Stopping Sotalol after an ablation

I had an ablation with Dr. Natalie on February 23. Several days after the ablation, he put me on sotalol. Things have been fine during this period. It is the plan for me to stop the sotalol on 4/21. Frankly, I am already doing something I should not be doing ………thinking ahead and wondering what will happen when this drug is stopped.
I have had 2 failed ablations and can’t help but think about the roller coaster ride I was on after those. I have not yet asked questions about going off this drug and I have put my faith in the expertise of Dr. Natale . I am wondering, though, if anyone has gone through this kind of treatment plan and how/if it affected your normal sinus rhythm.

Sherry

Yes, I have. Not with sotalol but Multaq. Natale put me on Multaq for two months following my ablation. Being the sort of patient who does things like this, I started skipping the morning dose after about 3 weeks to just test things out. That went okay so I tried skipping both doses, and that didn't go as well so I resumed the drug. And then I tried again a week or so later, and this time nothing happened. That was September 2017. I've been in continuous NSR since.

I know exactly how you feel. I spent every day for the next 6 months waiting for the other shoe to drop. I'd been wrestling with afib and 5 failed ablations for over 7 years and had come to expect failure. But at 7 months they had me wear a monitor for a week and it recorded not a single aberrant beat, not so much as a single PAC. But honestly, it took me almost a full year before I truly believed my afib was gone and I could finally relax and quit paying attention to my heartbeat. My Kardia has been sitting in a desk drawer with no battery in it for 3 years now.

Have faith in his skills. My prediction is that on 4/22 and beyond you're going to be in NSR.

When Dr Natale ablated me 8-6-21 he had me only on eliquis. He also told me to not count anything for 6-8 weeks. At week 2-3 i had an episode that lasted a few hours but self converted. Of course i counted it lol. Ive been NSR since 8 plus months

Thanks for the encouragement, Carey and Tom. When I was told to take my heart rate only twice daily, I thought that would be impossible for me to do, but it is working…….just breath in and out, right? There was a lot of activity in my LAA and he suspects there might be 4 spots that may need a touch-up. By, the way I an not even reading the posts about the watchman. It is another new strategy of mine to help cope and improve my anxiety related thoughts.

Sherry

I had my ablation by doctor Natale in December 2020. He also put me on sotalol for 2 months. I had the same fears that you are expressing now. In fact I stayed on the sotalol for a month longer, on my own, out of fear of going back into AFib. I finally got up the courage to stop the Sotalol and I have been in NSR ever since. Best wishes,

Frankangelo

Oh, I want to stay on it longer, also. I think 3 months would be better than two………or forever?? Glad to know someone had the same fear. I am so glad to hear about the success you are having.

Sherry

I'm in a somewhat similar situation. I had my third ablation and Watchman done mid- December 2021. About 2 weeks after the ablation I started flutter (not afib) and PACs and it continued persistently until cardioversion mid March. I have been in NSR full time since cardioversion. I've been on Multaq about a year, and doc wants me to continue Multaq for at least 2 months post cardioversion.
The main purpose of getting ablation #3 was to hopefully get off Mutlaq long term, but since I'm feeling good and in NSR after cardioversion, I'm leary of going off Multaq.
Has anyone had experice with pill in pocket for flutter- whether that would be an option if flutter came back after stopping Multaq inm a month or so?
Thanks!
Ken

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KenKY
Has anyone had experice with pill in pocket for flutter- whether that would be an option if flutter came back after stopping Multaq inm a month or so?

Yes, quite a bit of experience with that, and here's the thing I learned about flutter.

Flutter is actually a very stable rhythm. It's regular and so once it starts it tends to keep going all on its own. Unlike afib, which is very irregular, it offers few opportunities for a drug to interrupt it. I found that antiarrhythmic drugs can prevent flutter, but none of them are good at stopping it once it gets started. The only things I found effective at stopping flutter are cardioversion and very high doses of potassium (much too high to take safely without the ability to monitor your potassium levels in real time).

Unfortunately, I don't think a PIP approach to flutter will work. You either prevent it or you cardiovert it.

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Carey
Flutter is actually a very stable rhythm. It's regular and so once it starts it tends to keep going all on its own. Unlike afib, which is very irregular, it offers few opportunities for a drug to interrupt it. I found that antiarrhythmic drugs can prevent flutter, but none of them are good at stopping it once it gets started. The only things I found effective at stopping flutter are cardioversion and very high doses of potassium (much too high to take safely without the ability to monitor your potassium levels in real time).

When I use flec to convert afib, it tends to convert me to flutter. As you state, it is very stable. I've found I then need to do something to "break" the flutter and go back to afib, which will commonly convert. I've used a variety of ways to convert the flutter, on top of the flec. This can include Wim Hof breathing with exhaled breath holds, headstands, cold baths for 10+ minutes. Also jumping rope, pushups, weight lifting, walking or etc. during an exhaled breath hold, I don't necessarily recommend others try these anitics for conversion.

