First Cardioversion failed after 7 days. Can I get back into Normal Sinus Rythm On Sotalol and Vit C alone?

[MrFizz]

Cardioversion failed after 7 days. Can I get back into Normal Sinus Rythm on Sotalol 40mg twice a day and Vitamin C supplements alone?

Can’t see cardio ‘til late April.

Backround

========

56 year old male. Extremely active and fit ie 80kms mtn biking per week and 10kms running/week.

Developed persistent AF From September 2020. Was in AF 24*7 with no perceived symptoms that I was aware of at the time.

Diagnosed by cardio with ‘moderate’ enlarged left atrium. I have had high blood pressure issues for years and on meds for it now.

Had first electrical cardioversion last Wednesday and it was succesful. Put on 40mg Sotalol twice a day to help retain rythm.

I had unexpected major benefits after the first 24 hrs post cadioversion (see listed below at bottom of post)

I started light runnning post cardioversion and the odd cpl of red wines (but never exercised and drank on same day).

Confident, on day 7 after cardioversion, I rode an easy 20kms on the bike with friends and celebrated my rid of AF with 3 small glasses of red wine after the ride.

Woke up 4am next day in persistent AF 24*7! Ahhhhh!

From anyones experience, will Sotalol and Vit C alone be enough to get me back in rythm and out of persistent AF? I want those benefits back!

Thx in advance.

Benefits of NSR Post Cardioversion:

==========================

Breathe better/easier

- Sports watch now showing big deep sleep segments at night

- Heart doesn’t feel like has rubber band around it

- BP 118/86 (at 56bpm) FINALLY get diastolic <90

- Feel 10 years younger - energy wise

- Sleep resting hr now 56-59bpm (from 76bpm)

- Walking with sports watch hr ; in low hr zones 0 and 1 only

- Night toliet urination urges *3 times a night gone completely (I read that afib triggers hormones to kidneys to generate urine)

[dmjtanner]

Hi, perhaps taking the “extremely” out of active would help. Extreme athletes have a higher risk of afib. Read “The Haywire Heart”by Dr John Mandrola and others. It was recommended before in this forum. There is a balance between over-exercising and no exercise. Also wine or alcohol can be a trigger. Stress reduction techniques may also be quite helpful and perhaps these other actions will help the Sotalol to work better. I am on Sotalol 40mg twice daily and so far, it has worked well for me. You might have done too much of everything too soon.

[MrFizz in reply to dmjtanner]

Its funny you mention the book ‘The Haywire Heart’ because I orderred it last week and it arrived today. ✔️

I do lots of kms but not extreme endurance like athletes by any means; my workouts are ‘weekend warrior’ style with stops for pub stops and chats 😀.

[BobD Volunteer in reply to MrFizz]

It is precisely people like you who are likly to suffer the most. Professional athletes who retire and de-train in their late 30s seldom get AF but the older amateur ones regularly do I'm afraid. You may have done too much too soon.

[MrFizz in reply to BobD]

Thanks BobD - you summed things up quite nicely there.

It is so ironic that as I got older I wanted to be fitter so rode more - I didnt do much when younger at all.

For my 50th birthday I rode a mtn bike over the whole length of Vietnam, south to north over 2 weeks. ...and then my quest for fittness went from there as I had more time.

[Karendeena in reply to MrFizz]

Mr fizz, I think the pub stops are probably something you will need to look at this may be your trigger. I loved my wind and some lager but can't tolerate either as it fires off my afib

[Karendeena in reply to Karendeena]

Lol I mean WINE!

[MrFizz in reply to Karendeena]

Hi Karendeena, I live in Australia and have easy access to some of the best 🍷 wines in the world very cheap.., the devil is playing with me... lol.

I’ve decided I will have to drink alot less....but Im going to make sure I drink better stuff when I do! 😜

[Karendeena in reply to MrFizz]

Mr Fizz, love it, not letting afib control you! We should perhaps all take a leaf out of your book! 🙃😉😊

[Karendeena in reply to dmjtanner]

I am on sotalol 40mg twice per day and it seems to work well for me. I walk regularly between 5000 and 10,000 steps but can't tolerate excessive exercise. Had to give up the wine as that is a definite trigger for me. Also watch the combination of exercise and wine as this may dehydrate you another dangerous trigger for afib I've found.

[CDreamer]

As someone else remarked recently - funny how so many cyclists on this forum struggle with maintaining NSR.

I would have thought you might have a much better chance of success by sticking to no alcohol and much less exercise, at least until NSR pattern has been established for a few months. But one thing I’ve learned is that AF is very quirky so what works for one, fails in another so who knows, I gave up trying to guess.

