Is anyone taking Lisinopril and metoprolol ?

I'm not medically trained, although I am an atrial fibrillation patient and have had two ablations. One thing they worry about is hypertrophy in the left atrium when it fibrillates too long and too much of the time. Similarly, the left ventricle can enlarge if blood pressure rises too high and stays high for months. Or, if the AF patient like me has what is called 'rapid ventricular response', or RVR, the left ventricle can develop fibrosis and hypertrophy because it is acting aggressively and too much of the time when the atrium above it is beating chaotically.

Those two drugs limit the aggressiveness of the myocytes. It means reduced volume pumped and reduced rate of contractions. So, I would not expect an ejection fraction to improve on them. It might not get worse if they do their job of limiting cardiac output, and thereby limiting further hypertrophic progression.

Then, with enlargement, there is such a thing as 'stretching' the tissue surrounding the mitral valve between those two vessels, and this might encourage prolapse. A valve that cannot function properly will allow some regurgitation past it the wrong way, and this would reduce the ejection fraction. Those two drugs, working as they are meant to, would discourage further damage to the supporting tissues surrounding your mitral valve. NOTE: I'm not suggesting you have mitral valve issues, just pointing out that some hearts have this limit to their ejection fraction. You cardiologist would/should soon know this about you.

Thanks so much for your insight. I don’t have any ventricular issues or any valve issues. The electrophysiologist wanted me to go on farxiga as a further preventative but I do not have kidney disease nor am I diabetic and I am borderline normal ejection fraction and the side effects from that drug are not good and once on them, they are difficult to come off of without complications. It did not seem like the potential benefits would outweigh the risks especially since I feel well and do not have issues like shortness of breathe or difficulty exercising. I guess we never know exactly how the heart will progress but since the Lisinopril is a new drug for me I think it is reasonable to wait to see how things are with it before adding other medications that are for patients with kidney disease, diabetics and heart failure.

@wews I can't disagree. Most of us live with or without symptoms of some kind or another, some tolerable, some barely, and some quite intolerable. Most EPs want you as symptom-free as they can make it, but in good conscience (ethically) they want you both informed and in charge of yourself and how you live. So, they 'splain the various options they would be prepared to prescribe, probably in descending order of efficacy/ascending order of risk.

Thanks so much for your thoughts. It is hard to know what to do. Honestly the side effects may or may not happen for me but I really don’t believe in taking drugs as a preventative especially if they may make things worse and there is no guarantee they would do anything beneficial. He called farxiga the miracle drug but I can’t find a single supporting study done suggesting it is right for someone like myself.

I sometimes think doctors feel like they have to do something for you and he tried four times to ablate me without success. So he was throwing this out as a “I think this will prevent things from getting worse”’ without realizing that is was the Lisinopril is supposed to do!

@wews If you're not thoroughly dejected, and still hold out some hope of a successful ablation, and if you don't mind travel and have some resources at your disposal, I advise seeking the services of either Dr. Andrea Natale at the Texas Cardiac Arrhythmia Institute or Dr. Pasquale Santangeli at Cleveland Clinic. Four ablations that haven't worked suggest to me, a non-expert, that you weren't being ablated properly, either not with enough energy applied long enough or in the wrong places. You may be a 'complex' case where more than two or three walls of the six walls comprising the inner left atrium are beset by the rogue signalling cells. You might also wish to look toe AFib Education Centre channel on YouTube, Dr. Scot Lee. He claims a high success rate because he is willing to tackle complex cases.

@gloaming thanks so much for your recommendations. I do have the resources and I will check out these physicians. I watched the video and it was very interesting. I really don’t know where in my heart he ablated and if it is true that most electrophysiologists don’t do complex ablations then perhaps I need to move forward. He started the program at the heart center where I have been going and is well respected. I will though talk to my family provider and get his opinion regarding further attempts.