UPDATE: I saw an EP today. He advised that, unless I had a pacemaker implanted, medicinal control of my afib was too dangerous because of my already low heart rate. He also went over results from the 30 day monitor and the only time my heart rate went up to 170 bpm was when I was exercising while in afib (I knew I was in afib but had NO IDEA my heart rate was going so high; my Garmin showed a much lower heart rate at the time). He advised for me to take it easy and avoid exercise while in afib to keep the stress on the heart lower and henceforth I will follow this advice . (I liked being physically active while in afib because then I wouldn't feel my heart and exercise calms my anxiety.) My ablation (with a different EP) is scheduled for Oct 14. Now that I know my Garmin is WAY OFF when I am in afib, I finally used my Kardia for the first time and was happy to discover it was so easy. . . . .
Results from my 30-day heart monitoring device show mainly sinus rhythm, a 3% afib burden (plus PVCs and PACs), heart rate ranging from 41-170 bpm with an average of 63.
The cardiologist is saying, because of the high heart rates, he would like me to begin taking bisoprolol 5mg daily. (Just his note on the test results that I can see online - we won't be discussing it for another couple of months when I will be seeing him next.)
My initial reaction is why the %^!! do I want to feel bad the other 97% of the time and what about the low heart rates that keep the overall 30 day average down at 63 bpm.
Yes this is a decision I will make after discussing with my cardiologist, but I would love feedback and or suggestions from others who are in the trenches with afib. I am already on two potentially lifetime medications (statins and apixaban and really, but really, hate to start another).
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Ask your doc about Tikosyn. If it works for you there are no long term side effects such as fatigue. It has kept me afib free for 5 years now. Best of luck.Etheral
I refused to take Tikosyn, but the EPs kept urging me to. You have to be hospitalized for 3 days to see whether the Tikosyn kills you.
Finally, I was in the hospital for a throat infection, and the EPs showed up to push it again: "As long as you're in the hospital anyway..." So I took it.
The next morning I was awakened with, "Well, the Tikosyn is not right for you; your heart's chambers are responding too slowly." (They looked worried!)
I had a magnesium drip for 3 days, during which I decided to go with my intuition about taking risky meds and stand my ground in the future.
Hi, Because TIKOSYN can cause life threatening ventricular arrhythmias, it should be reserved for patients in whom atrial fibrillation/atrial flutter is highly symptomatic. Google says it is not available in Europe or Australia.
The questions I would be asking is are the highs and lows only when in AF (3% of the time) and to get your usual resting rate when in NSR (97% of the time) as that is what the bisoprolol will be lowering when it (maybe) doesn’t need to.
HR should only be measured by counting beats over 60 seconds while in AF as 3 quick ones in a second could give a 180 and then a pause of 2 seconds between beats could give a 30, both quite normal in AF I think.
This is my understanding and hope it makes sense and helps with decision.
Thank you for your reply. My unmedicated, NSR lows are in the 40s (very occassionally high 30s) every single night. Right now, seated and typing on my laptop, my NSR bpm is hovering around 54. I've always had a low resting heart rate - normal and comfortable for me. But I don't think I would be comfortable if it were reduced further! The higher values occur only when in afib. The values I provided are from the medical technician report for the 30 day heart monitor, so I will assume the professional knows - During the same 30 days, my Garmin shows a high in the 130s rather than 170.
Your concerns are justified in my opinion. My unmedicated NSR lows were in the 50s and 1.25mg put me in to the 40s and an increase in dose to 2x1.25mg put me in low 40s. I believe that going too low in to bradycardia could allow the AF to take over more often for some and make the burden higher.
It’s a good drug if you need it but what they call a small dose can have a dramatic effect. I’m off it now (see my bio) and long may that continue.
You might discuss using rate control as a PIP - ie: only when you need it? 3% is a low AF burden and Bisoprolol is energy sapping and with your concerns about lowering your already low HR - not something I would be wanting to take every day - but then I am very biased against Bisoprolol as I couldn’t tolerate it at all.
