hi, I saw a consultant yesterday after an echocardiogram. TBH I came out not having asked enough questions and am annoyed at myself. Basically he said ‘we need to get your heart rate down’ and prescribed me 10 mg daily bisoprolol. I had been taking between 2.5 and 5 mg since being told in April by A&E that I had a fib, but tbh I have (foolishly ) been taking these off and on. Presume this is why my rate has remained high…. Silly on my part I know …. So… as my heart rate is generally always 120 ..130 (except middle of the night I have seen it at 70), that’s why he said to take 10mg. He also said he will get me in ‘when possible ‘ potentially in a month or so, for cardioversion.
What I should have asked is … do we not try controlling via medication first ? Also, how dangerous is it - remaining at that high rate? Is it usual to try cardio version at this stage?
also, am wondering how quick would the start …just taken this morning …of this big dose of bisoprolol start to work?
Sorry to sound a bit all over here…but just feel lots of unanswered questions?
I would appreciate if anyone can advise if similar experiences? thanking in anticipation..
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If your cardiologist is saying that your HR needs to be lower then I think you should follow his advice and take the 10mg regularly. 120/130 is definitely too high and if he's offering you a cardioversion in a month or so, he's actually rushing you through as IME normally you'd have to wait a lot longer. I hope the bisoprolol works for you. Did you tell him that you have not been taking your lower dose of bisoprolol regularly? I'm not a doctor and hopefully someone else will post on your thread but I don't think it's safe to take 10mg of bisoprolol if you haven't already been on a lower dose and have built up some tolerance. When I was in hospital, although I'd been taking 1.25mg of bisoprolol they gradually increased the dose (titrated). I'm not certain about this but would not like
hi....thanks for your reply. It is a bit concerning tbh...Not only did he say to take 10 mg...but he prescribed it as once a day in the morning. I was a bit concerned this morning taking such an amount, especially when it says in the information slip in the box that it is normally taken as 5mg twice daily!
If your cardiologist knows that you've not taken your previous dose regularly, it will be OK, try not to worry. I had my dose upped to 10mg but unfortunately it didn't work for me, so they changed it to 7.5mg twice daily, so you are not on the maximum dose. However I think they will want to get it down asap. I was booked to have an ablation but because I have atypical atrial flutter I needed a different procedure so I had a cardioversion instead which was very effective and kept me symptom free for nearly two years. I had it done as a day patient and was absolutely fine the next day, really nothing to worry about. You will need to be driven home though. After my cardioversion I was still taking a low dose of bisolprolol and a blood thinner. I know you asked about private treatment, purely by luck I saw my NHS consultant privately before I saw him on the NHS. He refused to do an ablation as he couldn't guarantee it would be successful and it is quite pricey and advised me to stick with the NHS for actual procedures but I have seen him again when I've felt the need to have a longer time to talk through my options and I've thought it was money well spent.
Hi…thanks again for getting back. Regarding private treatment, being honest, I could not afford actual procedures etc. But was asking about private consultations…just so I could ask questions to get clear info and this sound like you had such an arrangement? Is that so? … that you paid for time in effect to be able to get the info needed?
Thanks too for the reassurance about bisoprolol and the max dosage.
also, another question if you don’t mind….how long does it take to see or get the outcome of a new medication? What I mean is when you say the 10 mg did not work for you…at what point /how long after starting that dosage was it determined that it was insufficient for you? Thanks
Did the specialist say what was causing the tachycardia? Is it persistent AF? I have read that a high rate can cause ventricular problems in some people along with valve issues, but this seems often to be reversible. After my ablation for atrial flutter, my heart recovered its pumping capacity ("ejection fraction" or EF) fully.
From my experience, 10mg bisoprolol is a perfectly safe dose, with up to 20mg being allowed. I took 10mg while I had a persistent rate of 155bpm. It still didn't work well enough, however, as happens with AFl apparently, and, eventually, digoxin was added, which worked well. Other drugs that are used are amiodarone and dofetilide, I believe.
Hi Steve, tbh I should have asked those questions that you have asked…and that’s why I am frustrated with myself. I think I was just a bit shocked at his suggestion of increasing bisoprolol to 10mg and that he said I need cardioversion. Also, we are all so frightened of taking their time…silly but…
Your reply about 10mg being safe and sharing your experience is reassuring to me - thank you. And best wishes.
