Beta Blockers for Afib treatment in patients with already low rates

I know this is a question for my own physicians but wanted to see if anyone here knows the answer.

Something I fail to understand: Why are beta blockers almost always used as a first line maintenance med in the treatment of paroxysmal Afib in otherwise heart healthy persons with a lower than normal heart rate already? Isn’t there a theory that with a lower than normal HR (<60), ectopic beats can actually cause Afib episodes to begin? And if so, wouldn't a beta blocker make this worse and explain why a lot of people have primarily nocturnal episodes which occur when the HR is at its lowest?

Obviously, I’m not a doctor or pharmacist. What is it I’m missing here?

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MarkL
I know this is a question for my own physicians but wanted to see if anyone here knows the answer.

Something I fail to understand: Why are beta blockers almost always used as a first line maintenance med in the treatment of paroxysmal Afib in otherwise heart healthy persons with a lower than normal heart rate already? Isn’t there a theory that with a lower than normal HR (<60), ectopic beats can actually cause Afib episodes to begin? And if so, wouldn't a beta blocker make this worse and explain why a lot of people have primarily nocturnal episodes which occur when the HR is at its lowest?

Obviously, I’m not a doctor or pharmacist. What is it I’m missing here?

IMO, you're right. Their main purpose for the kind of afibbers you mentioned is to lower their avg HR while in afib, if necessary. If their avg HR while in afib is already below 100BPM, BBs would likely make things worse.

Beside of that, we're all different and, for some patients, taking a BB on a daily basis may prevent them having PACs (and then AFib).

The sad reality is we're dealing with a very common and easily described issue (ectopics and AFib), but for which there's no indisputable treatment. So, a lot of things are "worth a try", and the less they are potentially dangerous, the more they are easily prescribed. They may work or not. It's still a mystery.

Just my two (euro)cents...

I concur with Pompon. If you are paroxysmal afibber with a low resting rate, it would make more sense to prescribe the beta blocker on demand, for use during an episode with heart rates are higher. That being said, it is common to prescribe a rhythm med, like flecainide, with a beta blocker to reduce the risk of high rate flutter. So if one is taking flec chronically as opposed to on-demand, they'd likely be taking a BB also. It is worth discussing this situation with your doc to figure out what is best for your specific situation.

George, thanks to both you and Pompon for your responses.

I do realize some things: 1) This is an approach that obviuosly works well for the vast majority of people so that is a logical path initially for the med community to follow. 2) I have an underlying disease that exists (Afib), is not caused by a beta blocker per se, and needs to be addressed and fixed if possible. 3) I also realize physicians simply are not in the business to stop what they are doing and spend hours researching my particular symptoms, history and case. That's the fantasy, not the reality.

I do plan to have an ablation and have already had that discussion with my EP and am on the books for a procedure in the next 2 months.

It just seems weird that once my episodes (and from what I have read about others on different forums) increased, the knee jerk reaction is to crank up the dose of said Beta Blocker or switch to another. I know everyone is different and if it was truly a cut and dry treament for all people a great forum like this would not be necessary. I appreciate all I've learned since joining here.



Edited 1 time(s). Last edit at 03/04/2022 03:13PM by MarkL.

When my afib started 15 years ago, my heart rate was 180 during episodes. A beta blocker took care of that. 13 years after my first ablation, afib returned and my heart rate was 110 during episodes, without a beta blocker. Go figure...........

My guess is that beta blockers can help reduce PAC's. For me PAC's would trigger AFIB. I feel like they are two similar but different things. My ablation fixed the AFIB but the PAC's remain. Just a theory...

Your right Mark.

The Cardio and EP Dr's often tend to lump everyone into one main treatment category. This has been discussed various times in Forum over the years in regards to Dr's not recognizing Vagally induced AFIB. It complicates the treatment protocols for Dr's and the staff/nurses to have to think in terms of multiple treatments depending upon baseline HR's. Several of us in years past, have actually had Pacemakers recommended for having intermittent AFIB compounded by "bradycardia". The thing is the "bradycardia" was merely a low HR due to being in good cardiovascular condition from exercising.

Another danger from taking too many drugs that slow down the heart is in the scenario where you are being Cardioverted, and the excessive drugs cause a pause in your Heartbeat right after your conversion so the Dr's end up putting in an emergent Pacemaker that wouldn't have necessary otherwise.

I think part of the reason this happens is because there are other positive attributes to Beta Blockers they are taking into consideration. Lowering BP and protecting or even reversing Heart Failure are several things the BB's given to help with.

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The Anti-Fib
I think part of the reason this happens is because there are other positive attributes to Beta Blockers they are taking into consideration.

Another benefit, BB's also can reduce melatonin production up to 80% (sarcasm). "However, beta-1-blockers not only reduce sympathetic outflow to the cardiovascular system but also block sympathetic signaling to the pineal gland, resulting in suppression of nighttime levels of the soporific hormone melatonin,7–10 which may help explain the insomnia associated with beta-blocker use.2,11,12 Thus, melatonin supplementation may potentially counteract the sleep disturbances associated with beta-blocker use.10,11 " Source: FAJL Scheer et al., “Repeated Melatonin Supplementation Improves Sleep in Hypertensive Patients Treated With Beta Blockers: A Randomized Controlled Trial,” Sleep 35, no. 10 (2012): 1395–1402. [www.ncbi.nlm.nih.gov]

interesting. I'm conservatively managing my heart which is now in NSR (shh i don't want to jinx it), post 3 months of chronic AF post ablation for Lone AF, after amiodarone yuck, with 40 mg sotalol BB if I sense I'm worn out or high risk that day (stress)... seems to be doing ok. I have low drug tolerance in general, and respond poorly to daily meds. Resting HR in morning around 50. 60 in the day.