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Beta blocker after successful ablation?

Posted by otiswinston @otiswinston, Dec 7, 2025

I had a successful Pulse Field Ablation in Montreal 6 months ago. The painless procedure only took 90 minutes and I now have my life back! It’s on a par with a knee or hip replacement (have had both). I’ve had no AFib episodes since (touch wood) and my energy levels and outlook on life have improved significantly.
At the 6 month followup consult with the electrophysiologist I stopped taking Flecainide but am still on Eliquis and a beta blocker (Bisoprolol) - the later because as I explained to the doctor it has had a significant helpful effect on my blood pressure. It was around 140/80 before the beta blocker and around 112/65 since being on it. It’s apparently well understood that beta blockers help blood pressure. The electrophysiologist suggested I stay on it for now and discuss with my regular cardiologist who could perhaps swap the beta blocker for something else to help with blood pressure control. I’ve been told by non professionals my energy will increase significantly if I go off the beta blocker.
I am 72 years old and quite active - playing non contact hockey where my heart rate can average 125 for an hour with a max of 154. And no AFib afterwards! I feel great so wondering if I should stay on a beta blocker or switch to something else for BP control with hopefully no adverse side effects. I will of course talk to my cardiologist before making a decision but am wondering if anyone else faced this decision and have experience to share?
I should also mention my electrophysiologist was involved in a recent study showing no increased risk from going off blood thinners post ablation if symptom free for 12 months following an ablation. I’ll be asking about that at my 12 month anniversary.

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gloaming | @gloaming | Dec 7, 2025

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.

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gloaming | @gloaming | Dec 14, 2025

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.

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otiswinston | @otiswinston | Dec 21, 2025
In reply to @gloaming "Thanks for posting that link, otiswinston. Very helpful. Over at afibbers.org, we have steadfastly informed newcomers..." + (show)
Profile picture for gloaming @gloaming

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.

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@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.

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