Nebivolol

[Winston66]

Does anyone have any experience of using Nebivolol for occasional runs of irregular/fast heartbeats, probably afib, particularly adverse effects and in comparison with atenolol or bisoprolol? If negative, is there anything you would recommend more? Many Thanks for any info.

[Threecats]

Hi Winston66

I’m in persistent AF at the moment and tried Nebivolol as I felt the Bisoprolol was affecting my asthma and I didn’t get on with Diltiazem (a calcium channel blocker used as an alternative to beta-blockers for those who can’t tolerate the latter.) Unfortunately, whilst I didn’t suffer any side-effects from the couple of weeks I was on Nebivolol, it did nothing to lower my heart rate, so I’ve now had to go back on the Bisoprolol. However, I’ve seen reports from others, mainly on the AF forum, who have achieved a good result with Nebivolol and feel that they have got their life back. That’s the thing with these drugs, we are all so individual in our responses to them, the only way to know for sure is to try it. I hope it works for you.

[Winston66 in reply to Threecats]

Thanks Threecats. Many thanks - very helpful indeed. I also had trouble with Diltiazem and quickly off it. For the first two weeks there was no change in heart rate with Nebivolol either but during week three the rate dropped somewhat towards the target area and blood pressure is in the right area too. But adverse effects of shortness of breath and lightheadedness not consistent and I'm wondering whether to persist with it or slightly increase the dose or, indeed, like you to return to the "standard" beta blocker, in my case Atenolol, and the known pattern of side effects (which originally I had found unacceptable if I could find something better). I think Nebivolol does not control the heart rate when exercising as much as atenolol/bisoprolol but that's OK with me. It's the side effects that are the bother and I'm wondering if it just takes longer to stabilise. Paroxysmal AF/AFl/Atrial Tach still happening every week or so. Am leaning towards persisting in hope I think. Don't want to get into the anti-arrythmics if I can help it which is the cardio's next "weapon"!

[Threecats in reply to Winston66]

You’re welcome, Winston. It’s interesting that it’s taken so long for the Nebivolol to start having a positive effect. Like you, I do struggle with the side-effects of a lot of these drugs.

As for the anti-arrhythmics, I do understand your reluctance as it feels like the next step up, doesn’t it, plus the potential side-effects seem even more alarming! I did try Flecainide for a while when my AF first became persistent. It didn’t make any difference to me but again, I know of a number of folk, largely through the AF Association Forum, who have done spectacularly well on Flecainide and haven’t had an AF episode in years as a result of taking that drug, so it might be worth considering.

I would suggest it’s worth hoping over to the AF Association forum and re-posting your question there. That forum is dedicated to all things heart rhythm related and there are a lot of people there willing to offer advice who are far more knowledgeable than I am!

All the best to you, TC

[Winston66 in reply to Threecats]

Thanks again Threecats - very useful. Flecainide is indeed the cardio's next thought.....If it's not an intrusive question, do you have any experience of the electrophysiologists? Mainly whether they are willing to persist with medication variations or whether they want to get quickly to ablation. They do seem to be the acknowledged arrythmia specialists but my cardio is somewhat negative. I will follow up the AF Assoc Forum - hadn't heard of it so thanks again. Best of luck yourself! Winston66

[Threecats in reply to Winston66]

Hi again Winston, I do have a bit of experience with electrophysiologists as it happens😊I’ve seen two, one privately and one on the NHS. The private one was enthusiastic about doing an ablation sooner rather than later but I, for various reasons, am not so keen. The NHS EP I’ve seen more recently whilst in persistent AF was more laid back and happy for me to continue as I am on the Bisoprolol, just adding an anticoagulant when I reach 65. He said that, so long as the heart rate is controlled, being in AF continually will not affect life expectancy and so AF doesn’t need to be treated aggressively if it’s not causing troublesome symptoms.

In fairness to the private EP, when I was paroxysmal my AF was much more symptomatic but now, for most of the time I don’t even know I’m in AF. I suppose part of my reluctance on the ablation front is that there often seems quite a standard approach amongst EPs that ablation is the way to go - when you have a hammer, every problem is a nail! Having said that, I wouldn’t wish to knock ablations, a lot of folk have had a great deal of success with them. I just don’t feel comfortable that it’s right for me, that’s all. I have no doubt you will come to a decision based on the advice you receive but think it wouldn’t be a bad idea to have a consultation with an EP to see what options are open to you.

Apologies for the essay! TC

[Winston66]

Thanks again Threecats, that is really helpful, not least because your thought process seems to mirror my own. Not ready to go down the ablation road but would like the expertise of one particular consultant (who seems to be a country expert in arrythmias particular interest AFib). as a second opinion. However, he also claims some 200 ablations a year which would seem to suggest he does little else! I accept that I'll probably get to ablation one day but situationally it would be difficult at present. Problem arises from the fact that I had a general cardio with a particular interest in the medical treatment of arrythmias, the perfect combination, but the poor chap had to retire through ill health and the replacement, although young and very enthusiastic, does not seem to have the same depth of knowledge on drug alternatives or their side effects. So we're going round in circles a bit on whether some side effects are drug related or not and whether some symptoms (e.g. migraine auras) connect with the arrythmias or not. Case of wanting the aid of the hammer without presenting as a nail I think to the EP!

Greatly appreciate your advice - wish I could reciprocate. Only crumb of slightly useful info is that Nebivolol has now hit exactly the target heart rate and blood pressure balance we wanted, after six weeks. Not affecting the arrythmias though. Atenolol/Bisoprolol seems to restrict the top heart rate on exercise with me to a lower figure. Nebivolol reduces it a bit on exercise but allows it to go up more before coming back into range quickly on stopping. The lying/sitting/standing still figures are similar.

All the very best. Winston66