Athenolol Hans Question

More than six weeks ago I posed a question to the board about my use of 100 mg. of athenolol and after hearing from Hans that it did not control my incidents of afib but instead controlled the rate when I was in afib, I went to my doctor who agreed to wean me off it. Everything seemed to be going well up to 25 mg. when under stress it appeared that I had more of a reaction to adrenaline and had a very mild incident. A week later, however, when I completely eliminated the athenolol for two days I found myself quite sick with a cold and heavy coughing. I believe I inadvertently also ate some soup with MSG. Anyway, I had an afib incident that felt like galloping horses in the heart. I took 50 mg. of metaprolol which the doctor prescribed but now on demand and things settled down with the afib only leaving when I went to bed (my usual pattern). My question at this time, is it coincidental that the afib occured with the cough, msg (both triggers)or did the two incidents relate to the weaning of the athenolol?

What is to be expected when you wean yourself off these drugs? I was two weeks at 50 mg. and two weeks at 25 mg. before stopping completely. When I no longer have the coughing, will it be safe to assume that I can go drug free with no increased incidents based on not using the drug if I better watch these others triggers (coughing is a tough one to manage though)? Does the reaction to what felt like increased adrenaline have an impact on the afib without the drug?

Thanks for listening to all these questions. I was so excited about getting off this drug and would like to know I can still make the final step when this coughing is gone.

Thanks again. You all are great with your information and sharing.

Jerry

I have heard that when weaning yourself off atenolol it is best to confuse the body. So when you get to low levels you are supposed to take say 25mg, 12.5mg, 25mg 12.5mg, 6.25mg, 12.5mg. 6.25. The reason escapes me for the minute, but i know when I got to 12.5mg I had that day fast AF going on and took 25mg the following day. That seemed to do the trick as far as rate was concerned and then I went to 12.5 again and stopped. For a couple of weeks my heart raced a bit - but not too frightening - I was still in AF at this time. And my point was why was I taking tablets that never stopped my AF. It was the second week when I reverted back to NSR.

I know that virus's can affect AF and coughing may put more of a strain as it being antivagal or something. Either way I was very very sensitive (at least I felt it) for a couple of months, despite reverting to NSR for the first time in almost 2 years. I induced two runs with MSG chicken and magnesium citrate... I hope you are as successful as I was

Fran

Didn't I read in a post somewhere on the board that vagal AF'ers shouldn't use a beta-blocker??? Having "senior" moment

blessings,
MLM

When I had a cough and fever from a bad virus last winter, my afib was out of control.
The Cardiac Arrhythmia Unit said unconditionally that viruses and the cough were known to bring on bad episodes of afib. An inflammatory process from a virus will do it.

I am vagal/nocturnal, but when I was sick, I was getting afib day and night.

Carol

Jerry:

I went off Atenolol(25 mg) about 2 weeks ago & HR went from low 80's to low 100's (106) plus it was eventually revealed to me that I had some PAC's. Called EP doc at Cleveland Clinic & asst.(have never been able to speak directly to doc since they wheeled me out of operating room),
and was pooh-poohed about rate increase. Called regular EP who said get back on it. Rate returned to former level.

Friday it was again suggested to me to stop Atenolol. Rate went back up yesterday to 104.5 & started getting chills (plus usual hot flashes), but no fever seen. Depending on who I talked to at Clinic I had PAC'S. Plus the feeling of a huge bubble floating around in my chest came back--diagnosed as GERD & given Nexium about 1 month after PV ablation. Again today have really cold hands which is unusual for me.

These symptoms are probably a coincidence, but I too wondered if it was related to stopping Atenolol.

njb

Jerry,

Betablockers have no antiarrhythmic action and will not help stop an afib episode; however, they will help to keep the heart rate down to a tolerable level during an episode. Beta-blockers have no direct effect on the heart cells, but slow the heart rate by blunting the stimulatory effect of norepinephrine (noradrenaline) and the sympathetic nervous system.

Because betablockers inhibit the sympathetic (adrenergic) branch of the ANS (autonomic nervous system) they should not be used on their own by vagal afibbers on a continuous basis as they will further skew the balance towards parasympathetic (vagal) dominance. They can be used by vagal afibbers during an episode to control heart rate, but a calcium channel blocker (verapamil or diltiazem) may be a better choice.

Adrenergic and some mixed afibbers may find betablockers helpful in preventing episodes triggered by anxiety or emotional or work-related stress. Betablockers do have an anxiety-lowering effect but it seems that response depends very much on the individual so an individual trial is definitely called for. Time release metropolol (Toprol XL) is probably the most effective beta-blocker for preventing anxiety-related afib episodes - 25 or 50 mg/day is the most common dosage.

Betablockers are primarily used for lowering excessively high blood pressure and many afibbers have found that the decrease in blood pressure experienced when taking them make them tired and "spaced out". This effect undoubtedly vary from person to person and again, a personal trial is necessary to find out how they work for you.

When going off betablockers it is important to do so in a stepwise fashion so as to avoid a big rebound in blood pressure which could be detrimental.

So, to make a long story short. If your afib episodes are triggered by anxiety or emotional stress it is possible that a betablocker such as Toprol XL may be helpful assuming you can tolerate the side effects inherent in its blood pressure lowering effect - only a personal trial will tell. In any case, betablockers are effective in lowering heart rate during an episode. For continuous use 25 mg/day of Toprol XL may be a good starting point; 100 mg of atenolol is a very high dose and would likely have significant side effects.

Hope this helps and clears up any confusion caused by my previous answer.

Oh, and by the way, it is possible that supplementing with 400-600 mg of elemental magnesium from magnesium glycinate or chelated magnesium may be as effective as a betablocker in reducing your anxiety level and thus indirectly, your afib episode frequency.

Hans