sotalol vs sotalol AF

Hello,

I was recently tried on my first antiarrhythmic of propafenone which did not work out for me. I was sent to the ER by my cardiologist where they gave me IV drip of Cardizem & I converted to NSR. I was then started on sotalol 80 mg q.12 h. I was observed in hospital for 2 doses plus EKG & released on it. The 2-day hospital stay gave me a booklet of paperwork to take home, some to inform me of everything & some to take to my PCP eventually.

I recently was looking at their information on sotalol & was surprised to see that there were some distinctions made on sotalol & sotalol AF, the latter which I knew nothing about until reading their paperwork. Following are some quotes:

Sotalol is used in people with ventricular tachycardia or ventricular fibrillation.
Another form of this medicine, called sotalol AF, is used to treat heart rhythm disorders of the atrium. Sotalol AF is used in people with atrial fibrillation or atrial flutter.
Sotalol is not used for the same conditions that sotalol AF is used for.

I have atrial fibrillation & flutter. I do NOT have any ventricular problems. I called my dr's office to relate what I had read from the hospital handouts & was told there was not much difference in the two & it was fine for me to take sotalol, but if I wanted him to call in sotalol AF, he would. I had already been using the sotalol about a week & did not feel like going to the trouble of getting a new prescription & throwing out yet another prescription (as I had to do with 90 days worth of the propafenone).

Does this sound okay? I am doing fine on sotalol other than more tiredness in mornings & late afternoons. I also have a chronic dry cough, but not sure if that is from a URI that started 3/14/19 with lingering symptoms. We have tons of trees & flowers here with abundant pollen in the spring.

Thank you for your insights.

I was on Sotalol and it was not AF as far as i know. Initially on 80mg 2x/day but i kept reducing it over time. Even the 80mg didn't make me tired like the metoprolol i was given initially.

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Joe
I was on Sotalol and it was not AF as far as i know. Initially on 80mg 2x/day but i kept reducing it over time. Even the 80mg didn't make me tired like the metoprolol i was given initially.

Hi Joe,

How much metoprolol were you on? I do find that I don't seem to have as many issues as I did on even just 6.25 mg a day of carvedilol twice a day. I felt a change in balance, and normally my balance is excellent. Sometimes it seemed tinnitus was more prevalent too. I did not tolerate metoprolol well & was switched to carvedilol which was easier on me. Other than the tiredness on sotalol, I feel my balance is back, but my exercise endurance is not as strong. Look forward to being off medicines after an ablation. Other than AF and atrial flutter, my heart is sound & I do not have high blood pressure. While on the sotalol my pulse is running 61-62 unless it is after exercise or something slightly stressful & it may go up to 73-75. Even though I did not have high BP, I usually would easily run a higher than normal pulse before all these meds.

Many of the antiarrhythmic drugs used for afib were originally licensed for use as antiarrhythmics for ventricular arrhythmias. If you look them up and read their formal statements of approval by the FDA (and other countries' agencies), you'll see nothing about afib. That's not a problem. They've been found to be useful for atrial arrhythmias also and so they've been used "off label" that way for years, but there's no motivation for the drug companies to spend millions more to license them for atrial usage also. They just are.

Bottom line: Sotalol is a long-standing proven antiarrhythmic and rate control drug commonly used in afib patients. There's no reason to be concerned that they prescribed something incorrectly. They did not. Whether it works for you is another story.

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Madeline

I was on Sotalol and it was not AF as far as i know. Initially on 80mg 2x/day but i kept reducing it over time. Even the 80mg didn't make me tired like the metoprolol i was given initially.

Hi Joe,

How much metoprolol were you on? .

Sorry Madeline, i forgot, it was in 2016 but at a guess i think it was 120mg 2x/day??? Whatever it was, it reduced my HR by about 20 to 30/min - so was still at about 100 and very tired

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Carey
Whether it works for you is another story.

AIn't this the truth. If Forest Gump had afib, it's a certainty he would have been quoted saying something to the effect of

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Life is like a bottle of anti-arrhythmics - you never know what they're going to do to you.

I was only on sotalol for 5 weeks, and it had no effect on episode frequency or length, but it did cause conversion pauses of up to 4.5 seconds, and zapped my energy. It was a dangerous, worthless drug for me, and others report short-term to intermediate positive effect on frequency and duration, if not all out submission.

Madeline - When my AF first began, I was prescribed a betablocker (Betapace) and used that for about a year or so as I recall - directed by a cardiologist who was in my rather-restrictive medical plan.

