How do beta blockers help arrhythmias

This is following on from my other recent post... Today I was also offered a beta blocker to try for "palpatations" as the cardiologist called them. I have been getting a lot of ectopic beats (mostly single ones) but had what seemed like a run of them nearly two weeks ago which was disconcerting. I wondered how beta blockers help various arrhythmias? 
 

I remember as a teenager my vasovagal syncope was incorrectly disgnosed as "panic attacks" because "I couldn't breathe" (before fainting) as I told the GP. I now know this was my heart slowing down (which it used to do for a significant while before pausing). I was given beta blockers. These made me pass out. I obviously now have a bad association with the words beta blockers and the GP that incorrectly diagnosed panic attacks and not syncope. In my mind today, I shut down this idea and declined the offer for now, but wondered if I should consider this and how they might help? 
 

I know the same can't happen again as my PM won't let my heart slow down below 40 bpm. Another consideration is that I can always feel when I’m paced which I absolutely detest the feeling. 
 

Regardelss of my future decision, I would love to know how beta blockers help different arrhythmias...?

3 Comments

Beta blockers

by AgentX86 - 2022-10-08 00:48:17

Beta blocker can help arrhythmias but it's nowhere near a certainty.  Beta blocker settle nerves and slow the heart rate.  They're used by snipers to reduce any shakes so they can hit their targe.  This is why you were passing out.  If your heart rate is slow, you don't want to make it any slower. Since you have a pacemaker this isn't going to happen, so beta blockers may be the way to go.  At least try them.

Some people don't get along with beta blockers.  They tend to make some people lethargic but there are a lot of them and either the particular beta blocker can be changed or dosage changed to suit you.

Beta blockers are pretty benign so before trying anything "harder", start with beta blockers.  Stepping up from there gets into some potentially nasty stuff. Go there if the arrhythmias have a real effect on your quality of life.  It would be unusual for them to be dangerous, now that you have a PM.

Beta Blockers and arrhythmias

by Gemita - 2022-10-08 02:30:27

Claire, great question and huge subject.  Beta blockers work mainly by slowing down the heart. They do this by blocking the action of hormones like adrenaline.  Benefits of beta blockers will be different for each one of us depending on our heart condition, our personality type, the nature of any arrhythmia (how it behaves and the likely trigger).  

For example I have noticed that my arrhythmias tend to occur mainly when at rest, when my heart rate and blood pressure are at their very lowest.  We could say I have predominantly vagal or bradycardia induced arrhythmia, whereas when I am active and both my blood pressure and heart rate are slightly elevated, I am less likely to experience an arrhythmia.  For some of us however, exercise and increased heart rate and blood pressure are clear triggers for an arrhythmia.  We might call this an “adrenergic" induced arrhythmia.  See 2nd/3rd link below.

For me personally, the only part of arrhythmia control that is helped by a beta blocker is the control of my heart rate, because a beta blocker does not help control the “rhythm” of my arrhythmia.  I seem to tolerate a fairly ‘regular’ fast arrhythmia, but not an ‘irregularly’ fast one like Atrial Fibrillation (AF).  Beta blockers, for me at least, tend to make “irregularity of rhythm” more likely by slowing both my heart rate and lowering my blood pressure.  And remember that although the pacemaker can prevent a fall in heart rate below the lower rate limit, it cannot prevent a blood pressure fall.  A sudden blood pressure fall can clearly cause syncope too even with a pacemaker.  So for me, a slowing heart rate/blood pressure tends to make my ectopic beats worse and ectopic beats for me are clearly a major trigger for episodes of AF.

However, there is no doubt that beta blockers have a calming effect for many of us, slowing down the heart rate, controlling the blood pressure.  Indeed they are often used to help treat anxiety because they are so effective at controlling/blocking high levels of adrenaline. I agree totally with AgentX86, compared with a heart rhythm control medication, beta blockers are a far safer option and are excellent for the control of a high heart rate. Please see 1st link below on beta blockers and 2nd/3rd links on vagal/adrenergic mediated AF, to help you decide whether beta blockers are suitable for you.  Clearly you have a pacemaker, so your lower heart rate can be protected from any sudden fall caused by a beta blocker.

For some of us with vagally induced arrhythmia, I was told a calcium channel blocker like Diltiazem might be a better option but may come with a few more side effects than a beta blocker.  It was also mentioned that naturally occurring compounds and elements such as magnesium have also been shown to act as calcium channel blockers so perhaps continuing with your magnesium trial Claire for a little longer as well will do no harm?  I hope for the very best 

https://www.bhf.org.uk/informationsupport/heart-matters-magazine/medical/drug-cabinet/beta-blockers

https://a-fib.com/faqs-understanding-a-fib-5-adrenergic-vagal/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7533140/table/T2/?report=objectonly

 

Thank you

by _Claire_ - 2022-10-09 16:44:26

Thank you both, this info is fab. I’m going to check out those links too. 

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