My neighbour gets paroxysmal AF and her EP said she should take bisoprolol when it happens. It usually lowers her heart rate.

She woke this morning with AF and heart rate of 120 to 130. She has taken 12.5mg of bisoprolol spaced out during the day but she is still in AF at 7pm (UK time) and heart rate is still high

Can anyone help with advice about how much bisoprolol she should take? I have given her some Waller Water concentrate so that she gets a good dose of magnesium, and have advised her to take potassium.

Gill

I wouldn't dream of recommending any dose of the drug (no experience with it,I don't know the patient's history and comorbidities, etc, and I'm not a health care professional), but I would recommend she be seen by a physician after 24 hours with a rate higher than 100.

Thank you Gloaming. Yes, seeing a doctor would be the best thing but these days in UK that is not easy.

After being underfunded for 14 years by the previous government the National Health Service is in dire straits and if you go to the ER you are faced with a wait of perhaps 15 hours before you see a doctor. There are some very knowledgeable people on this forum and I was hoping to hear their opinions. My neighbour knows the maximum daily dose.

Gill

Are you sure it's afib? Could it possibly be flutter instead? I ask because flutter is often resistant to beta blockers. The obvious difference between afib and flutter is that flutter is very regular while afib is very irregular.

Carey - she bought a Kardia on my recommendation and it says AF. I felt her pulse and it definitely felt like AF to me.

She has seen EPs during the last two years but isn’t due for another appointment for a while. She is concerned about the high heart rate, which was 130. Bisoprolol has slowed it down in the past but doesn’t seem to be doing that today.

(I haven’t posted for a long time but used to be a regular contributor to this group, know quite a lot about AF which is why she asked me. I had AF for over 50 years, ablation in Bordeaux 2003 for long term persistent AF which lasted 19 years. Another in Bordeaux 2023 still working.)

Gill

Okay, so it is afib. I just wanted to mention the possibility of flutter. If she knows the maximum daily dose she should keep upping her dose until she gets near that. (She might want to keep an eye on her BP while she's raising it.) And if she's still in afib with tachycardia, a visit to A&E is in order. She can't just let a heart rate that high continue indefinitely.

Thank you Carey, grateful for your help.

She has been in touch with her GP who said that bisoprolol is not going to stop the tachycardia. He has prescribed 2 tablets of Flecainide, one to be taken now, the other later in the day. If that doesn’t work then she has to go to the ER.

Gill (pronounced 'Jill' and female!)

I am in Canada, and know only too acutely the exigencies of socialized health care.

The bisoprolol, like metoprolol, is a 'rate control' drug, not an anti-arrhythmic drug. What it is 'supposed to do' is to reduce the rate when there is a tachyarrhythmia, and it works modestly well, in my limited experience. Some patients do better than others. But, if the arrhythmia persists, and it won't reduce to a count under 100 BPM, the conventional advice from cardiologists and electrophysiologists is that you should seek assistance at the local emergency facility soon after 24 hours have passed.

Good luck, Gill.

Carey and Gloaming

The Flecainide worked - by yesterday evening heart rate was back at 70bpm but she was still in AF. This morning she’s back in nsr with normal heart rate. She now knows what to do if it happens again.

Thank you both for your comments.

Gill

Glad it worked out for her. Glad she had a GP who knew what to do.