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

12 Replies

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 explains. Might not be you, but it might be.


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


OK, thanks Cathy, understand.


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


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


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


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.


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.


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...


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


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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