I would doubt whether Sotolol (which is not usually advised for Lone AF in UK) and VitC will convert you to NSR but when in NSR may help sustain it.

Has ablation been suggested? Cardioversion rarely lasts but indicates that ablation could be successful. Enjoy the book.

[Karendeena in reply to CDreamer]

CDreamer can you elaborate on the sotalol for lone afib please. I have this diagnosis but as flecainide and bisoprolol didn't work for me (I developed pro-arrythmia) I was put on sotalol 40mg twice per day. My EP who is a top Professor and pioneers new robotic mapping ablations and is head of dept and research in heart arrhythmias and sudden cardiac death, said that sotalol was the first drug choice for me when I transferred to him privately

[CDreamer in reply to Karendeena]

I’d just refer you to NICE guidelines for prescribing Sotolol for lone AF.

I was warned against using Sotolol by an experienced EP who helped changed NICE guidelines accordingly. I refused Sotolol as a treatment.

I find it common to find difference of opinion between professionals.

See 1.6.2 nice.org.uk/guidance/cg180/...

[Karendeena in reply to CDreamer]

Hi there CDreamer again, it just mentions offer a beta blocker other than sotalol (it doesn't state why?) As bisoprolol didn't work for me perhaps that's why I was put on sotalol. The guidance is dated 2014 a lot of changes have probably been taken into consideration since then

[CDreamer in reply to Karendeena]

Sotolol is a beta blocker with rhythm control. The reason it was removed as recommended drug for Lone AF was because it triggered fatal ventricle arrhythmias in a very few people. I believe it was prolonged QRS?

[Karendeena in reply to CDreamer]

Oh dear that's a bit worrying, then again I understand all anti-arrithmia drugs can cause pro-arrythmias

[CDreamer in reply to Karendeena]

They all have the ability to cause arrythmias as well as help manage them and in order of toxicity my list would be Amiodarone followed by Sotolol as the 2 most toxic but Flecainide would be a close 3rd.

[Karendeena in reply to CDreamer]

If you don't mind me asking CDreamer what meds do you take, if any of course?

[CDreamer in reply to Karendeena]

Apixaban.

[Karendeena in reply to CDreamer]

Do you not get afib that needs treatment then such as beta blockers? Wish I didn't have to take the sotolol

[CDreamer in reply to Karendeena]

I stopped taking all meds in 2014 because they didn’t work & made me ill. Yes, I was very symptomatic but the meds were worse than the disease & as they are for improving QOL rather than treating the condition I couldn’t see the point.

Since then, after 2 ablations, I had pacemaker implanted in 2018 which has helped me more than anything.

[Elli86 in reply to Karendeena]

Karen who is your EP out of interest as my EP told me exactly the same thing. He wanted me to go onto sotolol also as bisop and flec hadn’t worked for me either and he said I needed an ablation. I had to come off flec as felt like it was killing me and I and bisop in my draw so convinced him to go back on these again and it’s been “ok” since so I didn’t want to go through adapting to yet another drug. He’s agreed to keep me on bisop now until ablation unless anything drastic changes between now and then

[Karendeena in reply to Elli86]

Hi Ellie86 it's Professor Andre Ng at Glenfield Hospital, Leicester. Was highly recommended by several people I know

[Elli86 in reply to Karendeena]

Oh right ok. Mine is dr boon lim and he’s also highly regarded. Like I say he gave me exactly the same advice as yourself

[The_Lord_is_with_Us]

I was around your age when AFIB first hit ... and quite active.

I had a rather aggressive arrhythmia that progressed quickly. I had nearly a dozen cardioversions. At first, I got a couple of months out of them. But, then AFIB hit two or 3 times a week.

I love natural solutions, but unfortunately after trying everything .... nothing worked to stop arrhythmia.

You're heading toward two choices .... managing it with meds or supplements. Or ablation. If you don't progress and have a mild case that only hits every 6 months .... pill-in-the-pocket is a good strategy, but I'm not hearing that in your story.

Wine .... along with cheeses and other foods have tyramine in it, which can produce AFIB episodes. Doctors used to call AFIB 'Holiday Heart' because all their patients drank alcohol.

You're waaaay beyond seeing a Cardiologist (although they will be a help prepping you if you decide ablation. Plus they can monitor meds). You need to see the best Electrophysiologist you can find. Fly there if you have to.

I had this discussion with my younger brother, who came down with AFIB after I did. His doctors kept stringing him along ..... not allowing him to see an EP ... all the while he was getting worse. Finally, they relented, and he consulted an EP who ablated him. He's been fine for 10 years.

