Sotalol side effects and an anticoagulation conundrum.

[pogven]

I'm a 61yr. old woman with PAF diagnosed 10 yrs ago. Episodes were becoming more frequent, and I was already up to 7.5mg Bisoprolol daily, not feeling good and neither was it controlling the AF. I started 120mg Sotalol, twice a day, 3 weeks ago, as a direct replacement for Bisoprolol.

i've had 2 AF episodes during that 3 weeks and my head kind of aches, but not in a normal headache way and at times I am feeling a bit depressed and just not 'myself'. Maybe this description is too vague for anyone out there to identify with as Sotalol side-effects, but would be interested to hear.

I have never yet been offered an anti-arrhythmic drug, maybe that will be the next thing to be tried if Sotalol is deemed to be not helping much.

I live in Central Scotland, and the cardiologist I have seen twice in the last year has given me the definite impression that she is not a fan of catheter ablation, well, maybe as a last resort, certainly not an immediate one, although when I ask my GP if it's still an option, he says yes. I have asked my GP how I get to see an EP, but he tells me that in Scotland, it is most likely that the Cardiologists themselves are the ones who would do an ablation (Obviously not the one I have been seeing - she is not a consultant but an ex-GP who is specialising in Cardiology)

This same Dr is not wanting me to be anticoagulated yet as I am deemed to be low risk,apart from having AF. This is despite my saying my mother had a major stroke at age 65. Since her's wasn't due to AF but CHD (from which I don't suffer) I was told my mother's stroke history was not relevant to me and my risk.

I do know that the 'leading lights' on this forum are very much FOR everyone with AF to be anticoagulated, and, knowing what a bad stroke did to my mother, it does worry me. However, I also have a bleeding worry. 15 yrs ago, I suffered a rectal haemorrhage, found to be due to diverticular disease. I gather it was an unlucky occurrence of a vessel running through one of the diverticulum (pouches) of the intestines.

I have not suffered anything similar since then, although I stay away from Ibuprofen, as I suspected that it could have been a trigger to the bleed.

The chances are that I would be fine an a NOAC (although I should feel even happier when there is a prescribeable antidote)

It feels as if it comes down to a choice of which condition I would find worse - a bleed or a stroke.

AF may be a mongrel, complex condition, and it sure faces us with difficult choices at times.

Any thoughts would be helpful,

Helen

[meadfoot]

Hi Helen, I can't comment on sotalol sorry as I have never been prescribed it. My comment really is about the need to see an EP as a priority. You need an expert on your case who will assess you and look at the pros and cons of meds, procedures, anti coagulation etc with you.

A cardiologist looks after the plumbing of your heart and an EP the electrics. Please don't be put off , fight to see an EP. Have a look on the af website for a list of them in your area even if you have to travel it's worth the effort.

Take care and be well.

Dee

[Finvola]

Hello Helen - When I was first diagnosed I was prescribed Sotalol at the same dose as you but it caused rapid runs of arrhythmia and scared the wits out of me. Sotalol is an anti-arrhythmic drug but is now no longer recommended by NICE for AF patients which is something to bring to your physician's attention.

I agree with Dee - an EP is the person to deal with, even if it means a journey to get seen. I cannot imagine that a cardiologist would want to perform ablations as the area is so highly specialised, so I think your GP may be guessing or winging it! Cardiologists are the heart's plumbers - AF is an electrical fault.

From my own experience here in N Ireland, you need to take charge of what you want, see the right person(s), ask questions and get the best treatment you can. Eventually, in desperation, I saw an EP privately and got the correct drugs at the right dosage. Two hundred pounds well spent.

The main AF website has a link to their registered EP's but there may be others in your area who are not on the list. It might be worth ringing some of the larger hospitals near you and asking. I am taking a NOAC but I'm 71, so it was automatically prescribed on diagnosis a couple of years ago.

I hope you can get a proper appraisal and the best treatment for you. If you have any questions do please ask.

Best wishes

[Susiebelle in reply to Finvola]

my cardiologist / EP is going to put me on sotalol after cardio verting me before carrying out an ablation for atrial flutter - willcheck NICE guidelines & speak to him about this

[DavDug]

Yes, the EP is the person to see. Don't be put off. Change your Doctor/Cardiologist if necessary. They are the same as accountants and lawyers. You have to find the 'Guy' that suits you and has the right information. If you can google NICE and their recommendations for AF brought in in in June 2014 do so Immediately. Or tap up someone that can. Keep reading these blogs to gather information. Treatment is still haphazzard UK wide