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AF Association
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Not what I expected !

I've just had a 5 day loop ECG - the cardiac nurse e.mailed to say it showed episodes of persistent AF ! I had a Cryoablation in Feb this year. The consultant wants me to change from Bisoporol 1.25 mg ( been on this for 4 weeks ) to Sotalol ( don't know the dose as waiting for phone call from cardiology nurse ) to have this for 2 weeks to see if it will chemically cardiovert me if not then onto a cardio version ... gulp !!

I took Sotalol for a short time when I first started with PAF 5 years ago and found it appalling I felt dreadful on it then .

Reassurance please. Cathy

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Commiserations, Cathy / Trilby8 . I understand the dejection of having an ablation fail - mine did so after 2 months, but it's not unusual and I assume you were probably told of that risk. Hopefully you can get a top-up, as I did, and get back to NSR.

I do struggle with how Cardiologists sometimes prescribe betablockers, though. "I am not a doctor" but beta blockers to my understanding are primarily a rate control drug, and the patient is expected to stay in AF but at a slower rate. It's quite a common stratgey with older long-term permanent fibbers. I think there may be an argument that by slowing the rate the AF will convert, (perhaps on the thinking that a high rate triggers the AF in some way). Also, if your rate in AF was dangerously high than agan a possible reason. But beta-blockers are not really a rhythm control conversion-type drug so I would personally not expect you to convert to NSR due to the drug.

I note you said beta blockers you were on before were "dreadful". If you perhaps had a lone AF which was refractory to several anti-arrhythmics, are younger (50 +/-) then they should be thinking of avoiding beta blockers and instead about drugs such as flecainide (albeit several provisos with that one). The video in this healthunlocked.com/afassoci... explains. Might not be you, but it might be.

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Thank you for your prompt and helpful reply JohnGrover.

Bisoporol at the lowest dose was a trial to see if it helped to calm the 'excess' adrenaline which seems to be a trigger and blight to me. Both anxiety and gastric / IBS problems have been my main triggers - as you'll see if you look back at my previous posts.

I feel I've made good progress with my digestion / IBS. The anxiety has been eased with the Bisoporol interestingly and a few sessions of ' solution focused hypnotherapy ' . My HR and BP are within good limits as long as I don't go near the GPs when they both soar ! Although getting the 5 day ECG result today has certainly increased my HR as you can imagine.

Still waiting to discuss the plan with cardiac nurse. Cathy

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OK, thanks Cathy, understand.

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If sotolol didn't work 5 years ago, it (and dromedarone) won't work now. Suggest they try amiodarone as a short term trial until they can schedule a followup ablation

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Ask Bob D, I didn't think sotalol was recommended in the uk anymore ( apologies I don't know where you are based!) x

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Yes 'jollies' I thought that to ?! But maybe for a short course to see if it will 'chemically cardioconvert' me may be ok ? I will ask the question when I speak to the Arythmia specialist nurse hopefully today - I've got a list of questions for her.

I live in Cornwall but currently seeing a EP cardiologist in Plymouth Devon. Cathy

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The problem with drugs is that they affect people in different ways. After bad experiences with Amariodone I was put on Sotalol with no bad effects and it has kept me in NSR since a cardioversion a couple of years ago. Hopefully your EP will be able to find a drug which suits you.

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When I visited the team at Hammersmith hospital heading the Avatar trial, they wanted to put me on Sotalol. I said that it wasn’t recommended any more but they disagreed and said many of their Afibbpatients were on it. I still declined.

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Yes Irene - I said the same to the Arythmia specialist nurse this morning - she said as did yours that they find it a very useful drug - and apparently the decision for Sotolol is led by what drug the patient is currently on and as in my case Bisoporol. Cathy.

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It was very difficult when faced with disagreement by the (very nice) professionals I was talking to, and they prescribed flecainide instead. Whilst I appreciate all the follow-up care and attention whilst being part of a trial, it was my own fabulous (not a word I use often) GP who, when I was telling him how unhappy I was with the the amount of drugs I was taking, looked at my record of AFib episodes and advised using flecainide as a PIP instead - the same advice that I had from Professor Schilling. I see the team this month when I will tell them how I reduced from a daily dose to two tablets in the past year...

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Don't think you can have episodes of persistent AF within 5 days Cathy- must be PAF??

Sotolol is not viewed well by NICE so in your shoes Oi would ask for an alternative, saying how bad you felt on it before

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Hello Trilby

I have taken Sotalol for 8 years for paroxysmal atrial fibrillation. I now take 120 mgs bd. I don't think it has caused me any problems.

Whether it helps, I am not so sure now. But I would not want to stop it unless an EP advised something better.

I believe ablation is considered a better long term solution for many people, rather than rhythm control meds. My ablation in 2013 worked well until recently.

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