how long is it okay to be in afib?

Hi,
I was put on sotalol 80 mg BID 8 weeks ago. On the 7th week, last week, I lowered to 40 mg BID Monday night. I felt better right away, more energy, less fatigue, better sleep. However, by the 2nd night (Wednesday) I got a short run of afib, about 1/1/2 hr, recorded 129 BPM. Yesterday, Friday, 4:30 pm I went into afib again. I am still in it now, though my BPM has come down some. Highest recorded over multiple Kardia EKGs has been 145 though mostly in the 120s to 130.

I am supposed to be getting ablation sometime in August with Dr. Natale.

If it is okay to lower sotalol on my own because it will not kill me, what about the idea that when they start you on sotalol you have to be in the hospital & also the fact that when I was begun on propafenone (Rhythmol) on a Saturday& went into afib Sunday night, I found out my dr was going to electrically cardiovert me by Tues morning after he had me go to ER Monday because of being in afib from the propafenone (tho that afib felt no different than any other I had had over the past yr, none of which I ever went to the hospital for). I did convert before that, with Cardizem IV drip. I do not want to go to the hospital again & I definitely do not want to be electrically cardioverted.

This morning since it has been 12 hr of afib (through sleep), I have returned to my sotalol 80-mg dose at 5 am, which is 4 hr earlier than my normal dose at 9 am. I was scared to keep taking 40 mg bec of what I wrote in above paragraph.

My cardiologist is out of town on family medical emergency through August. I had called his assistant to see if she could ask him if I could lower the sotalol fr 80 to 40 before I did such, and she is going to get back to me, but I have not heard from her yet. He has 900 patients. I had promised him to follow his orders this time & I also do not want to go to hospital & have him find out what I have done.

So how long is it okay to be in afib? And what else should I do now? I have a few alprazolam (Xanax) - should I take a 0.25 or 0.5 now? I did take a zolpidem at bedtime last night, but I tolerate those well without side effects. I do not get sleepy the next day from that. My symptoms are palpitations & tight chest & a bit of shortness of breath, all tolerable, but getting old! When will I now take my next sotalol dose? I certainly don't want to be on my 2 doses starting at 5 am every day. I was on 9 am & 9 pm.

Thank you.

Rate control to < 100 bpm and anticoagulate. Then you have nothing to worry about for days or weeks until you either convert or get shocked.

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wolfpack
Rate control to < 100 bpm and anticoagulate. Then you have nothing to worry about for days or weeks until you either convert or get shocked.

Thank you Wolfpack. Do you mean if I get to less than 100 bpm, and keep taking xarelto that is fine. But how do I control the rate - just by what I did - upping my sotalol back to 80 mg BID? I am never sure how to handle it either when I have made a change - as in today I took my med 4 hr early to try & get me back to nsr sooner. It has not totally happened yet at 2 1/2 hr later, though my rate is just now at 95, still possible AF by Kardia.

Should my 2nd dose of the day be at my old time of 9 pm still & then be able to return to 9 am/9 pm dosing tomorrow?

My Kardia app is not showing the brady/tachy aspects either. I believe it was you I saw wrote someone how to update, but I saw nowhere to do that, so I wrote an email to Kardia to ask about it. Maybe I will hear back in a few days.

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Madeline

I believe it was you I saw wrote someone how to update, but I saw nowhere to do that, so I wrote an email to Kardia to ask about it. Maybe I will hear back in a few days.

On an iPhone, go to Apps and then search on Kardia and select update (if it isn't done automatically). I'm not familiar with Android, but they must have a similar procedure.

If less than 50, it will likely read Brady and above 100 Tachy. You can just look at the output and come to the same conclusion.

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GeorgeN
On an iPhone, go to Apps and then search on Kardia and select update (if it isn't done automatically). I'm not familiar with Android, but they must have a similar procedure.

If less than 50, it will likely read Brady and above 100 Tachy. You can just look at the output and come to the same conclusion.

Thanks George. I do have an iPhone & managed to do it. At first when I would tap on Kardia, it just said "open" since I already have it. I think I tapped another spot eventually & the update came up. So will check it out next time I take a reading.

Just keep taking the sotalol on your normal schedule. It's a beta blocker and it will control your rate. Sotalol is often started without a hospital stay. I've been started on it several times without a hospital stay. You've been taking it without problem for some time so just don't worry about that.

Like wolfpack said, the afib won't harm you even if it continues for days or weeks, but I would bet it stops long before that.