You and me, too. I never ask the right questions. In fact, the last time I had an appointment, I typed out a few question but one way or another, he didn't answer most of them.
I think the reality for most of us is that the doctor knows we are safe and that it is we who are fearful - unnecessarily so. I have been told that the issues we have, being all in the atrium, feel far worse than they really are. Clearly, a few people do have a seriously bad time with AF and need hospital treatment, but for most, I think the worst symptom is fear, which, because it sends the heart rate up, causes a vicious circle.
I was told that compared with the anti-arrhythmic drugs (such as sotalol and flecainide), beta-blockers like bisoprolol are rather safe drugs. I would have no concerns in your case given that you are under a specialist.
In my case, I also have something called "bundle block" (LBBB - another conduction issue). This can cause me to have a low heart rate at times, so adding in a high dose of bisoprolol isn't now a good thing (even 2.5mg made me a bit light-headed). Oddly, when I had the tachycardia from the atrial flutter, back in 2019, I was able to take 10mg without issue, although my heart rate did on occasion fall to 38, if I recall. The specialist just said that so long as it isn't symptomatic, it was fine. I have been told that I can raise and lower the dose myself as required, too, up to 5mg. Ask your GP about this, if I were you. GPs have a lot of experience of AF and its treatment.
Again, many thanks Steve. Can I ask …did you develop bundle block more recently, … just with you saying you could take high dose bisoprolol in 2019, sounded like you did not have bundle block then? Hope you don’t mind me asking.
‘I typed out a few question but one way or another, he didn't answer most of them.’- this made me smile…I think we can all relate to this lol
I did have it back then, but I can only think it worsens, or, perhaps more likely, when my heart was persistently racing, it didn't matter to take a high dose. The ablation stopped the atrial flutter and, from that point, I didn't need any other treatment except an anticoagulant. That was until AF raised its head around a year later.
I was thinking - maybe ask your GP about taking digoxin? It was another sufferer here who advised me on that and it truly changed things for me.
The report to your GP from the specialist should state what the cause of the racing heart seems to be. Have you asked? You ought to have been sent a copy.
Hi there, my dad's HR was that high as well a few weeks ago and he has been able to bring it under 100 now with daily dose of Digoxin 125mcg and Bisoprolol 2.5mg daily dose.
Hopefully you told him that you took it on and off.
British heart foundation is very helpful if you have any questions regarding doses and medication but also speak to your local pharmacist as they have a lot of knowledge on this. I had to try multiple pharmacists before I found one with good knowledge.
thank you for your reply...yes, i have seen a few people comment about digoxin...And good idea about ringing the British Heart Foundation. Silly of me, but I did not think of that, so thank you. Best wishes to you too.
ps...yes i did say i took it 'on and off'...but being honest...i questioned myself after the consultation if he 'listened' to that....all very frustrating....
Excellent advice by all above but encourage you to follow up with your doctor about your concerns since he has the facts about your case and echo.
Google "bisoprolol NHS guidelines" and you will see your doctor is correct about dosage. Also, it is recommended to take in the morning since you will be more active during the day. If dizziness or other side effects are a bit much, seek advice about nightime dosage.
yes i did say i took it 'on and off'...but being honest...i questioned myself after the consultation if he 'listened' to that....all very frustrating....
I and others sometimes have the same issue. Don't be disheartened, doctors sometimes have this trait. But thankfully, I have yet to find my arrogant cardiologist wrong.
Why .. firstly a CCB amd BB need to be separated. Told to me by NZ Heart Foundation Nurse who worked under my private H/Specialist.
secondly I had my stroke at 2am. BP rises early morning.
thirdly as my heart rate is lowat night 47avg bpm reducing the heart rate further at night would be dangerous.
Work around my body clock at all times.
I was lightheaded when I started on 1/2 dose (360mg full) 180mg and this was reduced to 120mg CD.
Since regulating my Heart Rate I have been able to undergo 2 further operations (not heart) which were necessary. Anaesthetists make it clear it your Heart Rate is over 100, we cannot operate.
Drs have a tendency just to put up meds prescribed by Heart Specialists. But 2 Beta Blockers not controlling the rate should have been a warning of wrong med for this person. I went to 10mg Bisopolol and the 24hr H/monitor showed 156 bpm still.
That is why it's important to have an interested specialist. Heart Specialists cover every aspect of the Heart including the suitability of an ablation. . EPs are ready to operate.
