I have had PAF since 2021 which results in hight rate AF when it triggers. Incidents were originally about once a year and I have had two cardiofversions. I have had three incidents this year two reverted after a few hours and one required a trip to A and E and another cardio version, but I reverted under anaesthetic so didn't need the shock. I have been on Edoxaban for a few years but recently went onto a low once daily dose of 1.25g Bisoprolol in June and I am still waiting to see AF clinic to discuss Ablation. When I initially started taking Bisoprolol it upset my stomach lots of wind and IBS type symptoms which over time have improved but is still not quite right. I also get tired a lot and don't seem to have as much energy. I am trying to improve my diet but I have also started to gain some weight, not sure if that is due to medication or having less energy. Really not liking being on Bisoprolol. I have started to do some mild rowing training again and whilst monitoring my heart rate I notice the rate is artificially low for the intensity of the excise, this concerns me a bit as the medication is obviously doing this. Been to the GP who said keep with it for the time being as its a small dose but if things don't improve could look at changing the medication. Will I eventually get use to it or just have to put up with the tired effect ?
Bisoprolol: I have had PAF since 202... - Atrial Fibrillati...
Bisoprolol
I just couldn't get on with bisoprolol or any beta blocker, calcium channel blocker or any type of rate/rhythm control. They all made me feel worse than the AF. In the end it was decided to stop them after my first successful cardioversion and even though I went back into AF after 13 months and had another cardioversion they didn't put me back on any type of rate/rhythm control medication. I missed out on my ablation due to covid lockdowns and by the time all that was over was considered unsuitable for either more cardioversions or an ablation, even though 3 cardioversions had successfully kept me in NSR for 3 out of 4 years. I now only take an anticoagulant and have low rate permanent AF.
You may very well get used to bisoprolol and it's a small price to pay to keep your heart rate low whilst waiting for your ablation. It does or can cause breathlessness, fatigue and weight gain and I believe some people get some muscle pain with it sometimes too. With any luck your ablation will be successful and that will mean that you won't have to take it afterwards - though it is best not to stop cold but to gradually reduce the dose.
Good Luck.
Thank you for your comments it’s appreciated, I am going to be waiting a while I think.
Bisoprolol, like most of its relatives, causes weight gain because it slows your metabolism, and it is also problematic because it stops or partly stops you from responding to exercise needs. You may not need as much as you are presribed. I cut myself down to a quarter of the lowest dose pill and that still works on my heart rate. I also take it at night, so it has the least chance of slowing my activity down during the day. That makes it all more bearable. I hope you can do something similar. 
Here is a medscape article on these issues: medscape.com/viewarticle/ty...
Having worked in the pharmaceutical industry, I can say that most side effects disappear or lessen sufficiently over time. In the case of gastric issues, that is very likely to happen as the stomach can take a while to settle but nearly always does However, there are other beta blockers and families of drugs available. I would give it a bt longer but then ask for a change, maybe nebivolol as that acts differently?
Steve
Hi
Bisoprolol is one of the better Beta Blockers in the line of them.
We found on 24hr Heart Monitors it only brough down Heart Rate a little in my case. Metoprolol 186 - breathless, fatigued couldn't exert, and pauses at night. Even at 10mg Bisoprolol and monitor again H/Rate Day 156 no breathlessness, no pauses.
I am taking for high Systolic Rate (BP) contro.
Diltiazem CD controls my H/Rate at first down to 86-96 but having lost 3kg 60s now.
At night my normally low H/Rate is 47avge.
Separate BBs and CCBs though said the NZ. Heart Foundation nurse. We don't have AF nurses here in nZ.
cherio JOY. 75. (NZ)
I agree with Steve, Bisoprolol does take a few weeks to settle into the system and side effects can lessen after this time. However, it does indeed reduce the heart rate, both normally and when you exercise. I’m on the same dose as you and have been for three years ( hoping to come off soon following an ablation) and I initially I felt very fatigued on it, but have got used to it over time and that fatigue has lessened, even though my pulse can go in the 50s. I haven’t put on any weight since being on it, so perhaps it may be the tiredness you are feeling at the moment that is causing that. If things don’t improve for you, you could try switching to a different medication and it sounds like your GP is open to this ( many prefer a cardiologist to decide on medication).
I notice you said you’ve been waiting to see an AF clinic about a possible ablation. Is there a date for this in the horizon yet? If you could push to it, you could see an Electrophysiologist privately on your area ( around £200 for a consultation) if they offered an ablation which you agreed, you could be placed on the NHS waiting list a lot quicker. Unfortunately a lot of us have had to end up going privately like this in order to speed things up. It’s easy to find them, you just google them locally and usually contact them via their secretary.
Thanks for all your responses it is appreciated. I will give it a while longer and see how I go. Need to follow up the AF Clinic and will definitely consider a private consultation.
Hi Macmedal I've been on bisoprolol 5mg mornings and night for 4 years along with rivaroxaban since finding I have permanent AF. I have had no real problems apart from weight gain. I recently asked GP if I could change meds as he agreed they do slow metabolism but as I've been fine in that time, apart from gaining weight , he wasn't keen to change anything so I am continuing to try to lose weight ! Apart from that I think you have to give yourself time to get used to new meds.
After 7 weeks of 2.5mg of Bisoprolol I started with painful urticaria. While being weaned off 2.5, taking 1.25mg, I had a very rapid onset of asthma which resulted in emergency admission to hospital. I was taken off all beta blockers.
I had then, and still have, permanent, though asymptomatic, AF with a resting heart rate on the 80s. I was offered a Calcium Channel blocker by a Cardiologist, not an EP. I consulted local GP who advised as my heart rate was in normal range, he thought it would be of no use, ( given a history of not getting on with a variety of medications). For AF I take only Warfarin.
If your episodes of afib are spread out have you thougt about taking the Bisoprolol as a PIP to reduce your rate when in afib? If your rate is normal when in NSR why lower it more? Bisoprolol is a rate control drug. It does not stop episodes occurring .
You may find this of interest, as it cites that Bisoprolol is for treating high blood pressure and doe not mention its use for treating AF:
I personally do not have high blood pressure, but I am aware that it is used to treat other conditions. I need to see an EP and I am looking trying to just pay for a consultation. But I am in the Highlands of Scotland so that will not be as straight forward. I certainly need to discuss the ongoing use of Bisoprolol and how it benefits me being on it permanently, given the infrequency of the episodes, (albeit having three in the past year) vs a pill in the pocket. I know it relates to the high rate when I do go into AF but as has been mentioned it doesn’t stop the events happening in the first place, and I have been previously told I am suitable for Ablation. For some reason I did say originally I was on a 1.25mg dosage, but it is actually 2.5mg a day.
Breathlessness Bisoprolol 
bisoprolol 
Poor sleep. Should I change Bisoprolol time?
Ive been put on 5 mg Bisoprolol
