Hi wise fellow afibbers. So I have had PAF for a number of years, my heart has not remodeled so far, echo’s and stress tests remain normal- though apparently that can change quickly.
But recently the idea of trying a low dose of the HR med beta blockers during an event in case it shortens it (they last from 4-16 hours) came up- sounds worth trying.
But another doctor suggested I take a low dose of beta blockers permanently “to calm things down and maybe balance things” which strikes me as odd. In sinus I have very low BP and low HR(43 at night).
Most people do not take BB gratuitously or for fun and giggles, what did I miss? Plus I found the study below.
Hi agnostic1, you mentioned you have low BP and HR and the study you're referring to does mention that beta-blockers for those with normal ejection fractions and low HR may not necessarily be the best choice. But the study also suggests that further research is still needed since it raises concerns about emerging findings.... so still in the works as they say. It also suggests that non-dihydropyridine calcium channel blockers may be better alternatives.
I take diltiazem, a calcium channel blocker but I have flutter and it on occasion keeps a fast regular rate from 2:1 to 4:1. But it also lowers my normal blood pressure way down. Again everyone is different. My cardiologist mentioned this works best for my AFL presentation (at least so far). Calcium channel blockers don't slow your heart down too much, especially if your heart pumps normally and you already have a low resting heart rate.
My suggestion is bring up the study, (though depending on the doctor, some listen others don't) and mention your concerns with your normal EF and low heart rates. The tailored treatment as you've mentioned during an event may be better though there may be a specific reason, not knowing your personal medical picture, that your cardiologist mentioned a low dose to "calm things down". And it's best to start any medication with some degree of confidence. Even with years of training, doctors continue to "practice" medicine and medication is still an art not a science especially regarding AF.
I’ve been put on 12.5mg metoprolol which is equivalent to Bisoprolol of 1.25mg I’ve reduced that to 10mg as my resting HR is around 60 without drugs. He initially tried me at 25mg but HR would go down to low 40’s especially if we added Fkecanide. My Cardiologist suggests in my case the BB is to tamp down the adrenaline spike which he thinks associated with stress rushing around alcohol caffeine has historically put me in AF. So in my case it’s not for slowing HR
I took Bisoprolol whilst awaiting an echo (albeit at half the prescribed dose) and then stopped completely after the echo showed normal structure and ejection fraction. It was clear to me that prescribing 2.5mg Bisoprolol was the automatic ‘safe’ response to AF diagnosis. I suspect that most PAF sufferers may continue with medication regardless - it was quite a task for me to question its utility once I got the echo results. After challenging the cardiologists I got their blessing to stop the beta-blocker altogether and take an ACE-inhibitor for blood pressure alone, whilst avoiding excessive cardio exercise (limiting my bpm to peak 150 at the gym).
I get the impression that each medic develops their own favourite pills approach as AF is such a mongrel condition that no firm guidelines have evolved.
Eg. If you consulted my cardliogist he would probably recommend a low daily dose of Flecainide and no BB/CC; well that's what he did for me and I have similar vitals to you.
I only take my bisoprosal when needed and find I’m controlling it a lot better. When I’m off to play badminton or other activity, I’ll take one as high heart rate always triggered mine
That study is one of many that are conflicting. I doubt the safety or otherwise of beta blockers is yet known. I asked the cardiologist I see about this a while back, and he is an enthusiastic professor at a medical teaching school. He said that without question bisoprolol was the preferred choice where rate control was needed.
Nevertheless, and with studies like that one on mind, I keep wondering whether to ask if I really need my 1.25mg daily as I already have bradycardia. My AF is slower and less uncomfortable than it used to be, too, although far more frequent.
Thanks for posting. I am on 2.5 bisoprol and have heart failure with reduced EF. It does say that these conditions are the only ones that benefit from beta blockers so good. Until further reading which says might not be too good for persistent AF which I am in. Seems it is something to do with how the heart fills with blood. I will have to look into it. I don't have any problems taking BBs and seems to lead a normal life including running and cycling without any shortness of breath. Heart rate at rest is in the 50s but can reach up to 180 when exercising but averages around 150.
I have chronic asthma and so was never prescribed beta blockers. I took Flecainide daily until I was found to be in persistent though asymptomatic AF. Following a rise in heart rate if 190+ while under general anaesthetic to remove my appendix, a hospital doctor prescribed 2.5mg of bisoprolol for life, despite my protests.Nothing untoward appeared to happen, but then painful intermittent rashes appeared on my body. I managed to photograph some of them, saw a GP who specialised in dermatology, who decided I needed weaning off bisoprolol. During the weaning while on a lower dose of bisoprolol I had a very sudden exacerbation of asthma and was admitted to hospital for three days.
