Beta blocker after successful ablation?

Posted by otiswinston @otiswinston, 3 days ago

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 | 3 days ago

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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