I have been on Flecainide for about two years and it controlled my PAF breakthroughs pretty well, reducing episodes to about every couple of months, lasting anywhere from 1 to 5 hours. They lasted one to two days before Flecainide. Now, after a cardio stress test this week, my Cardiologist says the ECG showed a widening of the QRS duration during exercise of 35% which is over the 25% recommended limit. Now he is switching me from flecainide to Solotol and I am worried as I read that it helps prevent episodes but is not as good as returning an Afib episode to Sinus once it starts.
I'm a bit apprehensive and disappointed that the Flecainide, which seemed to be working relatively well, was/is causing this "silent" problem with my heart. I did very well on the treadmill getting my heart up to maximum rate without much breathlessness, etc.
Solotol also has quite a daunting list of possible side effects-some possibly serious and life-threatening. Have others here been on Solotol or transitioned from one to another of these drugs and what was your experience. I'm a bit apprehensive and disappointed that the Flecainide which seemed to be working was/is causing this "silent" problem with my heart. Thanks for any experiences in this area.
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willec49
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I think you are quite lucky really considering. Whilst sotalol is not commonly used here in UK it does have both beta blocking and rhythm control benefits.
The important thing is that flecainide was damaging and could potentially have caused you considerable harm. I do not buy your "silent" description and totally understand why the doctors were keen to get you off it.
Do understand that any and all treatment for AF is generally for quality of life as it is not a life threatening condition and provided that rate is well controlled and you are anticoagulated where appropriate then all is good.
Bob D, Thank you for your reply. Yes, if Flecainide is damaging my heart or heart functioning, of course I want to stop it. Having been on it for two years, I wonder if It should have been stopped before.
Yes, Afib is not theoretically life-threatening. I think the major motivation for controlling it is the possibility of stroke and the possible ramifications of that. Thanks again.
Why are you on aspirin which we know has little benefit in preventing AF related stroke and is not recommended for that purpose here in UK or for that matter Europe? The length or severity of any AF event has no bearing on stroke risk. Clots do not have a finite time to form and can do so in short order. Any diagnosis of AF brings about that five fold risk.
Have you or any of your doctors done a CHADS2VASC2 score based on your co-morbidities?
I'm in the same boat. Was changed from flec to Sotalol about 5 or 6 weeks ago. Like you I also had my doubts and concerns.
Started on 40 mg twice a day which has just been increased to 80 mg twice a day. So far I haven't had any of the bad side effects you read about. I asked about it on the forum and many said they found it fine although some said it didn't suit them (as with any med's). Overall though I found the general consensus reassuring. I'll link to the thread as you may find it worth a read.
"Solotol also has quite a daunting list of possible side effects-some possibly serious and life-threatening"
Many med's do but I'm sure your doctor wouldn't put you on it unless he / she thought it would help. Burst that 'fear bubble' and think about the positive effects it could have - not the negative one's.
Good luck - I'll be interested to follow how you get on. I'm sure you'll be fine.
Paulbounce, thank you so much for sharing your reassuring experience with Sotolol which I hope I can duplicate although as you note here, every one is different in regard to tolerance and reactions to medications.
I am trying not to allow fear and apprehension to overtake me and go into the new med with an open mind. I read that Sotolol is very effective at preventing Afib episodes but not as good as Flecainide at stopping them and returning the heart go sinus when an episode occurs.
I wonder if it's possible, even while on Sotolol, if an episode occurs, to take a Flecainide on a one-time basis. I've read some studies on that combination medication regimen.
"I wonder if it's possible, even while on Sotolol, if an episode occurs, to take a Flecainide on a one-time basis. I've read some studies on that combination medication regimen"
I don't know the answer to that Will as I'm not a medic - you would have to check with your doctor.
"I am trying not to allow fear and apprehension to overtake me and go into the new med with an open mind"
I might know the answer to that. Have a positive mindset but expect to be apprehensive. That's normal starting on a new medication and part of it. Most of the time the fear is much worse than the reality - I think you may well find this applies to you. It does to me and I doubt we'll be very different
Yes, I've heard of folks on flecainide for many years with no problem. To answer your question, an ECG I took with my Kardia showed a widened QRS which my Cardiologist said wasn't very severe. But he had me in for a cardiac stress test anyway which showed a 35% wideningn of the QRS duration. Anything over 25% is undesirable. He attributes that change to the effects of the flecainide. I am also on 25mg. metoprolol which he said to stop because Sotolol is also a beta blocker and I already have Bradycardia, always in the 40's.
