Beta blockers

[Paultay]

I am 64 years old and generally fit and healthy. I do suffer from paroxysmal A-fib. Bout s are approx once per month and vary in length from a few hours to 2 days. The bouts seem caused solely by stomach upsets. I have tendency to swallow a lot of air which causes severe wind and burping. If this is bad enough and goes on for long enough it causes A-fib or, if I try to exercise while "windy" it can cause A-fib. This leads me to think that I have vagally mediated A-fib. My cardiologist has me on Sotalol, a beta blocker which seems to have made no difference. There seems to be considerable on-line medical opinion that beta blockers are, in fact contra-indicated for Vagally mediated A-fib. Apart from some very slight aterio-schlerosis, my heart is structurally sound.

What should I do?

[Dr J Singh]

Hi,
Beta blockers are the drug of choice in patients with continuous or paroxysmal AF. They are effective for both rest as well exercise induced AF. The only contraindication of their use is the presence of obstructive pulmonary disease. Hence, I sincerely feel that your doctor was right in prescribing a beta blocker for the same. For the confirmation of the vagally induced AF, a 24 hr holter monitoring is required. You’re right in mentioning that in that condition beta blockers are useless and may in fact be contraindicated as they tend to induce AF. Please get a holter monitoring done. Flecainide & disopyramide are more effective agents for the same. I sincerely hope that helps. Take care.