UK and US do have slightly different attitudes and protocols toward treatments so for those not in US reading this thread - Tykosyn is not available in Europe as far as I know.
Yes, that was my thinking - as a PIP it could be viable. I feel so uncertain when the healthcare "expert" proposes something that seems to go against my understanding of the situation. He may still have his reasons and I'll listen to them and may learn something new, but at least I know I'm not completely out in left field in my thinking with the information available to me. That is just one of the reasons why this forum is so valuable. Thank you for your input!
I was on 2.5 Bisoprolol in the morning which exhausted me. I then started taking 1.25 morning and evening at the moment I’m taking when I feel flutters and know my heart is racing. That is suiting me for now. Bisoprolol wipes me out
Interesting, I am also 70 and saw my cardiologist a week ago on the same subject with broadly similar circumstances.
I will be starting my 48hr monitoring device next week to find out what is happening. So far I have been on Flecainide (medium dose 200mgs) which has been v successful and recently Edoxaban (this AC maybe has a different name in the States) due to my recent new 'flutter' type issues.
I have been on the Flecainide for 11yrs but unusually without any Biso which most take. Like you this new situation of current infrequent beats are just mildly uncomfortable and can be tolerated provided they don't get worse. I told the cardiologist my main concern was that I suddenly get a very high heart rate and queried whether I should have a PIP prescription for such a situation. He said the older I get the risk declines and didn't seem concerned but did give me scrip for Biso as a PIP 2.5mg, only once in any 24hrs.
After the monitoring result, I am due a telephone follow-up appointment with the cardiologist. So we will see what happens next but I will need convincing if he suggests daily Biso.
PS I have resisted suggestions from other medics to start statins, which started 15 years ago!
The medics argue you need to reduce cholesterol, I don't agree, I understand most cells including the brain need it. Plus I don't think they do your liver any good or your general wellbeing.
I have had total cholesterol around 7 for 25 years and 11 years ago my arteries were checked and were fine.
Agreed, very similar scenario to yours but my added reason is that statins are known to exacerbate Myasthenia and in a few cases, even trigger it.
Even my GPs agreed not a good idea for me. I have used plant sterol supplements and diet and that has brought my Triglycerides down a little simply because I know I don’t clear lipids from the blood stream quickly so I have to be careful with what and when I eat and exercise.
When I am experiencing afib with tachycardia, I take an old prescription of propranolol that I had for public speaking situations. I tried metoprolol, but with it I experienced a pretty scarey near syncope event that the health professionals think was a heart pause. It may just have been coincidence, but that had never happened when using propranolol.
After a year of trying to reduce my LDL-C through lifestyle modifications, I caved on the statins because I do have the risk factor of elevated lipoprotein-a. But, the statin I was taking nearly doubled my lipoprotein-a levels, so I have recently switched to a different statin to see if it plays better with the lipoprotein-a. I will say, my calcium score was zero before I started statins. With the way the statin affected the lp(a), the calcium score may have changed as well.
I switched to pitavastatin and I am at 1 mg, but after my next blood tests I may be doubling that depending on lp(a) levels and LDL-C levels. Before I was on a low dose of simvastatin, but it had bad effects on the lp(a). The other BIG difference between the two: Once I started taking simvastatin, I was hungry all the time -- I mean I NEVER felt satiated. There is none of that with pitavastatin.
Bisoprolol helps the heart in many ways, I gather, not least from beating too fast. But, if I were you, I would ask my GP about taking it as and when needed. I did that for a log time quite successfully. It takes about an hour to start working, but, back then, work it did. In deed, I wrote a post here, called, I think, "Bisoprolol: my friend".
