How Long to Maintain Metoprolol After Surgery?

[Still Ticking]

Prior to my OHS I had an AFIB episode which lasted 2 1/2 days before it finally resolved itself using medication alone (Metoprolol 25 mg twice per day). After it resolved I was kept on a low dose of Metoprolol (12.5 mg once per day) in the 2 months lead up to my minimally invasive surgery to have my defective mitral valve repaired which I was told was the likely "structural cause" of my AFIB. During this 2-month time period I did not have any additional AFIB episodes.

Fast Forward: Eleven days after surgery I did experience another AFIB episode which lasted about 3 hours and was brought under control by a single 25 mg dose of Metoprolol. At about the 1-month post-surgery point, I was weaned down to just 12.5 mg of Metoprolol daily once again, which I have been on ever since. I am now at the 3-month post-surgery point and I have not experienced a repeat AFIB during this time.

In my post-surgery consultations, I asked members of both my surgical team and my cardiologist team about how long I should stay on this low maintenance dose of Metoprolol and was given very vague advice. They wouldn't give me a specific time frame and basically just told me "when you feel it is right for you, you should stop taking it".

My Question for the Group: The dose of Metoprolol I am currently on is so low I don't know that it is really significantly impacting my activities, but by the same token I don't like the idea of being on any medications indefinitely if they aren't really necessary. I was told that during the post-surgery healing process the heart would essentially be "re-wiring" itself, and that after that had occurred sounded like the logical time to try going off of Metoprolol. Any idea how long the whole heart re-wiring business actually takes? and does anyone else have any advice on when to stop taking Metoprolol?

Thanks to all in advance!

 

[pellicle]

Good morning ...

Prior to my OHS I had an AFIB episode which lasted 2 1/2 days before it finally resolved itself using medication alone (Metoprolol 25 mg twice per day).

to me this means "the medication allowed the body to have the circumstances under which it resolved.

I guess that its important to be on the same page here, so ... as far as I understand things, AF is caused by damage to the nerves which are embedded in the muscle tissue. These nerves seek to coordinate the actions of that part of the heart muscle (yes, the atria is contractile muscle) to stiffen and help push as well as take the pressure jet from the valve as the ventricle muscle contracts. As you can imagine (if you think about this) at (say) 80 beats per minute this "coordination" happens at the millisecond level. Yes that's thousand-ths of a second and all the myofibrils have to contract in a proper sequence or you get 'fibrillation'

So now go and look at your wife's hips (around the tops at the front) and (in case she gets angry tell her its for science) look for "stretch marks" ... you are now looking at scar tissue (which goes deep into the tissue) caused by late bone developopment. You'll (likely) find the same under her breasts.

This (if you could look at it) has happened to your atria.

Scar tissue doesn't go away.

Its a bit worse for your atria however because the nerves in there have an insulation on them called myelin and that is now also damaged effectively creating (chemical based) short circuits.

So what I'm saying is ... this may be permanent or at the very best you'll get some years before it resurfaces and in (say) 10 or 20 years you'll likely need metorprolol again (maybe less)

After it resolved I was kept on a low dose of Metoprolol (12.5 mg once per day)

was this metoprolol succinate or tartrate (yes it makes a big difference).

However that's likely because your cardiologist knows (and probably in at least if not greater detail than I just gave) the above information; or at the very least the statistics.

in the 2 months lead up to my minimally invasive surgery to have my defective mitral valve repaired which I was told was the likely "structural cause" of my AFIB. During this 2-month time period I did not have any additional AFIB episodes.

yes, and the structural cause was the stretching of the tissue ... check back agin on your wife, her stretch marks came from puberty ... they're still there right?

Fast Forward: Eleven days after surgery I did experience another AFIB episode which lasted about 3 hours and was brought under control by a single 25 mg dose of Metoprolol.

so sounds like the cause is still there ...

At about the 1-month post-surgery point, I was weaned down to just 12.5 mg of Metoprolol daily once again, which I have been on ever since. I am now at the 3-month post-surgery point and I have not experienced a repeat AFIB during this time.

Good job of dose titration from your team; 3 months is stil learly ... 1 year is the next big marker; my tachycardia was settled by 1 year, but re-emerged 11 years later, thus I'm now back on 25mg of metoprolol tartrate twice daily (50mg in the day) ... I'm coming up on year 13 now (ohs was in late 2011)

In my post-surgery consultations, I asked members of both my surgical team and my cardiologist team about how long I should stay on this low maintenance dose of Metoprolol and was given very vague advice.

probably because it takes a lot of work to explain the stuff I've explained above and not everyone is that patient.

They wouldn't give me a specific time frame and basically just told me "when you feel it is right for you, you should stop taking it".

and that's actually about as good as it gets ... we aren't calculating the joules of energy needed to raise the temperature of water by x degrees here, its a lot more complex.

My Question for the Group: The dose of Metoprolol I am currently on is so low I don't know that it is really significantly impacting my activities

perfect ...

but by the same token I don't like the idea of being on any medications indefinitely if they aren't really necessary.

get used to it. Consider it like the new vitamins you need ... the outcomes of other options are not ideal.

Look in the mirror and take in a picture of you at 19 ... see those differences? Yep ... things change.