I had 9 months of increased afib (for) me last year. I had 15 episodes ranging from 3 minutes (converted with an exhaled breath hold) to 9 hours with an average of 155 minutes. After the last one on Oct 27 was converted with a cold bath (having tried many other things) after a nearly 5 hour episode, I decided to take 50 mg of flec in the evening chronically. This immediately stopped any excess ectopy as well as afib. After two months I reduced the dose to 25 mg flec in the evening. This continues to work, now after 25 weeks. I would reduce it further, but I'm cutting 100 mg pills & it is hard to do this without the pill completely falling apart after quartering it. I may get some 50 mg pills so I can quarter them to 12.5 mg, or dissolve them in a measured amount of water and take the requisite amount.

I bring this up as perhaps it is possible to do this with Multaq???? I'm a big fan of minimum effective dose. Obviously I risk an episode finding this,, but it is a risk I'm willing to take. My doses are so small that I still have plenty of "headroom" if I need a PIP dose to convert. I hypothesize my issues with afib frequency may be due to electrolyte changes, so have also been working on that as more of a root cause solution. I periodically wear my recording beat to beat monitor overnight and sample PAC's to get PAC/hour rates as an indicator of heart "happiness." Currently these are at 2-4/hour, which is pretty nominal for me.

From the literature, doses of this size are nearly "homeopathic" and should not have any effect. For adults, 2x 50 mg/day, is the smallest dose mentioned.

Here is an episode from Sept 2021



Edited 2 time(s). Last edit at 04/18/2022 03:03PM by GeorgeN.

I also found that exercise could sometimes terminate flutter, but it was very much dependent on heart rate. I had two separate flutter circuits, one that produced a HR of 230-250 and another that produced rates of 120ish. I could quite often terminate the fast HR with exercise, but I was never once able to terminate the slower flutter with exercise alone.

Later, I figured out why exercise can terminate flutter, and why it worked better for the faster rate. It turns out that exercise -- especially intense and/or prolonged exercise -- greatly increases your serum potassium levels. One study of professional soccer players found that they sometimes reached levels as high as 7-8 during training, which under normal circumstances would be potentially lethal. Very odd that it's harmless during intense exercise, and I don't understand the reasons behind that. So the mechanism is that increasing potassium levels widens the refractory period, and if you widen it far enough that can interrupt the reentrant signals that cause flutter. It also makes sense that a faster HR would be easier to interrupt because the refractory period in such a fast rate is already very short, so widening it just a little can suffice. But with a slower rate you have to widen it much farther to interrupt the cycle. I was able to do that with potassium supplements, but it required a whopping big dose that would be too dangerous to take unless you can monitor potassium levels in real time.

You are fortunate you were physically able without additional symptoms to intensify your exercise when having >200hr.

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susan.d
You are fortunate you were physically able without additional symptoms to intensify your exercise when having >200hr.

Yes, I was. Trust me, that was noted by me based on my EMS experience, and by my local EP and other medical professionals. Prior to my own experience I'd never encountered someone with a HR over 200 who wasn't in major distress. My EP's comment was that I apparently have a very healthy AV node that can transmit a rate that high. He said top 5% of the population. He also said what I needed was bit of heart disease to slow it down, but he was being a bit facetious on that one.

Anyway, it doesn't change the point of my post. Exercise can sometimes terminate flutter for the reasons I mentioned no matter what the rate.

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Carey
Prior to my own experience I'd never encountered someone with a HR over 200 who wasn't in major distress. My EP's comment was that I apparently have a very healthy AV node that can transmit a rate that high. He said top 5% of the population.

On my second afib episode ever, in 2004, I'd learned that for me afib was not a trip to the ER. I was yet to use PIP flec. I woke up in afib, went to work. I didn't actually know that afib was the rhythm issue I had as at the ER, while I was on a monitor, they never got a printout before I converted and they could not tell by looking at the moving display on the monitor. At lunch I threw on a heart rate monitor and went for a walk to see how my heart responded to exercise. I was walking around the downtown area at around 145 BPM. At one point I was walking across the street and had to sprint to avoid being hit by a car. My HR went to 220 and then converted.

On one of my 2021 episodes, I pushed it over 200 (210 or 220, as I recall), it was doing exercise during an exhaled breath hold, having taken PIP flec. I think it was while I was jumping rope. It stayed there, perhaps in flutter. I then went and did a headstand till the rate dropped into the 130's in flutter. I have it stored in my heart rate data, but it would take an effort to find it.

Interesting thread ! Thanks for your informative posts !