Like you, my heart rate can run slow. My afib burden was low (had an ablation but still get some runs of tachycardia at altitude and PACs/PVCs). My EP told me to only take beta blockers as needed. I tried my daughters propranolol and like it as it doesn’t make me feel muffled like some of other blockers. So I have a prescription for that and it is my new favorite med! I rarely take it but will if I am having arrhythmias and I know it’s going to be a rough night as it helps me sleep too…
I'm with you. I used to take a half tablet of 10 mg propranolol prn for anxiety related to public speaking and never had a bad experience with it. I use my old propranolol prescription when I go into tachycardia - take 5 mg initially to slow the heart rate and if that doesn't do the trick take another 5 mg after an hour or so. I've never had a bad experience with it and can't say the same for the more heart specific beta blocker (metoprolol) I tried.
My cardiologist was more concerned about my heart beating too slowly rather than the odd speedy burst. So I am limited to a moderate dose of Diltiazem. He also said I couldn’t take extra as PIP because if I reverted while it was still effective my resting rate would be too slow. I certainly wouldn’t be willing to take a large dose of medication for a 3% or less problem.
I had fatigue and breathless and pauses with Metopolol.
None of the above with Bisoprolol. 2.5mg PM.
Diltiazem AM 120mg controls my rapid heart beat.
Its walking long distances that get me.
I used to a 1st medal finalist running 100m up until at least 40.
I can be driving and shopping get home, relax and fall asleep. Being single again makes it easier.
Can't run fast, cant walk brisky just walk. steps ok if not too many of them.
Much better on 60s Heart Rate. Night rate doesn't worry me.
At 75 with AF I just accept what life is now. I love driving and my m. schnauzer and I go exploring NZ. She has grade 1 heart murmur with no symptoms but she has a sleep id day for however long she wants. Mine comes early evening.
What is your dose of Diltiazem? I have periods of heart rates in the 50s that make me lightheaded. Diltiazem has been reduced from 300 mg to 240 mg and now 180 mg
180mg, it’s tricky because according to my fitness watch my HR varies between 50 and about 120, neither of which are good but are brief, so I guess the balance is about right.
Statin and anticoagulant daily for me although I only take 3.75mg Bisoprolol at onset of AF which after about an hour or so reduces HR down to a manageable 80-odd until it peters out some hours later. However, as bouts between my AF are slowly becoming more frequent, it's been suggested by my GP, whilst I wait for a cardiology appointment (which could take months here in the UK) that I start taking Bisoprolol on a daily basis which I'm reluctant to do. Will it prevent the more frequent bouts of AF? Like you, why take it when I'm fine the majority of the time? Will it diminish the effect as a PIP? I guess I won't know until I try it. So I've decided (whether rightly or wrongly), to wait and see if my bouts of AF become a bit more intolerable then I might give a daily dose of Bisoprolol a go.
Good luck with your decision but would be interested to hear how you get on.
Once you're on bisoprolol, it's hard to get off it. I don't mean it's addictive, rather that the medical profession don't seem to like taking the risk of stopping a drug you maybe didn't need in the first place.
I was prescribed bisoprolol in 2016 by my then GP, who added it to the apixaban I had been told to use on a cardiology report after wearing a monitor for a week. There was one incident of 2 seconds "suspicious of atrial fibrillation". To say bisoprolol ruined my life would be perhaps exaggerating, but my ability to do my teaching job while on 5mg suffered hugely. I eventually had to take early retirement. I eventually managed to persuade the GP to drop my dose to 1.25mg which I can tolerate. We have since moved, and no-one will consider taking me off bisoprolol now because they don't want to take the risk. So beware!
Drs won't take you off it unless a cardiologist approves. Usually a Cardiologist prescribes it in the first place.
I was stuck on Metoprolol for 1 year 5 months. I didn't want it in the first place but she ignored. I sent a letter of complaint and was told every Stroke victim has Metoprolol. I was breathless and fatigued. Pauses at night. The 24hr Heart Monitor showed that I was uncontrolled at 186.
