Sotalol - for better or worse

Hi. I haven't posted for a while because I have been in limbo since hearing that my health coverage won't apply to the Austin facility. I am hoping to get another appointment with Dr. Natale in January.

In the mean time I am getting worried that the afib is going to get worse and interfere with my ability to work and live.I am 52 with paroxysmal afib that went from a few days a week to several times a day. I have been on sotalol since January and see it as a blessing and a curse. It makes all my episodes milder and more tolerable, but I still get them, and more frequently since I have been on it. So I suspect it may actually contribute to the arrhythmia.

Does anyone know if that can happen? I know it could cause torades, but can it increase the afib, even while dampening it down? I have often thought that my afib needed to have a full-blown episode in order to get it out of my system for a few days. Could sotalol make me feel better, but increase the persistence of the afib? Unusual questions, I know.

Hi Gary - Not really unusual. It's known that Rx drugs and other chemicals deplete magnesium easily and it's difficult to get enough magnesium from food. So, if you're marginal in intracellular magnesium, then you may need to supplement along with the sotalol.

Have you taken any of the recommended steps to assess your electrolyte/minerals that we talk about...ie, supplements or from food sources... magnesium, calcium, potassium, sodium - just as a start? It's not uncommon to find through a dietary assessment of daily intake that often there is not enough magnesium and potassium... and too much calcium and sodium. Adjusting those have often been found to make a difference and while it may not eliminate AF completely, it can help to space out the time between bouts until you can get lined up for ablation.

Many people have identified other Afib triggers as well with the lifestyle/risk factor management assessment suggestions. Did you see the recent post on Trigger assessment? [www.afibbers.org]

Jackie

Sotalol is not known to cause or increase afib. The only arrhythmias it can promote are torsades de pointes and v-tach. One possible explanation is that your afib simply has progressed. Although that's usually a slow process taking months or years, sometimes it can take sudden turns for the worse.

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GaryS
I have often thought that my afib needed to have a full-blown episode in order to get it out of my system for a few days.

You're the only other person I've ever heard express that, but it's a phenomenon I've recognized in myself for many years. No EP I've asked about it has had an explanation or even heard a patient say it before.

Jackie,

Thanks for the info. Yes, I do take magnesium and potassium, along with CoQ10, Omega 3, and some others. Sotalol blocks potassium channels--correct? I have always been confused on whether potassium supplements help or hinder. I had not heard about sodium. So reduce salt? I will take a look at the article you linked. Thanks.

Carey,

We are a study of two. Now you can tell your doctor.
I do think there's something to it. Since I never have any big bouts anymore, I am constantly annoyed with the little bouts. This is part of why I would like to go off sotalol and just control the rate with cardizem.

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GaryS
We are a study of two.

Ha ha! Apparently we are. I think there's something to it too, but I can't figure out what that something is.

You know, you can just stop the sotalol and see how it goes. To be safe you should of course discuss that with your doctor first, but it's probably okay to give it a try. Worst case, being off it is worse than being on it so you resume it.

It's not worth the risk of Side Effects to take a Anti-Arrythmic if it is not working, or even making the AFIB worse.
Most people's episodes are made more manageable by others drugs like Beta-Blockers, or Calcium Channel Blockers like Diltiazem. Sotalol has Beta-Blocking properties, so that is probably why it makes your episodes more tolerable. What other Drugs besides Sotalol do you take to help with Rate-Conytrol and manage your AFIB? What has your HR been during your episodes?

Gary - read through Conference Room session 72 about the role of the sodium/potassium ratio for clarification.
Both are essential but have to be in proper ratio. Important also to understand is that in order for potassium to function as it should inside cells, there must be optimal IC magnesium levels as well. Potassium prolongs the refractory period or the time between beats. When potassium is low, then the 'beat' sequence becomes more rapid (ie PACs). However, the caveat is that just adding more potassium and if intracellular magnesium is low, can make the arrhythmia tendency worse instead of better. It all goes together.

The importance of evaluating intake of electrolytes via food and supplements can not be overemphasized... or ignored. Important to actually look up sodium content of foods you eat...because commercially prepared foods - packaged, restaurant, etc are typically high in sodium because of acquired 'taste' habits. So... often afibbers find by eliminating those high-sodium foods, it's easier to optimize potassium levels by eating those foods which are high in potassium.

Here's the intro paragraph from CR 72

SUBJECT: Potassium/Sodium Ratio in Atrial Fibrillation

Sodium and potassium! Biophysicist Richard D. Moore explains:

"For purely physical reasons (connected with the law of osmotic
equilibrium), inside the cell the sum of sodium and potassium
must be constant. This means that... sodium and potassium are unalterably
linked together like two children on a teeter totter. You can’t change one
without changing the other.

"Thus, in the perspective of biophysics, it makes no sense to
talk about either sodium or potassium alone - these two substances
always affect each other in a reciprocal relation. Hence their ratio ...
reflects the state of the living cell more completely than either sodium\
or potassium alone... It is not only a simplifying concept, but a much more
scientifically valid measure of the state of health of the living cell.

"Reflecting the action in the cell, potassium and sodium always work in a
reciprocal manner in the whole body... means that increased consumption of potassium
will drive sodium out of the body through the kidneys. Thus, potassium has been called
"nature’s diuretic"... This is an example of the fact that elevation of sodium inside our body
cells must always be accompanied by a decrease in the potassium level." [1, 11]

Continue: [www.afibbers.org]


Jackie

I've been on Sotalol for a couple of years now. Haven't had any problems.
Nancy

AntiFib,
I am only taking sotalol for rhythm/rate. During an afib episode it might be in to the eighties. Sotalol seems to slow my rate down by about 15 bpm.
Gary



Edited 1 time(s). Last edit at 08/24/2017 11:03PM by GaryS.

Jackie,

Thanks for that article. On the surface it makes sense, yet it seems pretty technical. I wish I had more time to delve into these things like I used to. There are so many points to understand and nutrients to balance, and then maintain for a long enough period to really see if the supplements make any difference. So many factors to juggle--makes me want to throw my arms up and forget it

You mentioned triggers earlier. One of mine is eating--especially sugar. Another is being too hungry. Go figure. Then there is the too-little-sleep trigger, and of course normal daily stress. Ugh!

Hi Gary - I can appreciate "busy." In the long haul, though, it's worth the effort to understand what happens in your body that has an influence on your arrhythmia. I'll type up some connections for you based on your response so you can consider and make some adjustments. In the long haul, this is very important overall.

Just remember that daily stress is a huge depleter of magnesium so optimizing your magnesium is a priority.

Be well,
Jackie

Hi,

I also feel I sometimes need a big episode to stop the feeling I get when an episode is looming. I get missed beats, fast runs, slow runs, breathlessness in short burst and a feeling like I'm going to pop. my chest feels tight and full, only way I can think of to describe it. That can be for up to a week before I have an episode.
As much as I hate AF I do experience a much lighter feeling after AF when I'm back in SR.

Joy