Doc prescribed Metropolol after a-fib, but do I really need it?

[mark1234]

I'm 54 and have had maybe 7-8 short bouts of artrial fibrillation since I was in my early 20's.  They come several years apart.  I just had it two weeks ago, and prior to that it was in 2008 (when the market crashed and I let it screw up my mental health at the time).  

When I get it, it lasts a day or two, and it's always gone away without a cardio coversion, but along with medication taken at the onset, most recently Metropolol.   Every single time I've gotten it, I've waken up in the middle of the night or first thing in the morning with it.  After it converted to sinus rhythm, I stopped taking the medication.  I have taken no other medication on a daily basis for it. Until now.

This time, after 48 hours of no conversion of heart rhythm, my cardiologist did a cardio conversion on me at the hospital. It worked. But he's had me on Metropolol since then, two weeks ago.  At first it was regular 50mg Metropolol twice a day, and then he changed that to 100 mg of the XL version of Metropolol once a day, which I began doing yesterday.

I am in excellent health, and I have quit drinking wine (that's all had drunk) and caffeine. I exercise quite a bit, every day. I believe I was imbibing in two much of both of these substances, and I'm glad the afib has gotten me to quit them, although I will likely still have a glass of red wine from time to time but just one at a sitting.  (I was not drinking the night before this last bout.)

Here's my problem.  I don't want to be on a beta blocker, and I don't see why I should be on a beta blocker.  After all, I never have after an a-fib the prior times.  And, this is what I don't understand: if my a-fib always begins when I am sleeping, it means that it begins when the heart rate is slow.  If that is the case, why is my doc concerned with keeping my heart rate slow?  I have never had a problem when my heart rate extremely high at the gym, surfing, hiking, etc.

By the way, the reason he switched me from the non-XL to the XL version is because I asked him if I could have less medication (since he would not let me off completely) than the 2X 50mg Metropolol. He was reluctant and then said okay, and prescribed the 1x 100mg XL version instead. Then, he had to rush out to the hospital. leaving me with the question I could only ask myself, "Hey, isn't this really the same dosage?"  I have the feeling he tricked me, to get me to shut up.

By the way, he made the comment that he wanted me on the medication since "it's working" and I have not had a relapse.  But so what, I have no history of relapsing after an event. And he knew that.

So, now he has me on this XL version for the next six months!  And I hate being on it.  I don't want my heart to "get used to" the drug and the low heart rate.  What happens when I get off of it?

I used to be able to get my heart rate to 140-150 at the gym now I can barely get it to 100.  It's like having my foot on the gas and the brake at the same time.

So, given what I have outlined,

1) do you think I really should be on beta blockers now?
2) do you think the doctor tricked me by telling me the XL dosage was "less" than the plain Metrolopol?

There are eleven cardiologists in the group. I don't know if I should make an appt with this doc again, or ask for another.

Thanks in advance to anyone who has any help for me.

[mark1234]

Again, I want to thank everyone for their comments. The support in this community is really incredible.  I'll be sticking around and doing what I can to contribute.

[LindaTX]

Mark, normally i have normal to low BP and fairly low heart rate ( about 60-70).  When I got off the Metoprolol ( TopralXL) I did experience several days where my heart rate seemed to stay in the 80's to 90. That kinda freaked me out, but it reverted back to the lower rater after a week or two.  I am myself going back and forth on the ablation issue, now leaning towards it,  but at the same time, I've never had to be cardioverted, so in truth I'm still vascillating. :)

[Jerry_NJ]

My experience with high dose Metoprolol (100 mg twice a day) is my body adjusted - my very low BP and HR came back closer to normal (albetit I never had a problem with a too lo HR, I'm lucky to get that down to 70 at rest).  As said, I am now on 50 mg BB and a CCB.  

During my periods of NSR and Propafenone (that is what worked best for me in holding me in NSR following electrocardioversion rather than Metoprolol) I was exercising and running.  This continued until the age of 67 when AFib and other problems returned.  My experience an my medical advice was and is exercise is good for you and when in NSR I had good endurance.  When in AFib, as now, I still exercise but no longer run as the inefficiencies cased by AFib pushing me to my maximum HR when just walking fast or walking slowly up a hill.  I  will be 71 this month... you should have many more years of good physical strength.