Jmbrph, Yes, I've heard of folks on flecainide for many years with no problem. To answer your question, an ECG I took with my Kardia showed a widened QRS which my Cardiologist said wasn't very severe. But he had me in for a cardiac stress test anyway which showed a 35% wideningn of the QRS duration. Anything over 25% is undesirable. He attributes that change to the effects of the flecainide. I am also on 25mg. metoprolol which he said to stop because Sotolol is also a beta blocker and I already have Bradycardia, always in the 40's.
Hi Willec, I have taken sotolol for the past 2 years and now on Max dose with no side effects. As each level of dose failed to controlmy af it was increased. The last
Increase was a month ago which seems fine. I have to have regular ecg’s as it can extend the QT interval
At the higher dose but so far so good. I also have a PIP as a backup should I have an episode to calm the heart rate. Please don’t worry and give sotolol a go-you may have to increase the dose via your cardio to get the best result for you.
Hi Fibber,Thanks for your reassuring response. Yeah, tonight is my first night without the Flecainide in two years to see if my heart rate will be at least 50 tomorrow or else my Cardiologist won't start the Sotolol. So will see. Kind of hoping I don't have an episode before then.
I see that Class I Antiarrythmics are prone to extending the QT interval but thought Class III's like Sotolol didn't but I am probably mistaken. My ECG showed a widening of the QRS duration by 35% causing my doctor to try switching me from the flecainide.
Of course I am starting on 40 mg. twice daily, the standard lowest starting dose. So, does the PIP work? I'd read that Sotolol is good for preventing Afib episodes but Flecainide is better at stopping them once one has occurred. Also, have you had any of the very unpleasant side effects? Also how often do you need an ECG?
Hi Bill, I’ve only had the long QT interval since the dose was upped to 160 twice a day but it’s within limits at the moment so I have my fingers crossed it stays that way. I like to keep a check on it, therefore the monthly ecg’s. As far as pip I was taking bisoprolol as a pip but whilst it didn’t stop the episode it slowed my heart rate. I have paroxysmaL af which usually stops on its own. Your cardio may suggest a different drug as a pip. I learned it’s all a case of trial & error until they get it right. I have a new cardio now and he favours propranolol as A pip but again I’ve to see if it works better than bisoprolol. I’ve not had an episode for 5 weeks so haven’t had occasion to try yet. I def haven’t had any side effects that I have noticed. I eat a well Balanced diet, low sugar and fruit & veg and try to avoid additives where possible and no alcohol as it is a trigger for me. I wish you well on your new regime and hope it works well for you. Don’t hesitate to ask questions
Yes I changed over as I felt rotten on Flecainide. Sotalol seems to suit me much better. They all have side effects but then all bodies are different and it's finding what suits you best. Good luck.
Hi, I was changed from Bisoprolol/Flec to Sotalol when I had my PM fitted. Although I still have AF every two weeks or so I feel better in myself on Sotalol. For some reason my sessions of AF last about 19 hours. Your frequency and duration of sessions of AF will be peculiar to you of course but Sotalol is and has been OK for me. Hope it works for you. Tx
I found this post a little concerning if I’m being honest, I am now taking 100mg x 2 of Flecainide (increased from 50mg x 2 eight months ago following an AF episode) and have not had an ECG or stress test to see if everything is as it should be, but having read this I feel that perhaps I should have one…
Summer 60, Thank you for your response. The only reason these rhythm anomolies surfaced is because I was having some foot swelling and mentioned it. So I have a 6-lead Kardia and sent some ECG’s to my Cardiologist where he saw the problems. Otherwise, I’d still be blissfully unaware of what was happening. Yes, an ECG is a good idea.
I was on Sotalol. 40 mgs was starter but did not help Afib. Increased to 80 mgs. 2 X per day. It helped Afib for 5 days then Afib returned. Had some side effects, shortness of breath, fatique, nausea, low heart rate etc. Dr. increased to 120 mgs. of Sotalol which kept me in NSR for two weeks then Afib returned. Side effects were worse and horrendous. Cardiologist claimed since Sotalol was good for rhythm and rate control, this med is the best one. Since I don't react well to beta blockers and other meds, my dosage was reduced to 80 mgs again. Then I added Magnesium Taurate and glycinate combo, Wild Alaskan Fish Oil, and Hawthorne Berry and that brought me back to NSR. I am happy to live a better QOL with Supplements opposed to beta blockers.
Yes, I guess we all react differently. I’m glad you are doing better on the supplements. I also felt terrible on 25mg of Metoprolol, another beta blocker and felt better when I cut it in half. I’ll be finding out soon about this Sotolol. I also take the Mg Taurate and Fish Oil which does help a lot, I think. Thanks for your feedback.
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