Atrial flutter/fibrillation medication

[Mota1]

Diagnosed with complete heart block in 2023. I had a pacemaker fitted and given Ramipril 5mg and Atorvastatin 20 mg. At a pacemaker check atrial flutter/ fibrillation was diagnosed and Edoxaban 60 mg added to my daily medication. I tolerate these drugs well.

My pacemaker was set at 50 bpm. I have always been very fit, 25 marathons before age 70 and now aged 81 still running though slower and much shorter distances.

My GP and consultant are considering the use of medication to help control the flutter. However, the bisoprolol recommended by the consultant has been questioned by the GP and me because it seems to lower heart rate and I already had bradycardia for which the pacemaker is helpful.

Has anyone in a similar situation been prescribed another solution with a drug which calms the flutter but does not lower the heart rate substantially? I recognise we are all different and prescriptions are for the individual and my talks with the pharmacist and GP must continue. I am interested to hear if anyone else has met problems similar to mine.

[L8Again]

I would expect that all cardiologists would consider the pros and cons of prescribing a drug to reduce AF and its effect on the heart, and any impact that a particular drug might have on a pacemaker’s function and its battery life.

I have seen on other forums, such as The Pacemaker Club, that some patients in your situation who are on bisoprolol have needed to have some adjustments made to their pacemaker settings.

A list of AF medications:

rbht.nhs.uk/our-services/at...

[Mota1 in reply to L8Again]

Thank you so much for your response. I will follow the link provided and discuss the pacemaker adjustment question with the appropriate team.

Thank you again for spending time to respond.

[Pauldoherty]

Hi I was a runner before my cardiac arrest and my and my pulse was 40bpm have got a ICD and it's set at 45bpm now I had fluttering and they put me on 2.5 Bisoprolol in morning and 1.5 at night and I am fine now

[Mota1 in reply to Pauldoherty]

Thank you Paul

Nice to hear from a runner - I do miss running events but needs must. It is interesting that bisoprolol has worked well for you. My gp was concerned about its heart rate lowering effect as, like you, I have a low resting heart rate already. I think I will return to the gp and see if I can try the bisoprolol or an alternative, to see what happens.

Best wishes and keep running

[Borderterriorist]

I have a pm set at 60bpm because I had a low HR but needed a higher dose of bisoprolol in order to keep my atrial flutter in check. I'm now on 10mg of bisoprolol daily and my HR never drops below 56 which I think is in tolerance level.

[Mota1 in reply to Borderterriorist]

Thank you for that. It seems that there are several on here with low heart rates who tolerate bisoprolol well. I am thinking that it is worth a try.

Thank you for your information. It is reassuring to hear from others who have experienced the same problems.

Best wishes

[Bowser1966]

Hi I had a bit of AF when I had my mini cabg op, they gave me Amioderone (spelling) which calms it. Was on 3 a day then 2 then 1. Now off it. AF has gone but it was the op that caused it, I'd never had it before.

[Mota1 in reply to Bowser1966]

Thank you for your response. It is reassuring to hear that drugs can be so effective and that they were successful for you. I have contacted my surgery’s pharmacist and hope for a resolution soon.

Thank you again for sharing your information.

[airforce100]

After experiencing increasing PACs (Premature Atrial Complexes) for about 3-4 years, I developed the Tachy/Brady version of the SSS (Sick Sinus Sydrome) and was given a dual lead pacemaker and Bisoprolol 2.5 mgm/day about 6 months ago. i.e., like you, my resting pulse was very slow at around 45 ( I'm also aged 80 but I have always taken a lot of exercise) and I could not be given bisoprolol for the troublesome paroxsymal tachy and PAC's because of my bradycardia . However, installing a pacemaker and setting this to a relatively fast rate for me ( 70 thro the day, 60 at night) completely solved my problem of tachy/brady (although I still get a few inconsequential PACs). I was told the rationale behind this was, a) the pacemaker will always over-ride the effects of any drug - i.e. if it's set at, say, a daytime rate of 70, it will always work at the minimum of 70 regardless of what drug you are taking! b) faster pulse rates are better at eliminating tachycardia and ectopics (apparently something to do with a shorter refractory period between beats ). I have no problem with a (relatively) fast rate of 70 even though I am used to a much slower rate - I don't even notice! At the end of the day, I guess each person should be individually 'titrated' between their PM and a suitable dose or mix of drugs tailored specifically for them by a cardiologist!! I hope this helps you in your decision making!!