Thoughts on Daily Bisoprolol with Sotalol as PIP?

[BigArnie]

Hello, so my cardiologist has now increased my Bisoprolol to 2.5mg in the morning and 1.25mg at night as I had a couple of early morning ‘near episodes’ immediately on rising, we assume when the amount in the body was at its lowest. Given my adverse reaction to Flecainide, if I do have an episode, the intention is to try first Bisoprolol 1.25mg as a PIP, and if that doesn’t work, 40mg of Sotalol, which I have never tried before. Any experience with this combination (or thoughts) would be much appreciated.

[irene75359]

When I was first diagnosed with AF 5 years ago, my doctor prescribed bisoprolol, I think it was 2.5mg. When I did have an episode, I took extra and although it slowed my heart it did nothing to stop the episode which could go on for several days. The consultant prescribed flecainide which I now use as a PiP in conjunction with 1.25mg of bisoprolol. If bisoprolol works on its own for you that's great, but if not there are alternatives to flecainide that your consultant can try you with. Best of luck!

[BigArnie in reply to irene75359]

Thanks Irene. I do think from your feedback and other sources/reading that I will go straight to the Sotalol as a PIP if needed. Bisoprolol is working relatively well for me so far in keeping away the episodes and it does have mild anti-arrhythmic properties. However if an episode occurs, I suspect that another 1.25mg won't be enough to stop it. On the other hand, if I try Sotalol and it doesn't work (or makes me feel as awful as the Flec) then I suppose I will give it a go!

[Mike-tyson]

Used to be on Atenolol which was good as no side effects. But had chest infection last year so was in Hospital for 6 days. And had a little heart failure. Stoke Cardiology changed my medication to 100mg Amiodarone in the evening and 5mg Bisoprolol in morning and 2.5mg at night. I do still get tired at times with taking Bisoprolol and have sleep problems due to taking Amiodarone. But it’s working for me as my a/f heart rate which i check with Heart Rate Free App on my iphone is between 60 and 110 bpm. Which I am told is ok. But only hits 110bpm on rare occasions. mike. n

[BigArnie in reply to Mike-tyson]

Thanks Mike, from my reading, Bisoprolol is a go to drug in heart failure scenarios. Hope it continues to manage the challenges for you. My HR will hit 140-150 occasionally in an episode if I happen to be moving around, but I feel able to cope since relatively recently I was hitting over 170 while running 5k. Don't know if the Bisoprolol will let me do that now though - I hope to improve enough to find out.

[Ecki]

Sotalol has much more of an anti arrhythmia effect than bisoprolol. I was on bisoprolol but my EP changed me to sotalol because he believes its better to prevent episodes of AF happening than to try to stop them once they've started. I'm on 20mg 2x daily and can take 40mg as a PIP, which I haven't needed to do yet. For me, it's better than bisoprolol as I'm not getting the exhaustive wading through treacle effects.

[BigArnie in reply to Ecki]

Hi Ecki, that sounds good for you! What was your frequency before Sotalol and what is it now? (Sorry, and also how much Bisoprolol were you on? I am no more tired with 2.5/3.75 than I was before, but that doesn't mean that I wasn't over-tired before as well due to the Afib!)

[Ecki in reply to BigArnie]

Hi BigArnie, I was on 10mg bisoprolol a day while in persistent AF. Following cardioversion in September last year I went down to 5mg a day. Still got lots of short episodes of AF and ectopics. Ablation in January this year and was put on sotalol 40 mg 2x daily, went down to 20mg 2x daily about 4 months ago, due to asthma symptoms developing. My RHR is mid to low 50s, which EP is happy with. My BP tends to be high so I'm on 5mg ramipril and 5mg amlodipine daily, also anticoagulant. The sotalol definitely suits me better. I had a period of about 2 weeks of feeling awful when I started it, probably due to the effects of stopping bisoprolol and adjusting to sotalol, but now I've been on it a while I feel good, more energy and more stamina.

[BigArnie in reply to Ecki]

Thanks Ecki!

[Karendeena]

I have been taken off flecainide as it wasn't working for me and I was still getting AF episodes, I took this with bisoprolol. I went to see a Professor and epiphysiologist who prescribed sotalol, he took me off bisoprolol too and said the sotalol replaces both flecainide and bisoprolol. I was unsteady the first week of change and had another episode. I am now hoping it's settling because sotolol is not really giving me any problems at the moment apart from my BP being a bit lower than I would have wanted...about 100/66 with HR of around 56

[BigArnie in reply to Karendeena]

Thanks Karendeena, and I hope it works well for you. Interested to hear how it goes.