For me ... ablation was the easy choice. My first failed after 9 months, but my 2nd AFIB ablation gave me 10 years of normalcy. If you go the med management route ... you're heart can negatively remodel over time making future ablations less successful. And meds have a habit of losing their efficacy, too, leaving you back at square one.

Good Luck! which ever direction you take . . .

[Hidden]

No. Not from any experience of your situation, just logic. Such a small dose of sotalol wouldn’t be expected to cardiovert af normally, but might help to maintain sinus.

[Dave0]

Sorry to hear, it’s so frustrating when you feel better and then symptoms come back again. As others have said, I think you need to give your heart time in normal rhythm before exercising. I’m 38 and have an enlarged atria through years of exercise and too many marathons. After my second cardioversion recently, cardiologist suggested I give it at least a month before exercising and Im still taking it very easy 6 weeks in. Frustrating but better than triggering AF again in my opinion

[MrFizz in reply to Dave0]

Thx for the reply. How long did your first cardioversion last Dave0? Do you have any idea what you did, if anything to get back to AF?

Staying in NSR is very fickle it seems - so what level of light activity are you doing to keep your sanity? And have you given up alcohol?

[Dave0]

I lasted 7 months the first time and just woke up again in fast AF. Couldn’t identify a trigger and hadn’t been exercising previous couple of days so was a bit stumped. Cardiologist wasn’t suprised it happened again though due to enlarged atria and once you’ve had AF, the original cause (covid in my case) doesn’t need to be there so I’m told.When having my six month call after the first episode (when all was well) I was maybe running up to 10ks and maybe 25 a week over 4 runs and he said to cut down to exercising 3 days a week unless training specifically for something. I think I was told to wait a week after first cardioversion before exercising but this time I was told at least a month so guessing exercise is a big factor for me. It’s been easy to cut out drink almost completely not seeing anyone and not sure if I’ll start again when things return to normal, not been told it’s a trigger for me and I would miss it but not sure I want to risk it as I don’t tolerate being in AF very well (wasn’t able to work for couple of months waiting for cardioversion) but hopefully any wait wouldn’t be as long now that the pandemic is more under control in hospitals.

Down for ablation at some point fingers crossed.

[MrFizz in reply to Dave0]

Thanks Dave0 for sharing that information. I am getting more information from forum posts like this than my own specialist - “Drink moderately and moderate exercise was suggested to me when I asked.

Here in Canberra Australia Covid has had minimal impact on social activities - my friends are active party animals! If I have another cardioversion I’l follow your route of none, then minimal exercise for cpl months with 0 alcohol - rockin’ up in my car after ride events with my orange juice 🤪.

I have minimal side-effects in persistent AF so count myself very lucky.

Since you are affected by AF so badly (not able to work) theres more at stake taking risks.

Its a mental minefield I imagine- will this drink, this run, this ride, eating this piece of cheese ruin the work and $ cost spent to stay out of AF? Frustrating!

Thanks again Dave0 for sharing your experience.

[sleeksheep in reply to MrFizz]

I have minimal side-effects in persistent AF so count myself very lucky.

I am asymptomatic AF ( Western Australia ) , Sotalol never worked for me, I only take Diltiazem now since Flecainide stopped working a few years ago now.

When I was symptomatic cheese never was a problem but any wine with sulphides was totally out.

That rules out most red wines and a lot of imported cans and stubbies (ciders and beers) as these have sulphites as a preservative besides that drink moderately was never suggested it was more like one wine a week - less if possible.

[MrFizz in reply to sleeksheep]

Thanks sleeksheep. I also have very minor side effects being in persistent AF especially compared to others in the forum.

Drinking alcohol never presented any problems at all in the past, so if my specialist in late April suggest ‘living with AF’ I would continue to drink moderately.

But if I have another attempt at cardioversion Il have to give it up for a few months in case in triggers me back into AF.

Can I ask what the Diltiazem does for you? Maybe I can suggest this as an alternative to my sotalol Im on now...

Thx in advance

[sleeksheep in reply to MrFizz]

I was on Sotalol for too long(5yrs+) as it did nothing for me but when I changed cardiologist he put me on flecainide and diltiazem which kept me in sinus rhythm for four years.

When flec. no longer worked he just prescribed diltiazem ( calcium channel blocker ) as we agreed since I now was asymptomatic my QOL was good I only needed rate control.( nearly 3 years ago now )

I have found after years of staying away from red wine and any thing that had sulphides I dont even like a red tipple even thou it has no effect on me now.

[magendomike]

VERY SIMILAR TO MY SITUATION. Alcohol big triger for me. may write more later. May give up on nsr as my persist af does not effect me much good luck