The Urticaria took 4 years of antihistamines to leave my body. My doctors did research which led to my being taken off all beta blockers.
For my permanent though asymptomatic AF, I take only Warfarin, my choice of anticoagulant.
If you have low heart rate the beta blocker may lower it more but you will only find out by trying. As a Pill in the pocket (PIP) this may work well for you. I have heard of other people using it this way but only a few. As far as taking it permanently at a low dose again this may work for you as we are all different. For me Bisoprolol didn't work as it made me feel worse with fatigue, breathlessness and dry cough - but then my history is not the same as yours. I tried Bisoprolol, a calcium channel blocker verapamil and some others and a combination of a few different ones and then other rate rhythm medication but they all made me feel worse than the AF itself. Thing is to talk this through with your consultant cardiologist or Electrophysiologist (EP) and find an approach that will work well for you.
l use bisoprolol as a PIP as l have low blood pressure, but also the drug gave me awful side effects when taken regularly. It works for me as a PIP. My episodes last from 3/4 hrs. to 8/10 hrs. I am always of the opinion that the body gets used to a certain drug and, therefore, it doesn’t work so efficiently and the dose has to be increased. I am on the lowest dose of Bisprolol 1.25 mgs. intially and if AF not stopped l can take another pill, but rarely have I had to do that. I am not saying this works for everyone and l am fortunate that my burden is low. The medics. seem to think l should be on bisoprolol or a beta blocker regularly, but l find the drugs make me worse than AF itself and l am better off without. I have been stable this way for 6 years. If it isn’t broken, don’t fix it. Hope you find what’s best for you.
I find the remark about beta blockers "balancing" things a bit odd. What they actually do is lower your heart rate and as a result slow your metabolism. Some people get horrible side effects even on the minimum doses. I do not see the point of lowering a low normal sinus heart rate even further and there are some doctors who think that a very low heart rate during the night might provoke afib. Taking as a PIP is a different matter - again it depends what your heart rate gets up to during an episode. It might not shorten the episode but it might make you feel more comfortable . If you do decide to take one permanently my experience is that Nebivolol is better than Bisoprolol as far as side efects are concerned. Personally I would try the PIP route first.
(former AF sufferer currently in NSR): I didn't feel quite right on bisoprolol, it made me a bit lazy and I couldn't be bothered to exercise sometimes. I stopped taking it and carried on with just the apixaban which makes me bruise easily but now exercising very well 😊
My Cardiologist says I may take 1.25mg of Bisoprolol as needed. I also have BP which is variable, traditionally White Coat Syndrome,but the feeling is ,if you have this, then there will be other situations that cause this rise, so rather treat (other medics probably think differently).so I take 5mg of Lisinopril daily for that ,as well as 5mg daily of Atorvastatin and 20mg Rivaroxaban daily,.I only take the Biso if my HR gets into the 90 at rest, it settles quickly into the high sixties which suits me. Fortunately I seldom go into Afib. rightly or wrongly (mind over matter) I feel that if I reduce my HR before it rises above 100 BPM, I can avert it !!
This is exactly why it is not healthy to excessively google every study and trial ever conducted! It sends you down an endless rabbit hole and to the non medically trained (99% of us) and non cardiology medically trained (99.9999999% of us) they cause panic and often seem contradictory between different studies.
As another commenter said - bisoprolol is the bb of choice for these symptoms/ occasions.
I have always had a low resting HR of circa 55. I was diagnosed with SVT and prescribed Dronedarone Multaq. Within 1 week extremely effective and no episodes since. It reduced my HR to circa 48. I was still getting bad palpitations and so was prescribed bisoprolol of 2.5mg. Again, within 1 week extremely effective and no episodes since. It reduced my resting HR to circa 41.
I feel so much better with these medications and I have no symptoms of bradycardia. My cardiologist reviewed my 24 hour blood pressure and heart rate monitor and had zero concerns for my age and good fitness level.
Yes I feel cold in the evening with the bisop and tired in the morning and take 30 mins to ‘come up to morning energy level’ but these are well documented side effects and I put a jumper on if cold and just accept that it takes a bit longer in the morning.
Exercise I limit to steady state rowing and the only thing my cardiologist asked was no more high intensity interval training. I also accept that my HR is now capped at circa 140-150. I always wear a heart rate chest strap when rowing on my Concept2.
My honest advice is stop googling, take the medication and live your life.
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