I changed plans and saw a cardiologist connected with the EP department at the Cleveland Clinic and based on my symptoms, mainly a great deal of fatigue - was prescribed the antiarrhythmic, flecainide. It was a huge improvement relative to the side-effects. This new cardiologist told me that many people do not tolerate betablockers, esp. if they already have relatively a low heart rate, which was my case. My AF events in those early years were very infrequent and I did seem to get along somewhat better with flecainide.

Jackie

This is what Hans Larsen thought of sotalol.

From my first book:

"Sotalol (Betapace, Sotacor)
Thirty-eight (22 vagal, 3 adrenergic, 11 mixed and 2 permanent) afibbers had tried sotalol. Not one (0%) had found it beneficial although one vagal afibber thought it might have reduced severity, but not frequency of episodes. Twenty-nine (76%) of all users reported side effects with 11 actually reporting heart palpitations or fibrillation as the main side effect. Another 7 reported increased fatigue. The most common dosage was 80 mg twice a day. With a success rate of 0% and side effects occurring in 76% of users, sotalol is easily classified as the most useless drug for lone afib. Unfortunately, it is the most frequently prescribed one."

Hans

Well, sotalol was effective for me. I didn't like it much because all beta blockers leave me feeling extremely fatigued, but it did the job. I don't think online polls of groups with a built-in selection bias and trivially small sample sizes are meaningful.

I'm doing fine on Sotalol. I don't want to change it up unless I have to. Not looking forward to 3 days in the hospital again just to make a change that may or may not help.
Nancy

I was prescribed propafenone 2*225mg but still had afib and this dose was already too much for me.
I then switched to sotalol 2*80mg. Less afib (1-2 times/month) but very tired. Lowered to 2*40mg. Same afib recurrence, but less heavy side effects.
After my PVI, back to sotalol, but side effects were then unbearable. Still afib 2x/week and thousands of ectopics.
Switched to flecainide+bisoprolol. Far less ectopics, but still afib.
Had 3 touch up ablations, 1st one useless, 2nd & 3rd more efficient.
Free from rhythm drugs and BB now, and feeling far better taking supplementation...
15 days since my last afib episode (30min). Fingers crossed...

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Pompon
After my PVI, back to sotalol, but side effects were then unbearable. Still afib 2x/week and thousands of ectopics.
Switched to flecainide+bisoprolol. Far less ectopics, but still afib.
Had 3 touch up ablations, 1st one useless, 2nd & 3rd more efficient.
Free from rhythm drugs and BB now, and feeling far better taking supplementation...
15 days since my last afib episode (30min). Fingers crossed...

Did you have any of your ablations with Dr. Natale? How do you know when you have an ectopic and I need to look that up to see what it is again.
When was your last ablation since it’s only been 15 days since your last afib?

I believe Pompon is in France, so probably not Natale.

You know you have ectopics because you feel them. An ectopic beat is just a beat that's out of place. They feel like a skipped beat, or a particular strong one, or quite often both. They'll feel like a skipped beat followed by a strong one.

@ Madeline...
I'm living in Belgium, so it's out of question for me going to Austin.
I've recently told about my last touch up in this post :
[www.afibbers.org]

I'm a difficult case, it seems some isolated ectopics points don't show up during the procedures.
The two last touch up ablations were extensive.

Now, I've mostly ectopics in resting positions. They may trigger afib, but it's not continuous. I may have a couple minutes afib, then some seconds in NSR, then back to afib... It doesn't last long.

I've recently noticed I can get rid of ectopics with some breathing techniques learnt during yoga sessions.

I've never seen Sotalol AF here. Just sotalol. I don't want to take it, it lowers my already moderate BP. I'm quickly out of breath with "cotton legs", even with 40mg.

Last time I took flecainide, I had a tenth hours of atypical flutter...

We're all different. I'm so used to ectopics and afib (270 episodes in 40 months) I can tell what's happening without using my ECG monitor. Sometimes, I may stick electrodes on my chest for a couple of days, but I don't really need to look at the recordings.
The last time I used it because I wasn't sure of the result is when I've had my atypical flutter. It was a new sensation for me. Flutter I had before the ablations was always coupled with afib. I emailed some tracings to my EP and he called me the next day to comment them.

I'm so happy now being free from disabling meds. Days are longer, better weather, I'm back to moderate biking.

I don't fear ablations, but I hate drugs for afib...

Pompon - Good you are back to better feeling times. What is better weather in Belgium! I have a brother-in-law from there near Antwerp - last name Bauwens. One of my other sisters also lived there for a time. So cloudy.

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Pompon
@ Madeline...
I'm living in Belgium,

Oops! Well, I was close.

Good weather in Belgium is just some days without rain... 😁