I’ve been on bisoprolol 1.25mg twice daily and upped that to 2.5mg twice daily in the middle of May.
The past two days I’ve been getting long episodes of Afib lasting 14 hours then clearing around 3am Thursday. It came back lunchtime Friday and then stopped again 3am this morning.
I’m wondering if the additional dosage of Bisoporol is making things worse not better? Going to cut it back and see but wondering if others have had similar experiences?
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kitenski
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My understanding is that Bisoprolol is a drug prescribed for heart rate control, with some properties that lend itself for use for blood pressure control. This suggests it isn't a drug to specifically to eliminate AF - if only AF were that simple !
If you tweak Bisop then you need to do it very gradually as described in the paper in the packet. Perhaps there is another trigger at play which kicks off your AF ( like food or drink or stress - lifestyle issues ) which is nothing to do with your heart rate.
When I was put on Bisop ( right at the time of original diagnosis, aged 65 ) - it was specifically to bring my heart rate down, which it did. I spent 13 years on it and then progressed to Nebivolol and now Sotalol ....... the latter being the best of all. Sometimes the Bisop dropped my HR too low, i.e. 44 bpm when asleep and 60 bpm during daytime. Didn't particularly do much for my BP. Nowadays on Sotalol my HR is around 68 and BP around 124/75 .... and me and my heart are now 14 years older !
I think drug dosages, and indeed drug choices, are far from clear in the treatment of atrial arrhythmias. It seems a matter of trial and error, and even that is confounded by the condition itself which can come and go at will. This variability makes any attempt at judging drug efficacy difficult. How people conclude this or that food is a "trigger" or food supplement "helps" defeats my own experience and understanding.
Your background, apart from your younger age and higher levels of exercise, so much mirrors my own, it is fascinating to me to read your posts. I was given flecainide 50mg bd a month ago, but after taking one (with great success for my AF and ectopic beats giving my first day of NSR during a very bad spell), I have yet to take more since it also caused me worryingly heavy heart beats.
Yes blindly following the consultants/arrhythmia team isn't working for me at all. I think because they are used to working on averages so when my resting HR on flecainide went from 50->80 they told me all was fine as that was "within bounds" whereas I knew something wasn't right.
Again I've got the same feeling with bisoporolol, cutting back appears to have worked well, had a very enjoyable bike ride in the sun today with no ill affects!
I suspect that since even the best specialists truly often cannot know what underlies the arrhythmias that occur in an individual's heart, treating them becomes well, a bit more than a finger in the air exercise, but still a matter of experience and hope!
So far as my own experience, I was told by my GP that beta blocker dosages can be safely adjusted to suit up to 5mg, in my case, so long as my bradycardia isn't affected (whatever that means).
Firstly you shouldn’t change dosage without consulting your medics
Bisoprolol can work well for many to keep their rate in the controlled range (60-100) while in AF but if you spend most of your time in NSR then it can lower your heart rate in to bradycardia territory (below 60). For some this is not a problem but I believe for some the low heart rate can open the gate for AF to kick in.
You should discuss with your doctors and it’s helpful if you have some data what your heart rate is doing in both AF and NSR.
Fortunately my cardiologist has given me the green light to experiment within some bounds. My resting HR is well below 60, I have lots of data, it's too much for the doctors, they deal in averages and don't have the time to dive into the minutia in my experience, unless paying for private health care, when my diaries were apparently very useful in organising a 2nd ablation.
Do you know WHY your dosage on Bisoprolol was increased? What was the thinking behind that? There are other rate controllers you could explore with your cardiologist. I see you've had AF since 2019 (same as me) so if the regime isn't working for you it's reasonable for you to request a cardiology or electrophysiology appointment.
yes I do, it's because I wanted to increase it and the medical team agreed. Based on getting some increased episodes we thought it was worth a try. There appears no black and white in AFib, everyone is different and my consultant says he is continuously learning and often surprised!
Thereis no reason why taking 2.5mg at night and 1.25 morning to try next.
1.25 difference can make a difference.
Tweaking meds is OK as long as you don't stop them altogether.
I was on 10mg Bisoprolol - it was not controlling my Heart Rate. Specialist brought in CCB Diltiazem without telling me what to do with both. I rung the Healthline and got a Dr at weekend the NZ Heart Foundation on the Wednesday. I had reduced Biso down to 5mg.
Talking to Nurse who had worked under my specialist.
1) Asked me to separate them CCB AM and BB PM.
2) Reduce CCB to 120mg from 180mg (report read i could have up to 360!!!!!
3) Reduce BB to 2.5mg
4) Try 1.25mg PM. No it showed an ECG with a heart under stress.
5) When Heart rate came down to 60 I tried without Diltiazem that didn't work and no med lower than 120mg.
Sometimes its the specialist who allows us to twink our meds.
1) It is easier for us to try things out.
2) ECG on hand to get a result.
Actually the 24hr Heart Monitor is so accurate. I had 3 in 2021 whilst finding out what happened if I did this or that.
Whilst caution should be taken, common sense is at the fore.
It is known from scientific research that a betablocker can have a negative effect on people with vagally triggered AF, meaning: it can cause AF to worsen. There are other meds -calcium antagonists for instance- that can be used to reduce resting heart rate without this negative effect. Might be worth mentioning this to your medical team. Good luck!
just adding a bit of context using the AF burden on the Apple watch which I wear 24x7 apart from when charging, clearly shows a major leap up last week with the only major change in lifestyle being the increase in bisoprolol at the end of May. Will be interesting to keep an eye on this with the decreased dose.
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Flecainide dose 
PIP and Flecainide 
back for help please years later !
