The arrhythmia nurse wants me to reduce my bisoprolol dose after my cardioversion - fear of early relapse.

[Belle11]

I had a 2nd successful cardioversion 5 days ago, and the arrhythmia nurse told me to reduce my dose of bisoprolol immediately from 7.5mg to 5mg as my heart rate was around 50bpm. However, unless I maintain NSR for 6 weeks after the cardioversion, they won't offer another one, so I'm reluctant to reduce my dose before then - in case it might set me back into AF and I'd lose the opportunity for another cardio. I feel better in NSR.

After my 1st cardioversion in 2020, the cardiologist kept me on 10mg bisoprolol for more than 2 years, despite my pulse often being as low as 44, so staying on 7.5mg for a few weeks doesn't seem unreasonable, but I was still a bit dozy from the anaesthetic when she mentioned it to me.

When my dose was reduced to 5mg before, I started getting a lot of ectopics, and the dose was raised back up to 6.25mg.

Any thoughts welcomed.

[BobD Volunteer]

In many respects bradycardia is just as likely to bring on AF as not. Remember bisoprolol does not stop AF merely control the rate so I fully understand your nurse's reasons. What your cardioversion has shown is that you can attain NSR which means that other treatments such as ablation may be offered so good news all round.

[Buzby62 in reply to BobD]

Another good answer Bob. There does appear to be an awful lot of us with low HR (bradycardia) in NSR and I do wonder if that in itself contributes to PAF episodes. As always, finding your individual balance is the key I feel. I will be discussing coming off the Bisoprolol next week at my 3 month post cryoablation review.

[Belle11 in reply to Buzby62]

I didn't have bradycardia before I developed AF, but woke up from my 1st cardioversion with my pulse in the 40s (definitely not because I'm a fit athlete ) probbaly biso related, and it's stayed that way ever since until I went back into persistent AF. At the time, the cardiologist was of the school of thought that keeping the pulse slow helped to make recurrence less likely. New cardiologist, different opinion presumably.

Hope all goes well with your review next week.

[Buzby62 in reply to Belle11]

Thanks, rather than keeping the rate low, I would think the biso is to prevent it rising too quickly from adrenaline related reaction which can trigger AF. I’ve read that biso is mainly to control higher rate with minimal effect on resting rate but the smallest dose of 1.25mg dropped my NSR resting HR from 50-60 to 40-50, when my dose doubled it made little difference to those figures so it’s not a linear effect on dosage. I believe I felt better at rest after my ablation which raised my rate back in to high 50s-low 60s while still on 2.5mg and is coming back down slowly as I recover. The biso also has a lowering effect on BP so that has to be factored in too.

As with everything AF, we’re all different and so many contributory factors but good to discuss with others.

Best wishes

[Ppiman in reply to Buzby62]

That is much like me regarding bisoprolol doses and rates. I've read that the drug has a non-linear dose response effect, too, however, given that (although highly selective to the heart's beta-2 receptors) there are beta receptors in many other organs as well as the brain, I'd think the lowest dose that works is the one to aim for.

Steve

[Belle11 in reply to BobD]

Thanks for your reply Bob. The reason I'm questionning the decision is that I stayed in NSR for 3 years 8 months first time round after 9 months of persistent AF, most of that time on 10mg bisoprolol, with my heart rate in the 40s and 50 s throughout. It was after having my dose reduced slowly to 5mg that I started getting a lot of ectopics, and the dose was increased again, though only to 6.25mg.

Due to other factors, ablation unlikely to be an option for me unfortunately.

[Singwell in reply to Belle11]

Why not request to drop just a little in that case? Remind your arrhythmia nurse of this history and say you'd prefer to lower the dose gradually and in small increments.

[Belle11 in reply to Singwell]

Good idea.

[OzJames]

I’ve had 3 CV’s the first one kept me on drugs for 1 month post CV then wean off then stop. The second CV that day he cut the Flecainide and kept me on Metoprolol for a month then taper and stop as well as Apixaban. After the 3rd one after a month he dropped the dose of metoprolol to 12mg which now has tapered down to 9mg and I maintain that some 4 months later. The equivalent in Bisoprolol is .9mg I’ve also stayed on Flecainide and tapered down to 20mg

[2learn]

Hi, how do you feel. After 3 cardios and 3 ablations if I stayed on my 5mg biso my heart rate went down to @ 45 and I would feel lousy. So after each procedure I've been allowed/advised to stop taking it. Each cardio last over 12 mths and so far last ablation, fingers crossed, has lasted 2yrs.

[Belle11 in reply to 2learn]

Glad to hear your ablation is lasting well. How nice to be able to stop taking the pills.

After my first cardioversion, the cardiologist insisted on keeping me on 10mg biso for over 2 years despite my heart rate being 44-48 most of the time! And I did feel tired and short of breath on exercise. I was in NSR for 3 years 8 months before AF returned last September. I'd been allowed to lower my dose of biso to 5mg about a year earlier.

I think I've forgotten what it feels like to have normal energy and exercise tolerance! I will take the lower dose when (and if) I get past the 6 weeks mark in rhythm this time, so that I'd be in the running for another cardioversion