Other choice besides a Beta Blocker?

If you think you are feeling crappy due to being on a beta blocker is there an alternative? When I ended up in the ER with Aflutter and was put in the hospital for 3 days they added a calcium channel blocker. I swear I felt better and this is after me being on the BB for 10 years. They took me off the CCB and now Im only on my BB and flecanaide and feeling pretty tough again. Wondering if getting off the BB would help me feel better?

Diltiazem (that's probably what they gave you in the hospital).

What Beta-Blocker you on? There is the Cardio-Selective BB's like Bystolic that cause less side effects.
I agree with Carey on the Diltiazem, although its possible that if you have Vagal AFIB it could make the AFIB worse. Many people are unnecessarily taking BB's. I would go back to your Dr. and demand that a change is made, and ask him to explain why you need a BB.



Edited 1 time(s). Last edit at 05/05/2020 08:05PM by The Anti-Fib.

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The Anti-Fib
ask him to explain why you need a BB.

Because he's on flecainide. Almost all EPs will insist on a rate limiting drug if you're on flecainide.

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Carey

ask him to explain why you need a BB.

Because he's on flecainide. Almost all EPs will insist on a rate limiting drug if you're on flecainide.

OK right, he needs a BB or CCB if on Flec.

After looking at his other posts, he hasn't been on Flecainide for the last 10 years. Apparently the BB originally was for HBP. Just looking at treating HBP, there are alternatives to BB/CCB, like ARB's (Lorsartan).

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Carey

ask him to explain why you need a BB.

Because he's on flecainide. Almost all EPs will insist on a rate limiting drug if you're on flecainide.

Wouldn't that depend on the heart rate while in afib? For me - currently not on any drug - resting HR is 60 - afib HR is 75. Now taking flecainide as a "pill in the pocket". Doesn't seem that I need a BB.

After my January ablation, I did take flecainide for two months with no BB.

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Ken

Wouldn't that depend on the heart rate while in afib? For me - currently not on any drug - resting HR is 60 - afib HR is 75. Now taking flecainide as a "pill in the pocket". Doesn't seem that I need a BB.

After my January ablation, I did take flecainide for two months with no BB.

I don't take a BB with my PIP flec (and I've used it PIP for 15.5 years, though usage is infrequent), however, the standard answer is that taking a BB with or slightly before taking PIP flec reduces the risk the flec will bump you into atrial flutter.



Edited 1 time(s). Last edit at 05/06/2020 05:49PM by GeorgeN.

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Ken
Wouldn't that depend on the heart rate while in afib? For me - currently not on any drug - resting HR is 60 - afib HR is 75. Now taking flecainide as a "pill in the pocket". Doesn't seem that I need a BB.

After my January ablation, I did take flecainide for two months with no BB.

No, it doesn't depend on your HR while in AF. Not putting you on a BB was a judgement call by your EP and one that most EPs would disagree with. The reason for a rate control drug with flecainide is that flecainide has a rare side effect of causing 1-to-1 transmission of signals from the atria to the ventricles. During flutter, as George mentioned, your atria can be beating at upwards of 300 bpm. Normally, your AV node isn't capable of transmitting a rate that fast to your ventricles, but flecainide can make it possible, and there's the danger. I've experience flutter at 250 bpm many times, and trust me, it's no walk in the park. But 300 bpm? I doubt anyone would survive that for long. You would deteriorate into v-tach quickly and v-tach tends to deteriorate into v-fib, which is fatal.

How do you know if you are vagal or not? and if you are vagal, then what's the best treatment? No doctor i've seen has mentioned Vagal VS androgenic. (Must not have had time) In what way can CCB's make afib worse? More often? faster beats? longer lasting? Sorry for all he questions, but i think i might be vagal and doc did RX a CCB (haven't started it yet)

Vagal vs. adrenergic doesn't dictate treatment. Treatment is the same for both. Vagal vs. adrenergic plays a role in determining what your triggers are, but that's about it. Once you're in AF, it's exactly the same disease either way.

There is some evidence to suggest that beta blockers are contraindicated in vagally mediated AF. But if your anti-arrhythmic is Flec then you need the BB. I did propafenone minus the beta with no issue for the 3 months or so prior to my ablation. It’s something to discuss with your EP or cardiologist.

