Beta Blockers

[Mcgandy]

I had AF back in 2016, fixed with a CV in 2017. Then it returned a year ago march 24., both occasions triggered by chest infection/pneumonia.

This is permanent not paroxysmal, just a slightly fast irregular heartbeat, controlled with BBs + thinners.

After my CV in 2017, I was taken off BBs, and eventually Apixaban too, tho only after I pushed for it, and the cardiologist had me on 24 hr monitor + echocardiogram first.

This time around I'm now in regular rhythm after a PFA end Dec 24, and should be getting a call from the cardio team soon, after having an echocardiogram a couple weeks back. I am resigned to being on Riveroxiban forever, as I'm coming up 74 and have had AF twice. That's fine.

But I really want to come off BBs, which keep my heart rate a bit low (50ish at rest) and, I think, prevent it going high enough to help with exercise (I cycle). In addition, I'm a lifelong asthmatic, (so BBs not recommended) and tho Bisprolol is supposedly cardio specific, I'm not so sure. But my brief post op talk with the team suggested they might want me staying on BBs long term.

What experience have others had with cardiologists keeping them on BBs after restoration of normal rhythm? I know it will depend somewhat on how the heart has responded to PFA, ie, has the ventricle returned to normal size? But assuming it has, what reasons might cardios have to keep me on BBs ?

[Teresa156]

Bisoprolol isn’t generally ideal if you have asthma as it can aggravate it, the NICE guidelines which medics refer to, do actually advise that bisoprolol be avoided in patients with asthma, even though it’s cardio-selective. It says if there are no alternatives, it can be given with caution and under specialist supervision. If you do a search on Google and look under ‘BNF Nice guidelines’ you can read about it, but other sites refer to it as well. It’s generally known on this forum as well by some members.

I think you may be best to ask your cardiologist why they want you to remain on it and explain to them how it makes you feel and also the asthma connection. There are alternatives, if you need them, but you would be within your rights to question why you are on it and even ask for an alternative. I’m not sure you’d get an echocardiogram at this early stage after your PFA, so you may not know if there’s been any changes to the size, unless again, perhaps mention it?

[Mcgandy in reply to Teresa156]

Thanks. I had my follow up Echo couple weeks back , so they will have that info.

[ForensicFairy]

I recently asked a similar question but with a different context - I’m on Carvedilol, also a BB. I learned that Carvedilol not only slows my heart rate (which we all know) but it reduces the force of the beat which lessens damage to the heart’s walls, reduces oxygen demand which is particularly effective if blood supply is limited (such as when in AF or for me, spasms), it prevents enlargement of the ventricles, and it has antioxidant properties and lastly it reduces oxidative stress on heart cells - I think this last part is carvedilol only. They’re all BBs but have slightly different impacts.

[Mcgandy in reply to ForensicFairy]

Thanks suspected some protective effects like that. Gonna be a tough call, I fear.

[Efka]

Carvedilol vs Nebivolol? Jumping on a bit I hope you don’t mind…

Husband having just had his Bisoprolol dose increased and is causing side effects (fatigue, sleep issues, anxiety).

From the reading I’ve done I can’t decide if Carvedilol or Nebivolol might be better?

Both from a better side effects profile and of course as mentioned above from therapeutic effects.

Thanks