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How To Taper Off Atenolol After An Atrial Flutter Ablation?
Question: I am going in for an atrial flutter ablation a week from today. (I have atrial flutter and not atrial fibrillation.)
I am currently taking Atenolol 50mg x2 per day. Also Xarelto 20mg.
The doctor told me I could cut out 50mg of the Atenolol now.
One of my main goals of the ablation is to get off of Atenolol and the Xarelto.
Atenolol makes me feel very tired. And I have gained a lot of weight.
I want off Xarelto because of the dangers.
My questions are:
1.) My doctor said I could stop taking the Atenolol 50mg at night. The ONLY good side effect is that I sleep very well when taking it. Would it be OK to take 25mg in the AM and 25mg in the PM?
2.) Once the ablation is done. How should I taper off of Atenolol? What schedule and by how much?
3.) With the Xarelto what is the typical time frame after a flutter ablation before you can stop taking it?
4.) There is no tapering with Xarelto - correct?
Thank you.
I am currently taking Atenolol 50mg x2 per day. Also Xarelto 20mg.
The doctor told me I could cut out 50mg of the Atenolol now.
One of my main goals of the ablation is to get off of Atenolol and the Xarelto.
Atenolol makes me feel very tired. And I have gained a lot of weight.
I want off Xarelto because of the dangers.
My questions are:
1.) My doctor said I could stop taking the Atenolol 50mg at night. The ONLY good side effect is that I sleep very well when taking it. Would it be OK to take 25mg in the AM and 25mg in the PM?
2.) Once the ablation is done. How should I taper off of Atenolol? What schedule and by how much?
3.) With the Xarelto what is the typical time frame after a flutter ablation before you can stop taking it?
4.) There is no tapering with Xarelto - correct?
Thank you.
Brief Answer:
You should take care even after ablation!
Detailed Answer:
Hello! Thank you for asking on HCM! Regarding your questions i would explain as follows:
(1) Yes, you may take Atenolol 50 mg/day divided in 2 portions (25 mg/morning - 25 mg/afternoon).
(2) I would not hurry up to taper off Atenolol, as atrial ablation is not considered so a "big magic" solution. Sometimes occur relapses of arrhythmia after ablation, and the need for a repeated ablation may be required. Although ablation may result successful based on preliminary data post procedure, nothing can assure that arrhythmia will never come again; and the need for an anti-arrhythmic drug is always present. Lowering Atenolol to 50 mg/day is tapering enough. There are many other options for drug therapy after ablation. You may discuss with your doctor about that.
(3) Regarding anti-coagulation after atrial ablation there is place for some variation. Nevertheless, the general medical agreement refers the need to continue on oral anti-coagulation for 2-3 months after ablation. After that period the need whether to continue on oral anti-coagulation will be based on patient thromboembolic (stroke) risk profile level using CHA2DS2-VASc score. If the score is equal or greater that 2 oral anti-coagulation should be continued uninterruptedly regardless of ablation success.
(4) Unfortunately there is not tapering schedule with Xarelto. You should continue with your doctor prescribed daily dose till it is recommended. There are only some special medical situations such as renal dysfunction, etc where we lower the maintenance dose of Xarelto.
At the end, I hope to have clarified your uncertainties regarding your questions.
Feel free to ask me whenever you need. Greetings! Dr. Iliri
You should take care even after ablation!
Detailed Answer:
Hello! Thank you for asking on HCM! Regarding your questions i would explain as follows:
(1) Yes, you may take Atenolol 50 mg/day divided in 2 portions (25 mg/morning - 25 mg/afternoon).
(2) I would not hurry up to taper off Atenolol, as atrial ablation is not considered so a "big magic" solution. Sometimes occur relapses of arrhythmia after ablation, and the need for a repeated ablation may be required. Although ablation may result successful based on preliminary data post procedure, nothing can assure that arrhythmia will never come again; and the need for an anti-arrhythmic drug is always present. Lowering Atenolol to 50 mg/day is tapering enough. There are many other options for drug therapy after ablation. You may discuss with your doctor about that.
(3) Regarding anti-coagulation after atrial ablation there is place for some variation. Nevertheless, the general medical agreement refers the need to continue on oral anti-coagulation for 2-3 months after ablation. After that period the need whether to continue on oral anti-coagulation will be based on patient thromboembolic (stroke) risk profile level using CHA2DS2-VASc score. If the score is equal or greater that 2 oral anti-coagulation should be continued uninterruptedly regardless of ablation success.
(4) Unfortunately there is not tapering schedule with Xarelto. You should continue with your doctor prescribed daily dose till it is recommended. There are only some special medical situations such as renal dysfunction, etc where we lower the maintenance dose of Xarelto.
At the end, I hope to have clarified your uncertainties regarding your questions.
Feel free to ask me whenever you need. Greetings! Dr. Iliri
Above answer was peer-reviewed by :
Dr. Prasad
Hello Dr. Sharka,
I do not have atrial fibrillation.
I only have atrial flutter.
I am on no rhythm medications.
Your advice is for someone with atrial fibrillation?
I have non-constrictive CAD.
On a CHA2DS2-VASc Score I would be a 0.
But, I do not have AFIB.
I do not have atrial fibrillation.
I only have atrial flutter.
I am on no rhythm medications.
Your advice is for someone with atrial fibrillation?
I have non-constrictive CAD.
On a CHA2DS2-VASc Score I would be a 0.
But, I do not have AFIB.
Brief Answer:
My advices are addressed specially to you.
Detailed Answer:
Hello again!