[Karendeena in reply to BigArnie]

Hi again Big Arnie, I will keep you posted. Sotalol seems to be ok at the moment but I am expecting some heart irregularities again as I felt it a few times this morning but it settled. I am under Professor Andre Ng in Leicester, he had an article in the Times about performing a new type of robotic ablation which takes a lot less time, so when I see him in February I am going to ask to go on his waiting list. He has quoted me an 80% success rate of cure at first attempt with 1% risk of stroke and 1 - 2 % risk of tamponade so I think it's worth trying. Are you on a blood thinner? I take apixaban, I'd rather not because I want to horse ride again but equally don't want z stroke.

[BigArnie in reply to Karendeena]

Hi Karendeena, it sounds like you are in good hands. I am not on blood thinners due to where I am on the risk scale. I must say that the 1% risk of stroke from the ablation would not be for me at this stage, but we must all decide based on our situation and personal feelings. Good luck!

[Karendeena in reply to BigArnie]

Hiya again, if you don't mind me asking what is your score on CHADS for stroke risk? I only score 1 and that's for being female but they still wanted me on blood thinners. Also I was told that the earlier you have ablation (best done when you have paroxysmal afib) the better chance of a cure, once many episodes have taken place and afib progresses the chance of a cure goes down greatly. How often do you feel your heart go irregular or get episodes? When mine come on they last almost 24 hours to the hour. Thanks, Karen

[BigArnie in reply to Karendeena]

Hi Karen, so I came out as 0 on CHADS and also had MRI and Echo scans. I am 59, pretty fit from regular running, although I first got Afib in July 2019, whilst on an injury break from the running. Over the last 1.5 years, I suppose I have averaged around 4-5 episodes per month of around 4 hours average each (range 2-7) plus around 4 other mini-episodes per month of 30 mins or less. All these episodes mainly terminated themselves or occasionally by using Flecainide 50mg as PIP. Over the last few months, the frequency and duration of episodes was increasing so I asked the cardiologist for a daily option. We started with Flecainide and it went badly - 28 episodes in 28 days, and hence switched to Bisoprolol 2.5 mg in the morning. This started fantastically with 10 clear days, then 2 in 3 days blip, at which point 1.25mg of Bisoprolol at night was added and I am now on a 'streak' of 5 days since then.

[Karendeena in reply to BigArnie]

Hiya again, thanks for telling me your story. I have had loads of tests and they can't find anything wrong that might have triggered my afib. I think I had an episode over a year ago but put it down to stress when my holiday was cancelled at short notice! Interesting, that you had problems with Flecainide, I had repeated episodes whilst on this drug, hence the swap to sotalol. I have gone almost 2 weeks in NSR but feel a flutter a few times. Hoping this works for me until I see consultant again in Feb. I have flutter and afib so when I had the first 2 major episodes I ended up in A & E but converted myself before they took any further action, although I was admitted on both occasions. I tend to 'sit it out' now if I can as it doesn't make me feel unwell, just annoying. I do get scared though, especially as I was told the episodes would start getting more frequent and last longer. The only side effect I get from sotalol is I struggle to sleep and have awful dreams. I often wonder if I have sleep apnea so going to ask to be tested. Do you know what triggered yours?

[BigArnie in reply to Karendeena]

I'm not sure the condition was really triggered by anything as such. Actually I was diagnosed after a couple of episodes whilst on holiday in France, and this had coincided with a 4-5 month period of virtually no running due to an injury and hence I had started eating and drinking a bit more, put on a bit of weight etc. However, with hindsight I now realise that I'd been having an odd episode every now and again for a few years that I had put down to other things - HR 'spike' whilst running, feeling a bit shaky after lunch and so on. Definitely check out the sleep apnoea - I did and they told me that whilst I did exhibit some of the symptoms in the overnight tests, they were not sufficiently frequent/lengthy to be classified as actually having the condition. (What that means for my Afib, who knows!) Where I am at is that after putting up with the episodes for 18 months and trying everything to get rid of them - avoiding triggers, better diet, minimal alcohol, more exercise etc., I kind of got battle fatigue and just wanted some magic tablets to make it go away for a while, so that I could regroup. Plus I started to get concerned that I was beginning to lose the battle and heading (perhaps) in the direction of more permanent Afib and the incumbent stroke risks etc. This (and the really bad daily Flecainide period) in turn means that I am finding myself much less 'tolerant' of having episodes now and really loath them as opposed to (grudgingly) accepting them.

[Karendeena in reply to BigArnie]

Would you consider an ablation to try and cure it?

[BigArnie in reply to Karendeena]

Possibly one day, but not yet. I want to try the other alternatives - and hope for technology improvements while I do.