Pacemaker

I was on 1.25mg of bisoprolol without a pacemaker as anything more than that dropped my HR too low, hence I felt shattered. I'm now on 5mg twice daily + digoxin. I'm still only on half the max dose of bisoprolol and I think that's the same with you. I guess it's the same with metoprolol but bisoprolol can take up to six weeks to be fully effective, it took that long for my arrhythmia to settle and for me to stop falling asleep in the afternoon! I'm another fan of the BHF website, I got lots of useful help from people who are experiencing the same issues that I do. We are all , of course, very different in the way we react to different drugs and looking back I realise I got depressed because I was feeling so dreadful and could do none of the things that I enjoyed but one day I woke up feeling very different and although I've had the odd really rubbish day, generally I'm pretty well. I hope you experience the same but whatever drug you are given, you do need to give it time to work.

Thank you for that suggestion.

Cardiologist is suggesting increasing my metoprolol dose to 200mg per day!! - but only with a pacemaker.

I was diagnosed with Paroxysmal Atrial Fibrillation plus Supraventricular Tachycardia at the end of August and prescribed a 2.5 mg. beta blocker daily and an anticoagulant.

I have a number of other health conditions including ME/CFS so it was hard to know the cause of any side effects, although I noticed my exhaustion increased a lot. I did some research and tried taking the beta blocker at night but I could hardly get out of bed in the mornings.

I couldn't get a GP appointment but on the phone a locum GP at my surgery advised taking a lower dose beta blocker and prescribed 1.25 mg. This dose didn't control my heart symptoms.

Eventually I rang the British Heart Foundation which is a charity which offers a free 30 minute appointment with a cardiac nurse. She had time to listen and to take into account all my other illnesses, and suggested reverting to the original 2.5 mg dose advised by the cardiologist I saw, but to take it in split doses - 1.25mg morning and again in the evening. I rang my GP to confirm it.

This was working much better until I developed Shingles .... but that's a different story

I would strongly suggest ringing the British Heart Foundation with any queries to get free advice.

DH had a pacemaked fitted earlier this year to deal with heart failure. He has recently been prescribed very low dose betablockers, to see how he got on with them. After 3 days he stopped taking them because they made him so ill.

My pacemaker is set at minimum 60 bpm without it my resting HR would be much lower than that. I was worried about the huge increase in beta blockers as I'd felt dreadful on a higher dose, it did take about 6 weeks for my body to adjust but I'm copying ok now. Main problem was I was very tired and lacking energy but that's improved. I've put on a little weight 2-3 kgs despite being very careful with my diet but I'm otherwise feeling well which is a huge relief as life had become miserable and I was quite depressed.
There's a lot of negativity around beta blockers but there are other types of drugs.tbh if I'd had easy access to my consultant I'd probably have asked for another drug but I just needed time to adjust. I would have had pace and ablate straight away if I could as I felt so ill but I feel so much better now I'm hesitant as it would make me pacemaker dependent.
Arrhythmias can be very difficult to manage and are often accompanied by another issue but we're so lucky to have more treatments available it's just trying to access them. There's a huge shortage of cardiologists and EPs so you spend your life on waiting lists. Do feel free to message me.

Thank you for that information. I am glad to hear you are doing well now. My concern is that the other side effects of the beta blockers (low BP and low moid) might be made worse at a highr dose even though the pacemaker is sorting out the pulse rate. Do you have any thoughts on that?

Yes it's exactly what I had done in May of this year. I have atypical atrial flutter so my left atrium is affected and after a successful cardioversion, nearly two years on I started getting episodes again. The pacemaker has enabled me to tolerate a much higher dose of bisoprolol without my heart rate dropping too low. I'm gone from 1.25 mg to 10 mg and initially I was very tired but my body has adjusted and I feel ok. Insertion was a teeny bit painful, it's taken a little time for it to feel completely comfortable but I'm very bony. I'm probably having a AV node ablation in the future but actually it's improved my quality of life so much I'm wondering if I might not need it. Good luck