Beta blockers for heart rhythm?

[gothic_beauty]

Just wondering how effective beta blockers are in controlling heart rhythm as opposed to heart rate. I have a prescription for a low dose of beta blocker that I take only as needed to control my periodically high heart rates. My rate has been really good lately, so I haven't needed it, but my rhythm has been crazy, with periods of time in which my heart will skip every few beats or so. I have had loads of tests done, and have been assured that my heart is structurally healthy and that the skipped beats are benign, but they still drive me bonkers and I would love to be able to get them under control. I called my cardiologist, and he said to try taking my beta blocker when the arrhythmia starts. I never knew that beta blockers could stop skipped beats before, and I am hesitant to try them. I guess I'm worried because my skipped beats usually occur when my heart is beating slowly. If my heart rate is low, and I take a beta blocker, is there a chance that it will drop dangerously low? In any case, has anyone tried beta blockers for rhythm control? Do you think that it is a good option for me, or should I just let my skipped beats be?

[pumba0603]

what to do? thank U   for your input. have been prescribed a multitude of drugs for skipped beats. the symptoms are so debilitating at times I just want to give up period! just been put back on flecainide, (tambacor) along with bisoprolol (first time). symptoms still pushing through enough to make me miserable. so many people with this problem, some worse than others. how we supposed to cope? don't think going off meds and reverting to magnesium/calcium would stand me in good stead but will definitely talk to my ep with reference to this and contact pharmacists to see if supplements with meds will help or contraindications may occur. a great read, got my hopes up again. will keep U posted and let U know. thank up.

[toourlady89]

Hello, I thought I should send this info your way as usually Physicians would give prescriptions for symptoms as expected..
There's other modes : Nutritional supplements could help.
If you would direct your search to Magnesium and Irregular heart beats , the nutritional aspect of helping yourself.
"The Magnesium Miracle " book of Dr Carolyn Dean is excellent. A testament  to how Mg is truly a miracle mineral.
Magnesium is involved in 300 body enzyme processes that lack of it will manifest in hundreds of health issues, irregular heart beats being one of them.

Here is a cut and paste from Dr. Weil :
Premature atrial contractions (PACs) are extra heart beats that come sooner than normal and may feel as if the heart is skipping a beat. They originate in the heart's upper chambers, the atria. They're very common, almost always harmless and as a rule require no special treatment.

The exact cause of these premature beats is rarely found, but they are often worsened by caffeine, alcohol, nicotine, and decongestants. If you routinely consume caffeine and alcohol, smoke, or use decongestants, cutting back or eliminating the use of some or all of them may help.

Take Magnesium supplements (they help stabilize the electrical conduction system of the heart). Start with 250 mg twice a day of magnesium glycinate or chelate).
Do the relaxing breath exercise (4-7-8) breath to reduce stress that may contribute to PACs.
Eliminate caffeine. (Remember that in addition to coffee and tea, colas and other soft drinks may contain caffeine. So does chocolate, cocoa and some medications.)
If you smoke - quit.
Make sure that you're sleeping well.
Take fish oil supplements for general heart health (2-3 grams a day).
Andrew Weil, M.D.
+++++++

Taking Mg will help you sleep soundly. Its the relaxation mineral. People who take sleeping pills could use Mg instead. Its the healthier alternative, as our body needs it.
Vit D is also important to take with Mg and eat Calcium rich foods for balance.  Mg relaxes the heart, calcium makes it contract, Vit D pushes these minerals into the cells where they need to be.
Hope this gives you a lesser frightening and a better choice.     Take care.

[gothic_beauty]

You guys are great: such informative responses. I didn't know all beta blockers were so different! The one I have is bisoprolol, and as I refer to is_something_wrong's super-useful comparison chart, I become sort of concerned about its effect on blood pressure, as my blood pressure is already low. On the other hand, if there is a chance it could help with my skipped beats, I would like to try it. It sounds like the only way to know for certain whether it will have an effect on my irregular rhythm is to give it a try, like so many things in life. My skips have been better this week, but if they flare up again, we'll see ...

[Jerry_NJ]

Sorry about the typo, I mean Atenolol in my reply above.

[Jerry_NJ]

Thanks, I'll make a save-copy of your explanation.

