Beta blocker after successful ablation?

Beta blockers are sometimes prescribed for 'incipient' hypertension. But, no drug is always free from side-effects in all users, including me. Metoprolol definitely cramped my mojo a bit, enough for me to notice on my daily runs. It also may lead to bradycardia (HR lower than 60 BPM) in some users, but it can also go much lower, enough to endanger some users. I had to go off it when my HR tanked taking 150 mg of metoprolol daily.

A successful ablation (12 months free of detected arrhythmia) would often allow the patient to desist from taking Eliquis or Xarelto. But it's never that simple. Although there may be essentially no risk of a stroke from the left atrial appendage if an ablation is successful, the patient may have other things going on unrelated to heart rhythm that makes continuing a DOAC (direct-acting anti-coagulant) a wise choice...and a wise prescription. So this desire, expressed clearly to a qualified cardiologist or other specialist with whom you might be dealing semi-regularly, is best run past that person. If you understand the risks, and still decide to forego a DOAC, it's always going to be strictly your choice.

https://www.ottawaheart.ca/news/landmark-canadian-led-trial-finds-many-atrial-fibrillation-patients-can-stop-taking-blood-thinners

Thanks for posting that link, otiswinston. Very helpful. Over at afibbers.org, we have steadfastly informed newcomers to that forum site that the very best EPs offer to either cut in half the recommended daily dose, or to eliminate a DOAC altogether if the person has no recurrence or if they have had a Watchman implanted and the six-month TEE shows no leakage. No mention of the Watchman in that article. Going forward, we might find that an anatomically 'normal' heart, no malformation or unusual geometry in the left atrial appendage, can forego both the Watchman and the DOAC after, say, a full year free of the treated arrhythmia (one full year free of AF is deemed to be 'successfully treated via ablation'). It would be a marvelous revelation because it would free up funds for people, reduce bother in renewing prescriptions two/three times each year, and eliminate the risks for uncontrolled bleeding for those currently taking a DOAC.

@gloaming I’m glad you found the article helpful. My original question was related to going off my beta blocker (Bisoprolol 1.25 mg/day). It’s a very low dose and as mentioned it has helped control my blood pressure very well. So I’m wondering if substituting a blood pressure med for the beta blocker would have a noticeable effect on my heart rate and energy levels. Even at this low dose the beta blocker certainly reduces my heart rate (resting averages 50). I will of course ask that question to my cardiologist but I’m wondering if others have made this switch in meds and what they experienced asa result.

Highly recommend Nebivilol 5mg is what I am takingb

Update: It’s now 14 months since my pulse field ablation in Montreal in May 2025. I am thrilled to report I have not experienced any Afib episodes (to my knowledge) since! My regular cardiologist took me off my beta blocker and said I likely would not need anything for blood pressure management. And he seems to be right: my blood pressure is well within normal range. My energy level has increased significantly since stopping the beta blocker. My heart rate has reached 170 when exercising vigorously and I feel great. My cardiologist said to see him again in April 2027 and if no Afib recurrence will likely take me off Eliquis. I am of two minds about that: I love the protection the blood thinner provides against stroke, but I play hockey, do backcountry canoe trips, x-country ski, cycle etc and cuts and falls while on Eliquis can be pretty risky. I’ll talk with him about the pros and cons next April.

@otiswinston I am ssoooooooo pleased to see this reality for you, Otis. I couldn't be happier. Fortunately, I'm still 'there' as well, now three-and-a-half years out from my second ablation.

I continue to learn as I go, and I'm beginning, with the help of other patient people, to understand that most ablations are successful. I don't know what the percentage is, although I continue to cite the industrial and empirical figures found on reputable sites that say it's running near 75%. I think as we go, and with PFA showing increasing benefits, that the number is going to reach a cited 85% before long, maybe five years only. The health fora, such as this one, is a place where troubled patients come for help or for tips. So, we see more of those unhappy and desperate please for affirmation, for help, for hand-holding, for advice....and we can only do some of that legitimately. It's a problem of 'self-selection bias' where only people who need guidance are likely to find this site and post of their experience. The rest are at the beach, shopping, on a cruise, or munching popcorn at the movies. Life goes on.

I just had an ablation and I will be excited to see if any of my meds can be stopped in the future. Beta Blockers always put me in the bed for a nap (I hate this) but its like someone removed my battery and I just quit. Would like to see Eliquis go too since it is causing awful bruising with the slightest poke.

@deniseheart This is not my counsel, and I'm far from qualified to give you any advice, but you might run a reasoned calculus past your EP when your Holter result in a few weeks shows your heart in steady NSR: Once you have gone a full year from your ablation and have no obvious/detectable arrhythmia, AND IF....all other factors are in your favour (no other risks for thromboembolic events due to other comorbidities, for example, and you're not already north of about 70), you could/might/wanna forego the DOAC for at least a few years until or unless it makes sense to start taking it again. At some point, almost all of us are going to start falling. It's dreadful, but you do NOT want a brain bleed or other rupture to cause internal hemorrhaging helped by a DOAC, and it might mean a few years of safety/insurance to be on the DOAC, and then you might as well stop taking it once you reach, say, 80/85 because there's not much point any more. Something along those lines.

And, most EPs will agree to stop the DOAC if you've had a Watchman installed and it shows to be leak-free at the one year TEE. (As time passes, the Watchman is beginning to slip in the esteem of the EP field. It's not quite the wonder appliance we had hoped it would be, and more of them DO leak than we'd like, so you can try to keep abreast of the latest findings through your EP).

@gloaming thank you for your reply.