I asked for a Cardiologist and she changed me to Bisoprolol. But up and up it went without controlling my rapid heart rate. She knew due to a Heart Monitor I was still at 156 Day.
My normal low Heart Rate at Night was 47bpm.
My Locum Dr suggested that I go to a private Cardiologist and named him.
I was introduced to CCB Calcium Channel Blocker Diltiazem. Twinked down to 120mg AM I immediately became controlled within 2 hours to 60s. I lost weight 6kgs.
I now take only 2.5mg PM to control my BP.
I controlled the amount of BB Metopolol and BB Bisoprolol myself when Diltiazem was introduced.
My HR has never been abnormal. Average BPM at rest is 67.
I was only put on meds because of a 2 second blip as described above. AF has never been confirmed. I was only put on apixaban by cardiology by letter; I've never seen one. The GP added the bisoprolol saying "I'll give you some 20mg tablets you can take if you feel you need them". Why would I? I've never felt any symptoms and my pulse is always regular. Now I can't get off the bisoprolol.
I wouldn't go right off them until you have seen a Cardiologist but 20 mg Bisoprolol is too much! I was told 10mg was optimum.
You are your own person and I'd get a secomd opinion from another but interested Dr.
Remember you are the CEO of your health.
Earlier in Feb 2020 after Thyroidectomy as a Low Risk for its return I reclined RAI Radio Active Treatment which can cause drastic damage or leukaemia and Suppression of TSH because I am a senior with a Heart Condition.
1.25 mg of Bisoprolol proved too much for me to take daily and was stopped after only 3 days! Now that I take Flecainide I have been AF free for over a year and a half and have recently reduced the dose with a doctor’s agreement so I take 50mg am and 100mg pm - was persuaded to take statins recently even though I’ve never been overweight and have a healthy diet. And I might try the Omeprazole again as it seems I have a hiatus hernia and the exercise I do that is supposed to push it back intompkace might not always be working! But I am 80 (and a half!)
First thing drink a glass of “room temperature” water. Then stand with your arms outstretched and hands to chest. Rise on your toes and then down with a thump ten times and then with arms straight up in the air breath through your mouth for 15 seconds. I’ve been doing it most mornings but I’m not that convinced it’s working so am going to discuss taking the Omeprazole again when I can get an appointment! I have the odd swig of Gaviscon too. I’m surprised that since the discovery of my damaged oesophagus there have been no check ups on it and I’m sure it hasn’t healed up yet.
Tikosyn is risky. It is class III anti-arrhymnic med.
Should not be used if ventricle bottom chamber are abnormal.
You should be hospitalised for 3 days whilst it is introduced.
Not available in UK, or Australia. Not passed for saftey reasons.
Etheral should tell you about the warnings!
Bisoprolol does not side effect fatigue. But it nothing for my rapid heart beat.
CCB Diltiazen was introduced AM low dose 120mg. It leaves my Night Heart Rate 47bpm avg. This is my night heart rate without drugs.
If you don't get H/Rate down below 100 at rest. Anaesthetists won't be keen for any Surgeon to operate.
Your other med is an anti co-agulant.
175 is not under 100. Do you need to lose some weight? This helps. I lost 6kg and my controlled heart rate day decreased from 88-96 to 60s. I feel heaps better on 60s h/rate.
BBs Bisoprolol 2.5mg PM to control my BP. Now 120-132 /. 68-78.
I have had good success with the recent prescription of bisoprolol 5 mg -- about three months now. I still get occasional palpitations, about once a week. It took a couple of weeks to get used to bisoprolol for me.
Even while in afib, my heart rate rarely exceeds low 120s, and that's for only a few minutes and I can breathe it away. I too am on a statin and apixaban. I am your age.
Your cardiologist's recommendation sounds fairly standard and might well work for you. I come from a family with plenty of doctors and you can be sure that they receive an amazing level of training.
I understand your frustration because I had similar feelings. I figured the medications were worth trying and, as I said, I have enjoyed some relief.
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