I'm on 50 mg Flec twice a day but I haven't taken the prescribed BB. On Flec my pulse is low 50's in bed; 59 to 60 normal resting. The highest I've ever reached exercising (moderate weights weight training and fast interval walking) is 79. How low would that go with a BB?

I've always used a BB when taking higher dose Flec to convert an episode but once collapsed and came to to to find my wife cleaning vomit of my clothes and two Paramedics kneeling on the floor in front of me - they'd taken my blood pressure which was 60/30.

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LaniB
How do you know if you are vagal or not? and if you are vagal, then what's the best treatment? No doctor i've seen has mentioned Vagal VS androgenic. (Must not have had time) In what way can CCB's make afib worse? More often? faster beats? longer lasting? Sorry for all he questions, but i think i might be vagal and doc did RX a CCB (haven't started it yet)

Yes try to find out if Vagal or not. Vagally triggered Ectopy/AFIB manifests itself when your Heart is slowing down usually when transitioning from excitement to relaxation, or activity to inactivity. Examples are transitioning right after exercise or stressful situation, lying down in bed, after a meal or very cold beverage. Monitor your heart functions in real time as best you can during these transitioning times for HR and Ectopy (PAC's), or even AFIB initiation. There are different ways of accomplishing this. I use a Pulse Oxymeter in combination with constant finger pulse checks. There are many gadgets out now that monitor cardiac function. A Holter Monitor from a Dr's office would be the most comprehensive, but maybe not as practical, as you would have to get the extended report, and go back and remember what you were doing days earlier.

CCB's such as the popular Diltiazem, work by decreasing Heart Rate, and by weakening conduction velocity and cardiac contractility. This can accentuate the mechanism of Vagally induced AFIB by contributing to slowing down Cardiac function to fast.

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The Anti-Fib
A Holter Monitor from a Dr's office would be the most comprehensive, but maybe not as practical, as you would have to get the extended report, and go back and remember what you were doing days earlier.

In the mid-2000's, several here got their own Holters. They were very expensive then ($3,000-$5,000). Holters from China are available on eBay in the low to mid 100's of dollars now. If you explore this option, make sure the device comes with analysis software. I think the Contec brand Holters do.

I’m off Flecainide and cardiologist asked me to do a trial off Bystolic to see if my symptoms of persistent fatigue and malaise ease up. I’ve been in NSR since getting out of the hospital March 1 and since my ablation for AFlutter in April. But I’ve been having this god awful fatigue and malaise for some time and nobody can figure out why. So we are trying being off the BB to see if it’s the culprit. I hope that’s it otherwise I don’t know what’s left as I’ve had oodles of other tests. Had a stress test/nuke scan last week. NORMAL. But I continue to wake up a couple times each night sob and not feeling well. My pulse ox is normal as well. All very perplexing & frustrating.

Kind of off topic - but I went for a bike ride with a girlfriend about a year after my Olympic trials. We went up this largish steep Missouri hill (but nothing like the mountains I was used to riding on).

All the way up she's complaining "my heart hurts" (we're in our 20s) and I keep telling her if you can talk, then you're not in any real trouble. We get to the top of the hill, it's flat for a few hundred meters and there's a baseball field there. She wants to stop there and sit on the bleachers.

Once we sit down, I take my HRM strap off and put it on her. It's been 4-5 minutes since the hard part of the hill and more than enough to recover. My HR is 42 when I take off the strap. Once it's on her, it reads in the 250s. It takes me a few seconds to see that's really what happening (highest I ever took it before was 204).

I said "Don't move! You're about to explode" It took about 30 minutes for her to get back below 100 - we rode home gently and she's still alive today. Not sure if this is related but a few years later she had her thyroid removed.

Who knows how high her heart rate was while going up that hill.

No way that heart rate was just due to exertion. She was very likely in SVT or possibly even v-tach. You really should have called 911.

HR > 200 = 911

If that’s an equation

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wolfpack
HR > 200 = 911

If that’s an equation

Yep, sure is in a person with no prior history.

This was before cell phones. I was trained in CPR but that's about the best I could have done. There was no way to even flag down a passerby. Total boonies.