual, palpitations and light headed...No chest pain or breathlessness’s.

Not sure if dropping Bisoprolol from 2.5mg to 1.25mg (docs advice) because of side effects triggered the episode, or if it is a pattern? My last three (nocturnal) episodes took place 9th June, 8th July and 1st Aug (monthly).

Or, could be food related? Irony is I felt good yesterday so as a treat we ate out last night 7pm.

Normally, I don’t eat after 6pm…

Anyway, I took another Biso and I start on Amlodipine 5mg today.

I will e-mail my GP with my app reports and let him know what happened.

It is challenging trying to get the correct medication to suit.

[Cavalierrubie in reply to Fight-the-good-fight]

It is very challenging to get stabalised on the correct medication. We are all different and what suits one is poison to another. I can’t take Bisoprolol regularly because of side effects and lowering my blood pressure too much, I also think it increased my AF episodes. My GP said l could take Bisoprolol as a pip. It works for me. I start with 1.25 at the onset and if that doesn’t work after 30 mins l up it to 2.5. There are many different drugs and it was trial and error which can take a long time. The most important is your anticoagulant. Keep smiling. At the end of the day, l am thankful they caught my AF as lots don’t know they have it and end up having a stroke. It could be a much worse diagnosis. This is treatable.

[Sleepyzz in reply to Fight-the-good-fight]

Big meal late is one of my triggers

[Tigger_2 in reply to CDreamer]

HelloI'll give you one cautionary tale relating to pacemakers.

I've had one for over 18-years and all was fine until this year when my normal paced rate of 60 BPM dropped to half that at times.

That was 8 months ago and I'm still getting slow erratic heartbeat.

It particularly sets in when I'm inactive, sitting or sleeping.

I've since been told I have ectopy with an average of 100 PVCs per hour.

I'm due to see a consultant in 4 weeks.

Until I hear otherwise, my theory is that the PVCs are interfering with the PM timing.

In the meantime, I'm on 10-mg Bisoprolol (5 twice daily) to try and reduce the PVCs.

I'm hoping that when this PM gets replaced in 15 months time, I'll get one better able to cope with ectopics.

[Sleepyzz]

I take my 5mg dose half in morning and half at night because taking it all together in morning left me with side effects so consultant said to split dose. Taking it at night doesn’t seem to have affected to afib other than my last two episodes have been shorter and less high rate at peak.

54 is around my usual resting rate

[Bodydoctor12]

hi, according to my pharmacist you should never just reduce your BISOPROLOL, it should be weaned off very slowly. The Herat can have a rebound reaction as the drug keeps it under a cosh to control the rate and then you remove half of it. I’d suggest you’re in rebound reaction to the reduction and will balance out within a week or two - if you’re lucky.

After my DCCV, with the guidance of my pharmacist, I reduced from 3.75 very very slowly over 6 months till I was taking .625 every second then every third day. Even with that very low dose it was keeping my resting heart rate in high 50’s. Now without it my resting heart rate sits around 67 and I’m aware that my heart is reaching a higher rate during normal activities in the day. I’ve had horrible side effects from the drug otherwise I’d have stayed on the low low dose.

[Ppiman]

To my knowledge, bisoprolol reaches what is called a "steady state" in the bloodstream after a few days of taking the drug. This should mean that taking it at 24-hour regular intervals will keep the drug at the same level, regardless of the time of taking it. Thus, the night-time episode would unlikely be caused by your taking it in the evening.

I also take the same dose as you and - fingers crossed - it has held off all AF attacks since I started doing this before a small op, last March (it hasn't stopped the palpitations, however, but has lessened them). My resting heart rate is similar to yours at night.

If your AF isn't overly symptomatic, then I would persist at the lower dose to see how things pan out over time.

What were the side effects that caused you to halve the dose, by the way?

Steve

[Fight-the-good-fight in reply to Ppiman]

Thanks Steve,

Since starting 2.5 mg Biso side effects were, fatigue, lightheaded, facial flushing, basically just feeling like a zombie…Plus, it was also being used to reduce my BP; however, whilst it slightly lowered it does not control, the erratic spikes. I have since been prescribed Amlodipine to reduce BP.

I realise getting the medication right can be challenging.

[Ppiman in reply to Fight-the-good-fight]

I was given losartan even though my blood pressure was normal as I was told it was, in the long term, it has been shown to be highly cardio-protective; I have read that amlodipine has also been shown to offer similar protection for the heart, even though it is a different kind of drug. I gather that the key, for anyone with hypertension, is to achieve <140/90mm Hg so if the amlodipine does that for you, without the side effects you had with bisoprolol, all seems good.

Steve

[JOY2THEWORLD49]

Hi

What time to bed.

You didn't awake to go to the loo?

54 BPM is not rapid. You must have an irregular heart beat.

I had a stroke which awoke me @ 2am.

I hope that you a re on anti-co.aglulant. Or Warfin.

Your heart awoke you because of the regularity. Not enough 02 getting around your body or a blockage in veins or arteries.

What is you Cholestrol and triglycerine levels.

Its like a warning.

Please see GP to refer you to H/Specialist. You may have AF Apnea. Not emough 02 getting around to your brain and other places.

Get Dr to check your Thyroid systems.

cheri Joy. 74. (NZ)

[Tigger_2]

Hello54 BPM is on the low side of the "normal" range, but it might be your normal.

Do you take records? A good set of records for blood pressure and pulse rate give you and your GP a baseline to work from.

There's a huge range of devices for taking pulse, but the one I rely on is my Omron M10-IT.

It measures your palpable pulse as you would if you measured at your wrist.

GPs and some consultants are far more receptive of DIY/home measurements than they used to be. If nothing else, it gets their attention.

If you are normally a slow pulser, then beta blockers might not be a good idea.

Bisoprolol is a potent drug and 1 mg is equivalent to 5 mg of something like Atenolol.

If you are concerned and it sounds as though you are, get it checked for peace of mind.

Waking in the early hours and finding something unusual can put the fear of God in anyone.

[Fight-the-good-fight in reply to Tigger_2]

Hi Tigger-2

Thanks for your response, in my haste and panic I posted prematurely.

I check my readings on FibriCheck app, it actually read 136 at the end.

[Tigger_2]

Well, good to double check.Not wanting to muddy the waters, a reading of 136 BPM, would not be normal for me, and I would want that to settle down fairly promptly.

Even when I struggle up my towns hills with the shopping, I don't get over 80.