What is normal for the blanking period

I had my ablation on December 15th. I was placed on sotalol 80 mg b i d. This is the first time that I am taking an antiarrhythmic. I was in NSR up until early this morning. About 5:30 A M I woke up in a fib and I've been in afib now for about 12 hours. I was hoping that I would self convert sooner but it hasn't happened. Is 12 hours or longer of being in afib during the blanking period something that is common? My nurse practitioner is away for the holiday and will not return until after New Year. The person covering for her asked for my blood pressure and heart rate which was 123 / 92 and the rate of 111. She suggested I wait to self convert to NSR and to call if the situation worsened.
If my rate doesn't go much higher than 111 do I need to be on an antiarrhythmic at all? I'm wondering if it's reasonable take a beta blocker like metoprolol on a PRN basis in lieu of an antiarrhythmic. Most of all I'm just hoping that the ablation is successful and that I stay NSR for a long time. I would like very much to hear of other people's experience during the blanking period especially those that wound up eventually being successful and staying in NSR. Thanks.

I was told by my np two days ago not to take a beta blocker while on solotol. Once you convert your hr could crash some. You can check drug interactions on drugs.com

It happened to me after my cardiologist had me take 75 mg Tenormin (atenolol) to lower my hr during tachycardia. The ecv crashed my hr and my heart rate dropped to 24. I spent 3 days in icu until it got up to 36. That was BC (before covid19). You don’t want to be near the icu now.

Do you have a local cardiologist or EP you can ask for advise?

You’re only two weeks post procedure so I wouldn’t worry too terribly much about the fact that it happened. I would think about adding some (or more if you’re already on it) beta blocker to get that rate below 100. That’ll be more comfortable.

Maybe ask to drop the sotalol and just go with metoprolol. You’re early in the blanking so just drop the rate and hope for the best.

Sue - I am not wanting to add metoprolol to the sotalol. I am asking about dropping the sotalol and only go on metoprolol when my heart rate is too high.
Unfortunately I do not have a local EP. I saw a cardiologist for the first time last month but may not return to him. This is on my to do list.

I had an 8 hour episode 3 days after ablation, then a 16 hour episode 2 days after that. That was a lot like I was before the ablation for monthis i had it almost every day for long periods. The only drug that worked for me before ablation was Amiodarone. I asked the EP if I could take it for a little while during blanking, and took it for about 6 weeks, weaned off, and been NSR for 7 months now. I understand it's normal to go into AF when the heart is healing. Hopefully, the staff will come up with something to keep you comfortable until the healing is complete.

Lani- thank you for sharing your story it is very helpful and encouraging. Congratulations on your 7 months in NSR and hopefully many more to come.

Frank - it took me a while (12 weeks) to settle down (and 1 last ECV)

On flecainide and eliquis only now. I dropped dilitazem when I had covid and didn't need to get back on - MD approval on all changes before I make them

Sotalol is a beta blocker, so it's already doing what metoprolol would do for you. And unlike metoprolol, it's also an antiarrhythmic so it will help break the current episode while metoprolol won't. So there's no reason to switch, and you definitely don't want to combine the two.

I would just wait it out another 24 hours then contact the NP again about arranging a cardioversion or increasing the dosage. This is where having a local EP would be helpful. I doubt an ER is going to cardiovert a rate of 111, so arranging it could be problematic.

NLAMA - thank you for your feedback and I hope that you will be able to get off the flecainide soon and remain in NSR.
Cary - sotalol makes me very nervous because of the danger of torsade. I reluctantly agreed to go on it at 80 mg b i d. I would not take it at a higher dosage. I understand that some may think I'm overreacting but that is how I see it. I wonder if flecainide is a safer anti-arrhythmic to use.
I guess one of the things I'm struggling with is that if taking an antiarrhythmic during the blanking period does not have any bearing on the success or failure of the ablation and if my heart rate doesn't get too high when in AFib then why take an antiarrhythmic at all. If my heart rate does get a bit High then perhaps a simple beta-blocker could solve that problem. I know you have many years of experience with Afib as well as a background in the medical field so I respect your opinions and any insight you can offer.
By the way, the good news is that I woke up in NSR.

Taking antiarrhythmic during 3 months post ablation as I understand is to help with healing of the atriums, by preventing artriums from fibbriliating, if breakthrough episodes occurred shortly after ablation . Prevention takes burden off the heart that suffered quite a trauma. In my case I will be off Flecainade after 6 weeks. I had breakthrough AF 5 days after procedure, converted in 20 min after administration of Flecanaide via IV. Cardiologists have different approaches to management post ablation. I rather take minimal dose of Flecanaide than risk having even few breakthrough AF episodes during heart healing period.

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frankangelo
I guess one of the things I'm struggling with is that if taking an antiarrhythmic during the blanking period does not have any bearing on the success or failure of the ablation and if my heart rate doesn't get too high when in AFib then why take an antiarrhythmic at all. If my heart rate does get a bit High then perhaps a simple beta-blocker could solve that problem.

That's 100% solid thinking and I think it's what your EP is trying to nudge you towards since he said the only way to know is stop the sotalol and find out. An antiarrhythmic during the blanking period is primarily for patient comfort. EPs generally don't want you to remain in an arrhythmia for extended periods during the blanking period because they want to give your heart a rest, but in the end it's more for your comfort than healing. So I think stopping the sotalol and keeping some metoprolol on hand is a great way to go. After all, you have to stop it eventually so why not now? Talk to your EP and see if he agrees.

Thank you Carey and everyone else who responded to my post. Your input is helpful to me in sorting out what I want and need to do. Thank you.
Currently I am in NSR so I feel much more relaxed. However overall I have not been feeling great since my ablation on the 15th of December. I do not have my pre ablation energy back yet and the last few days I have felt really fatigued. I suspect the sotalol is causing that. To top it off I was recently prescribed Flomax buy a urologist because of BPH. Taking both of these new medications for me I believe is responsible for my feeling very tired and not sleeping well since they are listed as side effects to both medications.
I have a follow-up appointment with my nurse practitioner on the 18th of January and I will discuss changes with her at that time. Thanks again for your feedback which helps me to put things in perspective.

Yes, the beta blockers will sap energy. We’ve all felt it. Goes with the territory.