Ablation in intrusive and has some associated risks.  Ablation for AFib is one of the more complex ablation procedures, as the ablation takes place in the left atrium, harder to reach than ablation in the right side.  The rule I have is the risk of complication is in the 1+  range, low but significant and thus if one can hold NSR from electrocardioversions (very low risk) for a year or more, just keep going that way.

[LindaTX]

I don't like taking beta-blockers either.  I get a-fib episodes  and was on Topral XL and used to exercise quite extensively and I always felt like I had a "governor" on my heart...just wouldn't go over 100-110.  I was also on Rhythmol which like most anti-arrythmia drugs work for a yr or so and then become pro-arrythmic and cause you to have the episodes.  I went off the Rhythmol in Sept, then weaned myself off the Toprol till I wasn't taking either. That lasted a few months, no a-fib, noPVC's, nothing...thought I was home-free until the last few months, the a-fib has returned, although shorter in length.  Still haven't returned to the Topral with NO adverse effects!  I'm just sayng in my own particular case, it has not been necessary to take the Topral. I have just started back on the Rhythmol this week and so far so good :) No a-fib

[mark1234]

I really appreciate the time you both took to reply to me.  

Yeah, it's a ***** turning 55.  

I just checked my BP and heart rate and it's 113/74 and 52bpm.  I'm on the XL now for the last two days, but prior to that when I was on the regular metropolol, I had BP significantly lower and heart rate in the high 40s.

@cindy707: Is Atenolol a similar drug to Metropolol?  

Do you find that you can still workout as hard, or is there danger in that? Any advice in that area for me?

How big a deal is an ablation? Doc told me that was an option in the future should this turn into more of a problem, since I was in good shape.

[cindy707]

Hi Mark i read your post and i am in your age group....same story as mine just about...i was super active....a gym rat, a surf rat, a runner, ate well did everything in moderation and then my body decided to rebel against me all of a sudden a few years ago and at the worst time possible...i was in the middle of teaching a bunch of doctors and nurses advanced rescue procedures for the heart and what to do and suddenly went into total a fib among other things.  I 100% agree with Jerry on this one.....the fact of the matter is that when we move into our 50's and our heart beats over 100,000 times in a day the odds start changing for us.  Don't be so stubborn about the meds...if they don't effect you in a neg. like making you sleepy, can't clinch a thought, etc. just go with it would be my advice.  I was in the same spot  as you were....refused to take the meds at first because heck no i knew my body better than anyone and then BAM!!!! the next incident my heart rate flew up into the 300's and then i really had to make a decision.  My heart doc one of the best in the world i am told explained to me that eventually low dose beta blockers will be the new "black" for people and used as a daily maintenance med and to me it made sense...the heart is a muscle and when we work out the heart works out as does the rest of our body...why would we not make it easier on the heart instead of stressing it out if there are no real side effects and only benefits....i consider the low dose of antenolol that i take each day as simply a safety net for myself to ensure if something pops up i am covered...i had an ablation a couple of years ago and still chose to go on the low dose after and now from what i have read that there are docs out there that take it....it not only blocks the adrenaline from pushing thru our heart making it work harder but it also relaxes the heart and we all know that is a good thing...my doc said it simply...he said think of a hummingbird and how fast their hearts beat and they live a very short life and then think of a larger animal where the heart beats so much slower and they live a very very long lilfe...it convinced me and other than one episode since the ablation i got my life back and now it is a distant memory for me with the episodes of a heart out of control..just food for thought............

[Jerry_NJ]

It is my experience that cardiologist (and EPs) want to keep AFib patients on some medication following a forced cardioversion.  I don't understand why you are on such a high dose, however, this especially given your rather good record of converting back on your own.  My experience says something more in the range of 50 mg a day would be more usual than your 100 mg, which I consider a high dose.

Remember, AFib becomes more prevalent and problematic as one ages... and over 55 brings you into the older group.  I didn't have any problem with AFib until I was about 55 and while I was converted several times I finally reached the point that I could not be converted with electrocardioversions and my mild symptoms do not justify the risk of trying an ablation.  So, I live with permanent AFib now... it is a very persistent heart problem and it gets worse as we age.