Beta Blocker thoughts...

So I am now off of any daily meds for my Atrial Tachycardia. I am using Propranolol to take the edge off so that I can sleep but I am just dealing with the tachycardia and PACs during the day. I have been reading a number of studies that talk about people under age 65 with >10,000 supra ventricular beats per day having a worse outcome with beta blockers, but other studies also discuss patients with >10,000 a day having a worse outcome period, irrespective of beta blockers. My EP didn't seem to be concerned if I was on a beta blocker or not. He said treatment is really aimed at symptom control.

I am having a really difficult time, however, getting any of the doctors to weigh in on Supraventricular ectopy burden limits, or Atrial Tachycardia/SVT burden limits at which point I should seek treatment. Have any of you found any info or research to speak to this? I have a 20% average burden of ectopics, with 30-50% average at night, And an overall burden of 11% daily tachyarrhythmia burden (Atrial Tach). The EP basically said that if I get tired of it, we can try Sotolol (although I have considered asking about Bisoprolol or Acebutolol as well). My current inclination is to do nothing for now and see how it goes while I wait for a Natale consult. Have any of you come across any studies showing an absolute burden of ectopics or SVT/flutter that would warrant treatment or cause damage to the heart? All I can find is info about Atrial remodeling or perhaps damage to the SA node at some point, but the Beta Blocker carries a similar risk......

You'll probably get similar results from all the beta blockers except perhaps sotalol. Sotalol is the only one that's truly an antiarrhythmic so it might give you better results.

Where did you read that beta blockers can lead to SA node damage? I've never heard that before and I'm very skeptical.

A great deal depends on your overall tolerance for your condition, anxiety over it, and the way the symptoms wear you down or degrade your perceived 'quality of life'. For example, if your sleep deprivation mounts over time, that will cause problems. Increased levels of cortisol happen during times of stress, and when the stress is intractable or unmitigated, chronically elevated cortisol has a way of disrupting your immune response, chiefly Interleukin II.

While it might not be a stop to your condition, there is a lot to be said for symptom control. Doctors tend to want to control symptoms as much as they want to 'make you better'. They hate sending patients away with little hope or help, so they do control for pain, anxiety, sleep deprivation, and other ancillary problems.

I don't mind a little help. I try to tough things out, as I did when I became sleep deprived after both my angiogram and the two subsequent ablations. I did accept some 'help' by resorting to Zopiclone, but at half the dose prescribed (on the quiet advice of my pharmacist who knew I have sleep apnea), and then only twice a week, not every night. So, there were honestly some tough and long nights, but the potency of the drug never paled, and I managed okay until my arousal/anxiety wore off over about three weeks.

My advice, for what it's worth, Megan, is to use help judiciously....but do use it. Keep on an even keel, don't get isolated or frightened, don't get worn down until you know the knight known as Natale offers you some help.

Thank you so much for the kind response, @gloaming . I appreciate it very much. That has been the toughest part about this arrhythmia - the increased burden at night, when everyone else is sleeping, and I am laying anxious, feeling awful. It IS isolating and frightening. During the day I can rationalize that I am fine, that it is not a bad rhythm, but at night, it is really tough to deal with. Thank you for the words of encouragement and advice. I will heed them and try to make a decision that minimizes stress, maximizes quality if life, and allows me sleep. I really appreciate it.

There have been studies for off label use for Renexa - ranolazine, has been found to help with ectopics and AFIB. There are likely some articles or research information on this web site regarding this medication. More recent research articles indicate that PAC/PVC particularly over a certain burden - should not be ignored.

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sldabrowski
There are likely some articles or research information on this web site regarding this medication.

Here is a search on the site with quite a few hits: [www.afibbers.org]