As for your cardiologist, I don't know what's up with him but a doctor doesn't just walk away from his practice for months without finding another doctor to cover for him. I don't buy the family emergency thing. Something's going on with him and if I were you and felt the need for a cardiologist between now and August, I would find another one. But do you really need one? You have the prescription you need, and a few weeks prior to your procedure Natale's office will give you instructions on what to do prior to the procedure. And after the procedure you'll get further instructions. He's the only cardiologist you should be listening to once you have the pre-op instructions and for months afterwards. You really don't need to be worrying what your cardiologist thinks of you. I doubt he'll be back, and if he does come back he won't have much of a practice to come back to.

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Carey

As for your cardiologist, I don't know what's up with him but a doctor doesn't just walk away from his practice for months without finding another doctor to cover for him. I don't buy the family emergency thing. Something's going on with him and if I were you and felt the need for a cardiologist between now and August, I would find another one. But do you really need one? You have the prescription you need, and a few weeks prior to your procedure Natale's office will give you instructions on what to do prior to the procedure. And after the procedure you'll get further instructions. He's the only cardiologist you should be listening to once you have the pre-op instructions and for months afterwards. You really don't need to be worrying what your cardiologist thinks of you. I doubt he'll be back, and if he does come back he won't have much of a practice to come back to.

I think my cardiologist is a good guy. Maybe you are right & the reason he is on leave is bec of something HE has, not a family member - maybe they found cancer & are treating him. I had a neurosurgeon once who was fine when I saw him & next thing I knew I heard he was dead. He had gotten of all things a very aggressive brain tumor & was dead a few months later. He was not old either. My cardiologist is with a large cardiovascular group & when the staff called to reschedule me, they did tell me they were parsing out all his patients to be seen by other cardiologists on the team. And, like you said I don't have heart disease that takes more management, so all they did was put my visit out further, no mention of me seeing another doctor, as I don't need that as long as I can get my meds & answers to questions I have like this, nothing urgent. Especially since I have the afibbers team!

This week will be 4 weeks since I got my first email from Natale's people & Kristen said it may take up to 4 weeks for someone to get back with me on a date for my ablation. Mainly I want it sooner, so I can get off the meds sooner. Once again, today after restarting 80 mg of sotalol at 5 am, I went to my bedroom around 1 or 2 pm to rest & read for a bit & ended up falling alseep rather quickly. After an hour or so, I forced myself to get up & go outside in the sunshine! But, I did get up real early the past 2 days around 4:30 & I do my walks and exercise & stay pretty active until I finally give in to resting some. I could not help thinking though that it was instantly the switch from 40 to 80 of sotalol that made me sleepy. I will say when I took my EKG before getting up, it was finally out of afib & pulse was 56. It did not say bradycardia, which I thought was odd since 56 is such a low pulse. So, I was in afib a couple of hr short of 24 hr this time.

As far as your question of how long it is OK to be in AFIB, there is no exact answer, but there is a rough 48-hour window that it usually takes for a clot to form while the Atria is Fibrillating during AFIB. Anti-Coagulation reduces but does not eliminate Clot/Stroke Risk. The fact that your back in NSR at 24 hours is good news. In my case, since I only convert out on my own about 30% of the time, I go to the ER room for a Cardioversion at about the 40 hour mark, to stay within the 48-hour window. The Hospital will not Convert me if it has been over 48 hours, unless they also perform what is called a TEE, in which they stick an Ultrasound device down the Esophagus, and look into the Atria to verify that there is no Clot prior to completing the Cardioversion. A TEE has to be scheduled as an Out-Patient procedure, which has been usually taking an extra 5-10 days to schedule.

The Kardia won’t say Bradycardia until the rate is below 50. Tachycardia is over 100.

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The Anti-Fib
As far as your question of how long it is OK to be in AFIB, there is no exact answer, but there is a rough 48-hour window that it usually takes for a clot to form while the Atria is Fibrillating during AFIB. Anti-Coagulation reduces but does not eliminate Clot/Stroke Risk. The fact that your back in NSR at 24 hours is good news. In my case, since I only convert out on my own about 30% of the time, I go to the ER room for a Cardioversion at about the 40 hour mark, to stay within the 48-hour window. The Hospital will not Convert me if it has been over 48 hours, unless they also perform what is called a TEE, in which they stick an Ultrasound device down the Esophagus, and look into the Atria to verify that there is no Clot prior to completing the Cardioversion. A TEE has to be scheduled as an Out-Patient procedure, which has been usually taking an extra 5-10 days to schedule.

In this case, I understand why GeorgeN takes care recording his NSR every morning! A TEE is really no fun.

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Pompon
A TEE is really no fun.

A TEE is a piece of cake if they use propofol. I would never agree to a conscious TEE.

In any case, Madeline is on an anticoagulant so a TEE wouldn't be needed.