I never got to an EP because of structural damage.
Glad it helped. I'm new on the AF forum and only sharing what I have learnt in the last 3 months. People are incredibly helpful here. You could always book a private consultation with an EP to get a second opinion. I would prepare any questions I have and also prepare a file of medical history so far. I never assume doctors have seen my records and always summarise my medical history in first 2-3 mins for them.
I too , forget to ask half the questions. I have private health care here in South Africa so I visit my Cardiologist annually. This year I decided to write everything that I have had, taken, effects etc. including drugs prescribed by my GP, and left him to read this 'tome' while his assistant organised the ECG and Echo😄
Hi there. It's all very scary when AF joins the family, isn't it?Are you in AF all of the time or now and again?
You mention that you thought they would give down the medication route first, which is usual but requires compliance by you and you've admitted you have been naughty on that score.
Certainly, question why something is being prescribed and question again if you're sure of the answer.
To be honest, I would jump (no pun intended) at a cardioversion if I was in AF most of the time.
I've had about 8 in 8 years and yes it's daunting but the relief you feel when it's done is great.
I didn't realise quite how bad I'd felt until I felt normal again.
Hopefully, the Bisoprolol will do the trick until you get in for the cardioversion.
Hi. This time last year, my medication was titrated over time in order to get my heart rate down. I ended up on 12.5 Bisoprolol, as well as Rivaroxoban and Candersartan. Digoxin was also introduced. I’d been suffering from breathlessness/air hunger and was admitted to hospital in one occasion. To be honest, I think that the digoxin led to the most improvement. Despite, my persistent AFib, I felt quite well by October, although the high dose of Bisoprolol caused bouts of tiredness. I took all of my tablets on a night to limit the tiredness though the day.
I had my cardioversion nearly three weeks ago. It worked but my heart rate was low and I ended up in A&E a week later. I posted on here about my concerns. Anyway, the clinic reduced my Bisoprolol to 7.5 and after five days I began to feel much better. I’m still in sinus rhythm and my heart rate has risen (still below 60 though). I’ve just been away for the weekend with friends and I’ve had no problem keeping up with them on some challenging walks. World of difference from this time last year. So far, so good!
It seems that getting the balance right can be quite a journey and I know that cardioversions don’t always work full time. In my case, it’s definitely been worth a try though x
Just putting up Beta Blockers first Metoprolol and the Bosoprolol DID NOT CONTROL MY RAPID EART RATE. 186 & then 156 Day Heart Rate is not controlling and unacceptable for QOL.
Firstly after the Stroke with rapid & Persistent AF I was left on 186 bpm Day for 1 year 5 months but like you Night rate was below 100 mine at 47avg bpm my normal,
A new Locum joined our clinic and she had experienced AF but had an ablation in Australia. She referred me to the best heart specialist in Northland. Like most Chinese Drs they are interested and excellent. I'm not sure why the hospital H/Specialist left after the 2nd 24hr Heart Monitor clearly showed that BBs wern't going to be right for me.
So for the last 2.1/2 years my med regime is:
AM CCB Diltiazem 120 CD for heart cotrol - now 60s Day
PM BB Bisoprolol 2.5mg for BP control. My ststollic was high. 120-135 /. 82.
Of course an anti-co-agulant PRADAXA 110mg.
I also take thryroxin for hormone replacement because on 4th day of my helicopter hospital stay the carotid scan showed a shadow on my thyroid. A FNA found Paoillary Cancer a carcinoma 19mm x 7mm in my right lobe & bit in left lobe. A Thyroidectomy was carried out in Feb 2020 under lots of arguments by the Endocrinologist to delay unril 6 mths post Stroke but it was done at 4 mths.
Do get your thyroid checked out. The thyroglubin serum moving up can be an indicator.
Otherwise can you say why you have developed AF.
After ECHO, ECG and 24hr Heart Monitor they decided that too much structural damage (caused by being left at such high heart rates ) I cannot have a cardioversion (2 types) by shock treatment or by using an anti rrhymnic med , both which have risks.
CCB Diltiazem acts like an anti-rhymnic med but if no ventricle problems it is safe.
Otherwise rhythn could go hey why and get worse.
Patience and always jot down any questions. I lost 3kg which helped too.
Do concentrate in having a Heart Specialist who is interested in your plight as we are all different.