I noticed that you experienced atrial flutter from the beginning (I read carefully your records on HCM when gave my opinions). And I am repeating that my advice is tailored for you, not someone else. Atrial flutter and atrial fibrillation are frequently interchangeable rhythm disorders in the same patient.They share the same philosophy when dealing with the risk of cardio-embolism. There are several risk scores for identifying patients at high risk of embolism and stroke. As your score is 0, then after the first 3 months post procedure, you may continue without anticoagulation, or a simple Aspirin.
No one knows if atrial flutter is relapsing after ablation, or atrial fibrillation appears.
From the other side, when dealing with ablation, AF and A/flutter ablation protocols are recommended concomitantly for the reasons I mentioned above. That's why international cardiology societies recommend those guidelines. You are using a beta - blocker that in fact is an anti arrhythmic drug.
Regarding your CAD I recommend to look after its true clinical significance (coronary angiography coupled with fractional flow reserve measurements may be needed).
Hope to have been helpful to you! Greetings!
My advices are addressed specially to you.
Detailed Answer:
Hello again!
I noticed that you experienced atrial flutter from the beginning (I read carefully your records on HCM when gave my opinions). And I am repeating that my advice is tailored for you, not someone else. Atrial flutter and atrial fibrillation are frequently interchangeable rhythm disorders in the same patient.They share the same philosophy when dealing with the risk of cardio-embolism. There are several risk scores for identifying patients at high risk of embolism and stroke. As your score is 0, then after the first 3 months post procedure, you may continue without anticoagulation, or a simple Aspirin.
No one knows if atrial flutter is relapsing after ablation, or atrial fibrillation appears.
From the other side, when dealing with ablation, AF and A/flutter ablation protocols are recommended concomitantly for the reasons I mentioned above. That's why international cardiology societies recommend those guidelines. You are using a beta - blocker that in fact is an anti arrhythmic drug.
Regarding your CAD I recommend to look after its true clinical significance (coronary angiography coupled with fractional flow reserve measurements may be needed).
Hope to have been helpful to you! Greetings!
Above answer was peer-reviewed by :
Dr. Raju A.T
Hello Dr. Sharka,
Yes. I definitely understand the risk with possible atrial fibrillation down the road. And even the return of the flutter - which is only a very small risk with the flutter ablations being 98% successful. Ablations are now the first line in treating flutter without atrial fibrillation.
That said a flutter is not the same as fibrillation. Flutter is rate and fibrillation is rhythm. A lot of people with "afib" have both. They are "cousins" and probably have a similiar cause. I was in the hospital, got cardio-converted, and my doctor is convinced it is flutter since it did not respond to anti-rhythm drugs and the flutter was there at the beginning on the EKG's.
So, I see why I need to be careful with the anticoagulation medicines and take those for 2-3 months to make sure I do not have the return of the flutter or develop afib. I am in 100% agreement and understand.
What I was asking was how to taper off of the beta-blocker? I am using it as an anti-rate drug not an anti-arrhythmic drug. There is no way I am going to take a beta blocker if I just have a chance of *maybe* having afib or a flutter return.
One of the main reason people have ablations for both conditions is to get off the beta blockers and anti arrhythmic drugs. The side effects are too numerous to even get into.
The whole reason I am getting the ablation is to stop taking Atenolol. The side effects are awful. And they are not getting better after 3 months.
I just wanted another opinion about how and when to taper off of the Atenolol. More than one opinion is always better.
Thank you - I appreciate your input.
Yes. I definitely understand the risk with possible atrial fibrillation down the road. And even the return of the flutter - which is only a very small risk with the flutter ablations being 98% successful. Ablations are now the first line in treating flutter without atrial fibrillation.
That said a flutter is not the same as fibrillation. Flutter is rate and fibrillation is rhythm. A lot of people with "afib" have both. They are "cousins" and probably have a similiar cause. I was in the hospital, got cardio-converted, and my doctor is convinced it is flutter since it did not respond to anti-rhythm drugs and the flutter was there at the beginning on the EKG's.
So, I see why I need to be careful with the anticoagulation medicines and take those for 2-3 months to make sure I do not have the return of the flutter or develop afib. I am in 100% agreement and understand.
What I was asking was how to taper off of the beta-blocker? I am using it as an anti-rate drug not an anti-arrhythmic drug. There is no way I am going to take a beta blocker if I just have a chance of *maybe* having afib or a flutter return.
One of the main reason people have ablations for both conditions is to get off the beta blockers and anti arrhythmic drugs. The side effects are too numerous to even get into.
The whole reason I am getting the ablation is to stop taking Atenolol. The side effects are awful. And they are not getting better after 3 months.
I just wanted another opinion about how and when to taper off of the Atenolol. More than one opinion is always better.
Thank you - I appreciate your input.
Brief Answer:
If side effects appear, Atenolol should be stoped.
Detailed Answer:
Hello! As you are facing side effects when taking Atenolol I would recommend to stop it gradually even before ablation procedure. 50 mg Atenolol per day doesn't seem to exert any such an important role in managing atrial flutter. Tapering should be gradual: from 50 mg/day to 25 mg/day for a couple of days and after that stop.
I hope that ablation procedure concludes with long-term good results, and you never again need drugs to control this issue.
My best wishes! Dr. Iliri
If side effects appear, Atenolol should be stoped.
Detailed Answer:
Hello! As you are facing side effects when taking Atenolol I would recommend to stop it gradually even before ablation procedure. 50 mg Atenolol per day doesn't seem to exert any such an important role in managing atrial flutter. Tapering should be gradual: from 50 mg/day to 25 mg/day for a couple of days and after that stop.
I hope that ablation procedure concludes with long-term good results, and you never again need drugs to control this issue.
My best wishes! Dr. Iliri
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Above answer was peer-reviewed by :
Dr. Raju A.T
Answered by
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