Sotalol, Tikosyn or Amiodarone

These are the choices my EP is giving me if we do a cardioconversion to get me out of my 9 day so far flutter.

He'd switched me to Metoprolol recently, combined with the Rhythmol I've been doing for a while now. Since that is just controlling rate, he gave me option of going along with controlled rate or conversion.

I'd like to do the conversion.

I will NOT go on Amiodarone. So the question to the group is - for a NON Vagal fibber (58 year old female, afib sporadically since 2000, can't have an ablation (too heavy)). What med works best for others and might work best for me?

Nancy

Nancy,

I can't give you any advice........I'll just share my experiences.

I took Tikosyn for 4 months......it appeared to keep me in NSR except during exercise.....which was a daily event for me. I would often convert back to NSR at the end of the day or during the night.

I then took Flecainide for the next 8 months at varying doses.....started at 50mg twice daily, then 100 mg twice daily, then 150mg twice daily, then back to 100mg twice daily......always with low dose of Metoprolol ER. It was never effective for me. In the end, prior to ablation on 1/27/15, I was spending almost the entire day in afib and was lucky to convert to NSR at night. The ablation appears to be effective for me at this time, three weeks after the procedure.

My mother, at 78, living with me, after a very severe stroke from throwing a clot on 5/19/13 (due to afib---INR of 1.8 at the time), has been taking Amiodorone for about one year after the cardiologist cardioverted her electrically. It seems to keep her in NSR. We recently had a CT Scan to check for pulmonary fibrosis and the cardiologist said everything was fine.

I have a friend who took Amiodorone for a brief period after his third ablation in our town-----not a Natale ablation. It helped to keep him in rhythm while he was taking it and eventually got off of it. I haven't talked to him in a few months but he was doing fine without it in our last conversation.

I never tried Sotolol so I have no experience with that.

I'm sure Shannon/Jackie/George and others will have additional information for you.

Good luck and best wishes for NSR.

Sincerely,
Ken



Edited 1 time(s). Last edit at 02/18/2015 08:32PM by kls5834.

How long have you been on the Rythmol?

The only thing that really worked for my AFIB was the Magnesium, I was taking Flecainide, but it was was the Flecainide that caused my Flutter. I am wondering if Rythmol can cause Flutter?

Dear Nancy,

I was on Amiodarone for 8 years with no problems. I started on 100 mg and ended on 200 mg. That's when I decided to go the ablation route. I've had 2 ablations so far and am now scheduled for my 3rd . This time with Dr. Natale. For the short time of 2 months, I have been on Sotalol 120 mg twice a day. This was after a breakthrough afib after my second ablation (not done by Dr. Natale). The Sotalol worked, but I was fatigued with this medicine.

Over the years I have steadily lost a lot of weight and continue to do so. I started out at 284 lbs and am now down to 205 lbs as of today. The medical research clearly shows that afib cannot be dealt with successfully in obese individuals. The antiarrythmia medicines lose effectiveness over time and often require increased doses with the resulting increase in side effects, as well.

My decision has been to aggressively reduce my controllable risk factors:

Weight loss to a BMI in the low twenties.
Exercise both aerobic and anaerobic.
Precise control of BP with medications.
Very healthy diet with no junk foods and lots and lots of veggies. I like "Eat To Live" by Dr. Furman.

And now, my decision has been to go see one of the best Electrophysiologists in the World...Dr. Andrea Natale.

This is my experience, so far.

All the best to you, Nancy, in making wise choices for your long term health.

JohnB

I've been on Rythmol for a couple of years now and this is my first flutter episode. So don't think that had anything to do with it. Doctor is thinking Sotalol might be the best way to go.

Personally I'd prefer pills with no side effects, but not an option .

Yes, I've got the Eat to Live book, and am trying to do well.
Nancy



Edited 1 time(s). Last edit at 02/18/2015 11:38PM by Nancy.

Nancy,
I had a very bad reaction to Sotalol....but I don't do well with drugs period, so I'm not a good person to base any decision on. I had basic debilitating effects for quite awhile (extreme tiredness, swollen ankles, etc.) then after 2 months, a truly scary experience. Extreme dizziness....the kind where you think you might fall down and my blood pressure, which is normally fine shot up. I also had a couple of serious episodes of the shakes....I'd never had those before and it created arrhythmia.

If you read the side effects arrhythmias might happen in 1% to 5% of patients....supposedly more often in female patients. When I went to see my own doctor (not the EP who had already seen me and taken me off it) she said that my reaction, although extreme, was in her experience not THAT unusual. It does a job that they want and that is the risky side....so you have to do your own risk/ benefit analysis on this. It sounds like you will need to take something to get to the other side of your flutter.

Nancy,
The Eat To Live commitment is real and necessary. I suggest you read the book cover to cover as Dr. Furman asks. The results are real and quick. I have been averaging 2 lbs of weight loss per week. I am not hungry. I love salads.
You can lose the weight. Please read the whole book.
Then you can consult with a first tier EP who can successfully deal with your afib with a state of the art ablation.
Just my opinion.
All the Best...
John

Nancy,

A friend of mine from church who is a cardiologist advised me a couple years ago not to go on Amiodarone. He had a female patient on it for just a few months and it resulted in lung problems and death. He said he would never put another patient on it.

I was on Sotalol for only a few days and could not tolerate it. It made me dizzy and out of breath.

I was on Flecanide for a couple years, but it finally stopped working, so I decided to have an ablation a year ago with Dr. Richard Hongo in San Francisco (Dr. Natale is his mentor), and I'm very glad I did. Eventually, all these meds stop working, so losing weight seems like the best course of action. I'll keep you in my prayers about that. I know it isn't easy to change one's lifestyle and diet, but it will be well worth it to be afib free by having an ablation.

Many blessings,
Nancy M