I was told that during the post-surgery healing process the heart would essentially be "re-wiring" itself,

a simplification which should now be a bit clearer ... simplifications are also knowing as dumbing down and in dumbing down information is discarded. In the absence of fuller information its pretty hard to make accurate predictions.

Like shooting ... I worked out the ballistics for my shot at that range and I miss because I didn't account for windage ... because I was using a simplified ballistic model.

and that after that had occurred sounded like the logical time to try going off of Metoprolol.

no reason why not, and resume when you get a recurrence ...

are you on warfarin? Because if you aren't you may get AF and not notice and that may cause you to have a small thrombo event ...

Any idea how long the whole heart re-wiring business actually takes?

sometimes never ... sometimes it is only enough to get you by for a few more years.

Have you ever heard people say that 15 years later a "football injury" really started to play up again (this time permanently).

and does anyone else have any advice on when to stop taking Metoprolol?

I strongly urge you discuss to discuss this with your cardio, and if you can brush up on the above tissue and histology points ... shoot questions here if you feel like it.

Thanks in advance!

welcome

Best Wishes

 

[Superman]

So far? A little over 14 years. Don’t really notice it.

 

[JWalters]

Due to occasionally recurring AFIB (weeks long events that were not pleasant) after my OHS in 2017 (caused by stress in the heart from the OnX valve install and surgery), I'm now continuously on 25mg/day of metoprolol. So after 7 years, this may be my new normal. I'm not aware of any downside of continuous usage.

 

[Justin Bendell]

Prior to my OHS I had an AFIB episode which lasted 2 1/2 days before it finally resolved itself using medication alone (Metoprolol 25 mg twice per day). After it resolved I was kept on a low dose of Metoprolol (12.5 mg once per day) in the 2 months lead up to my minimally invasive surgery to have my defective mitral valve repaired which I was told was the likely "structural cause" of my AFIB. During this 2-month time period I did not have any additional AFIB episodes.

Fast Forward: Eleven days after surgery I did experience another AFIB episode which lasted about 3 hours and was brought under control by a single 25 mg dose of Metoprolol. At about the 1-month post-surgery point, I was weaned down to just 12.5 mg of Metoprolol daily once again, which I have been on ever since. I am now at the 3-month post-surgery point and I have not experienced a repeat AFIB during this time.

In my post-surgery consultations, I asked members of both my surgical team and my cardiologist team about how long I should stay on this low maintenance dose of Metoprolol and was given very vague advice. They wouldn't give me a specific time frame and basically just told me "when you feel it is right for you, you should stop taking it".

My Question for the Group: The dose of Metoprolol I am currently on is so low I don't know that it is really significantly impacting my activities, but by the same token I don't like the idea of being on any medications indefinitely if they aren't really necessary. I was told that during the post-surgery healing process the heart would essentially be "re-wiring" itself, and that after that had occurred sounded like the logical time to try going off of Metoprolol. Any idea how long the whole heart re-wiring business actually takes? and does anyone else have any advice on when to stop taking Metoprolol?

Thanks to all in advance!

After OHS, I was on 25 mg of Metoprolol for a couple months, then upped it to 50 mg because of tachycardia. I stayed on 50 mg until the anniversary of my surgery, then weaned off the Metoprolol entirely. My tachycardia is back, at times, so I'm not sure if I'm good to go or if I'll have to return to the beta blocker. My plan is to give it a couple months and see what my Cardio thinks.

 

[Still Ticking]

Pellicle you make some very interesting points. I am an engineer by profession, so I do get a fair amount of the science to include how the transmission characteristics of electric transmission paths are altered when those paths are physically altered. I am also on the extended-release version of metoprolol which I know has very different chemical release properties than the tartrate version which I was also on in the hospital. The only other heart med I am on is one baby aspirin a day.

I think one of the most important things I've learned in this forum is that it seems like it takes the heart and the body about a year to fully recover and adapt from Open Heart Surgery. In the simplistic engineering model I have in mind, this means the wiring and the control algorithms will have had a chance to fully stabilize by that time. That all said, since the metoprolol dosage I am on (12.5 mg per day) seems pretty benign, I guess I will probably just give my body that year before I try completely getting off the medication. By that time I will also have seen my cardiologist to get any further advice he might have.

Thanks again to all for your responses! I think reading about people's actual personal experiences is invaluable in getting insights into how this incredibly complex machine (the human body) responds to all the unique situations has been very helpful to me!

 

[dornole]

I’d love you to update the thread on this as you go. I have mitral issues (stenosis and regurgitation both) and had a few afib episodes for the first time this year (maybe 10 of them over the course of 6 weeks). The first time it happened I went the ER, was dx with afib and then cardioverted. That worked by the afib came back a couple days later. All of the subsequent episodes resolved on their own within a few hours like 4-10. That said I was immediately put on Eliquis (was on 325 mg, full strength aspirin before) and after having a TIA they want me on that forever. So I share concern about making sure you are properly anticoagulated. They also tried me on metoprolol and flecainide and both were really tough for me to tolerate (blood pressure dropped to 86/55 even on very low dose). So I am not currently taking those. No episodes last eight weeks as far as I know (prior ones were not subtle!)

You might consider getting a Kardia to check yourself for afib and / or ask for a wearable from your doc for 24 hours before you go off the beta blocker. And double check with them if the aspirin is sufficient given your afib history. Sadly it seems like the mitral valve is super clotty so best to be cautious.