I have experience with both Metoprolol, both slow release and normal release, and with Altenolol and think at this point (less than two months on Altenolol) I like Altenolol best for the control of HR.  Even in the normal release its half-life is long enough to easily bridge a 12 hours period between doses.  I have in fact decided to lower my morning dose because I think the night-time does is still present in the morning and I like less during my waking hours - I still get good rate control, my only use of BB.

[is_something_wrong]

Beta blockers are a double edged sword when controlling premature beats. You are right that when your heart rate is slow, premature beats are more likely to occur. Beta blockers slow down BOTH the sinus node and the ectopic focus causing premature beats, the important question is; where is the effect highest?

This depends a lot on WHERE your ectopic beats occur, WHY they occur, etc. And there is a lot of difference between beta blockers. In my honest opinion, and based on my own experience, it could be as follows:

Propranolol:
+ The best beta blocker for rapid heart rate, anxiety and skipped beats that occur with rapid heart rate
+ 5-HT1 (serotonin receptor) antagonism may contribute to reduced anxiety
+ Also blocks physical anxiety manifestations like sweating and tremor
+ Good for POTS/IST due to sympatholythic and vasoconstricting effects.
+ Immediate onset of action

- Seems to affect sinus node a lot and may provoke premature beats at rest
- 5-HT1 antagonism may cause depression
- Nonselective beta receptor action (beta-3 antagonism) may cause weight gain (very rare)
- May cause shortness of breath, especially with asthma, due to beta-2 antagonism
- May interact with adrenaline and cause elevated blood pressure despite a low heart rate (beta-2 antagonism). Prevents vasodilation
- Short lasting effect (may be beneficial to prevent too slow heart rate at night)
- The worst side effects regarding cold hands/feet (vasoconstriction)

Metoprolol:
+ Reduces blood pressure more than nonselective beta blockers (may be bad in the setting of low blood pressure)
+ Available in controlled release formula
+ Weaker effect on sinus node than propranolol, may prevent premature beats during rest

- Will cross blood-brain-barrier, may cause depression or lethargy
- Not very effective on anxiety.
- May cause low blood pressure

Atenolol:
+Like metoprolol, but does not cross blood-brain barrier.

- No controlled release formula, but longer half-life

Bisoprolol:
+ Like atenolol/metoprolol, but completely beta-1 selective. No vasoconstriction or effect on lungs.

Sotalol:
+ Like propranolol, but also potassium blocking abilities (class III antiarrhythmics) and does not cross blood-brain barrier as far as I know.
- Will prolong QT time (class III antiarrhythmic effect).

[DeltaDawn23]

BTW, I could not take Toprol, it made my bp drop too low and made me dizzy.  My ep put me on Atenolol, saying it did not pass the blood-brain barrier and would serve me better -- and it has.  So the type of beta blocker is important.

[DeltaDawn23]

My afib was under fairly good control for 7 years with beta blockers, specifically, Atenolol.  My bp tends to run a little low and so I ended up (with my pcp's approval) taking 1/4 of a 25 mg. tablet and if my bp or hr went too low I would delay the dose. I took between 1-2 tablets per day.  If I had an episode, I would increase the dose, keeping check on my bp and  hr.  I also have taken Xanax (pcp says it cuts the adrenaline that keeps the whole thing going).  I take a half of a 25 mg. tablet under my tongue if I'm having issues.  Between the Xanax, the Atenolol, meditation and breathing exercises, I've done pretty well over the years.  Sometimes stopping episodes before they evolved into full blown afib.  I hope some of this is helpful.  You might discuss a trial with doctor and see how it works.  I think the beta blocker keeping your rate down does help the rhythm, at least that was so in my case.  Good luck with this.  I also want to thank you for your very kind post which I have not yet replied to.  I have not been very well this past week and not as active on the message board as I usually am.  The cardioversion kind of took the starch out of me!  Let us know how you do.  

[MichelleP_3811]

From what I understand for some it helps for others it makes it worse.  For some it only helps for a while.  You will really need to try them to see how your body reacts.  Though in general I don't think it totally gets rid of them but may help a person feel better, at least that is what my cardiologist told me.  Might be worth a shot if they are driving you bonkers.  

[caregiver222]

I would follow the advice of your cardiologist. If you are interested in studies relating to beta-blockers go to the U.S. government database "Pubmed".