I have had no palpitations, flutters or pain since my diagnosis Sept 2019 5 years ago. Except 2 weeks ago on Day 4 & 5 I endured a second's uncomfort of a flip inmy heart 2 and 1. But at that time I had a UTI which had not been medicated for. It was on Day 7 and the mild vertigo left me.
Apart from the symptoms of not walking far and having to stop in my tracks at exertion. Dr says that blood not circulating efficiently.
I hope they can sort it for you to give you confidence in your QOL (Quality of Life).
thanks for your reply joy and sharing your journey. As you say, we are all different, but it’s wonderful to have this forum for support, reassurance and to share knowledge. Best wishes to you.
Hi, I know this is not central to what you asked, but it might be useful. I hope so.
Google 'Vagus Nerve' and maybe look on YouTube how to calm it. I use this often. It works and is quick and easy. Find a video that you like the look of.
It's usually breathing, and very simple stretching exercises or massaging your ear. I know it sounds a bit cuckoo 😄 but this nerve is huge, runs directly behind your heart and has branches from your brain to your stomach. It's vital and you can calm it down by just simple, quick things and it slows your heart rate.
No need to buy anything from anyone, just find a video that appeals - I know some are a bit 'new agey'! But a lot of doctors also post about it.
yes…I have heard about this and keep thinking I must check it out but have not yet, but.. fate, …your message will nudge me to do this today. Here’s hoping . .
Many thanks for your reply and advice. Very best wishes.
I have had quite a long and storied combination of treatments and interventions for a-fib. I am not a doctor, but I would choose and recommend a cardioversion over using meds.
Hi there, talking as a non medic but someone who has had those high rates and for a long time...
do we not try controlling via medication first ?
Arguably they have tried that, without success. The higher rate dose might help but it might also come with a load of side effects (I couldn't tolerate even low dose of bisoprolol, made me breathless and dizzy). But I could tolerate other drugs.
Also, how dangerous is it - remaining at that high rate?
It's ideal for HR to be under 110. It depends for how long it's left like that. The Body can cope pretty well.
I developed heart failure from untreated AF but I'm talking 20 years of AF, 10 years persistent and untreated. I always managed the higher rates family well but would get dizzy over 140.
It doesn't pose an imminent threat.
Is it usual to try cardio version at this stage?
Well, yes if they can't get the heart rate down. It's a pretty straightforward procedure, for them and for you. It might not "last" but it will let them know if you are a candidate for ablation, as well as hopefully getting you out of that high rate. Its a day procedure. You don't feel anything
also, am wondering how quick would the start …just taken this morning …of this big dose of bisoprolol start to work?
It's pretty fast acting I think. I was given it in A and E a few years back (having never had it before) when my HR was stuck at 150 plus and it brought it down enough for me to go home that night.
Hi, yes that is a great help. I so appreciate this forum and people like yourself sharing your knowledge. Your answers are very helpful to me. If you don’t mind… how can you know you had AF for 20 years and untreated for 10?
Not quite sure what you mean by the question, but I know because I experienced it that whole time. I was diagnosed at age 29 but not properly treated until 46.It was untreated cos back then there were less treatment options and the cardiologist I saw back then discharged me cos he didn't think I was a candidate for ablation. The dominant thinking then was that it wouldn't cause any harm, and was just a quality of life matter. I developed allergies due to the meds so they stopped them and just advised to live My life as I was unlikely to have a heart attack. They didn't discuss stroke risk or heart failure risk.
So it was left to run its course.
My cardiologist now is excellent and despite there only being a slim chance of success he advocated for ablation. My EP did 3 in one year. I am extremely grateful for their proactive stance and tenacity.
I take my bisoprolol in 2 doses. Morning and bedtime. As a high dose in the morning lowers my blood pressure too much. I was told the sooner you get a cardio version the better. It’s got more chance of working if it’s done before 12 months of being in AFib. Good luck
10 mg Bisoprolol and flecainide were prescribed to me years ago. This worked until after Covid. Imperative you take it every day. I moved on to Digoxin but it made me feel terrible so I now take Amiodarone until I reduce weight for an ablation.
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I and others sometimes have the same issue. Don't be disheartened, doctors sometimes have this trait. But thankfully, I have yet to find my arrogant cardiologist wrong. 
High heart rate.
Flecainide and heart rate
Lower heart rate after cardioversion
High heart rate after ablation
