Bisoprolol, Sotalol and Coronary Artery Disease.

[Samazeuilh2]

I had a phone consultation with a cardiologist today and it was agreed that I would have a CT angiogram in 4-6 weeks. He considers that there is a “moderate” probability that I have coronary artery disease. In the meanwhile he wants me to switch from Sotalol to Bisoprolol. I am reluctant to do this as Sotalol is currently working fairly well -no PAF episodes since February of this year. He said “Sotalol is a beta-blocker and if you have CAD it’s more likely you’ll have a stroke or heart attack.” I have not heard anything about this before and would greatly prefer to stick with Sotalol. Does anyone know anything about this or has switched from one to the other?

[mav7]

drugs.com/sfx/sotalol-side-...

Check the above link.

Dependent on the patient, some physicians initially recommend a hospital stay to observe the effect of Sotalol as it can affect intervals and cause cardiac issues. Though you have taken Sotalol without issues, perhaps your CAD has become a factor to consider.

You may choose for a second opinion but the effects of Sotalol should be considered.

[Samazeuilh2 in reply to mav7]

My main worry is that without the Sotalol I would rapidly progress to persistent or permanent AF-something I would find very difficult to cope with. I thought I knew quite a lot about Sotalol and AF meds, but this came completely out of the blue. Very alarming.

[JOY2THEWORLD49 in reply to Samazeuilh2]

Hi

Why do you think you would revert to persistent?

However when controlled persistent is not bad because I dont feel it.

Only uncontrolled when I did too much.

cheers JOY. 73. (NZ)

[BobD Volunteer]

Bisoprolol is a beta blocker. Sotalol has both beta blocking and anti arrhrythmic functions . CAD can usually mean no anti arrhythmic drugs so best get checked first.

[Samazeuilh2 in reply to BobD]

In my opinion it’s almost certain I have angina (CAD). Does this mean that progression from PAF to persistent or permanent AF is more or less inevitable if you also have CAD and cannot take beta-blockers? This has all come as a surprise to me . I don’t recall ever reading anything about BBs and CAD.

[mav7 in reply to Samazeuilh2]

Understand your concern.

I have been in persistent AF since Apr '21 which is well controlled (per word of my cardiologist) with Metoprolol. I do have concern about the long time effects and I receive regular ECGs.

However, controlled, persistent AF is not the worst thing compared to other heart issues. So keep that in mind.

Best to you in managing your health.

[Samazeuilh2 in reply to mav7]

Did you get the persistent AF as a result of a switch from an anti-arrhythmic BB(because of CAD)?

[mav7 in reply to Samazeuilh2]

No, started out of nowhere as paroxsymal and went to persistent within 3 months.

Initially detected by a heart rate monitor (Zio) due to a fainting episode.

Looking back, I feel that I had AF much earlier in life. Not detected because of no outward symptoms and I am otherwise healthy.

AF can be silent thus why I advocate the use of medical approved heart rate monitors.

Encourage you to get a second opinion and adhere to the recommendation.

These cardiologists and EPs sometimes seem aloof and uncaring, but 99,9% are excellent.

[Healthy64 in reply to mav7]

Very interested in that heart monitor I faced some 10 plus years of being dismissed even with the Kardia monitor showing up v fast tachycardia and now caught at a flutter rate of 170bmp I have gone much higher to 250-270 bmp but that was really hard to cope withThe cardio cons stopped my bisoprolol 1.25 x 2 daily and out me on Sotalol 40 mg then a few days later following an ecg upped me to 80mg

That was a disaster as I'm asthmatic and have bradycardia like 35bpm at night with spikes to 199 and 170 etc short spikes

I ended up in ED majors 5 days later only to find consultant had changed his mind and reported lower dosage to GP by letter , who didn't contact me - he was elsewhere and busy so when he rang me I'm in ED in fast tachycardia

Not sure where this is all going but note Sotalol is a potassium channel blocker it does have a pronounced effect on the QT interval. The calculation using cardio software is used to calculate a corrected QT the QTc and its intended to reflect a range of heart rhythm and rate measurements derived from your ECG results

It should be checked and its preferable to have you in hospital to evaluate for 2 days .

Enough said on this forum about bisoprolol withdrawal Sotalol is in same family and should not be taken alongside .

Hopefully by relating this horrible experience which included a sinus pause of 6 secs approx I can help yourself and others to be cautious about this class 111 anti-arrithymic drug . It's great when used correctly and can lower blood pressure significantly in addition to improving conductivity and calming the heart

Good luck to all of us patients and its just a fact that sometimes the patient needs to communicate if apprehensive to the consultant especially if they don't know your history

Good luck all and thanks to BHF for providing a platform to educate us in our conditions and be aware of risks

Regards

Healthy 64

[JOY2THEWORLD49 in reply to mav7]

Hi

Metroprolol never agreed with me but it didnt stop the ECrinologist on the stroke ward to prescribe it to me. Couldnt climb stairs or attack elevated areas or walk a bit faster. I struggled for 1 year 3 months!

Fatigue took over at the time of using any energy.

Mind you I was uncontrolled with H/R 186.

Then Bisoprolol 156 but uncontrolled my resting was 120.

No pauses with Bisoprolol. No breathlessness and felt improved.

Diltiazem took me down to 77-88 Resting Day. 47 at night.

Sweating profusely and having to stop what you are doing is a sign of uncontrolled HR and AF is an added reason to keep H/R under 100.

No operations will take place until you are controlled under 100.

Good idea to check arteries.. My carotid Arteries were A1 but a shadow on my thyroid and a biopsy later showed Thyroid Cancer.

So important to physically check as my thyroid tests were good.

Asmatics cant have metroprolol.

chers JOY. (73)

[BobD Volunteer in reply to Samazeuilh2]

Sorry I never said beta blockers contra indicated with CAD. Some drugs such as flecainide are not permitted in such cases. Sotalol may also fall into that category but is not generaly known only as a beta blocker due to its dual nature.

[JOY2THEWORLD49 in reply to BobD]

Hi

My doctor, when I asked said that both Diltiazem CCB and Bisoprolol are both H/R controllers and rythmn controllers.

She has had AF and had an ablastion for it in Australia.

cheers JOY 73. (NZ)

[oscarfox49]

As Bisoprolol is ALSO a beta blocker, I wonder what he is talking about. Sotalol does have a possibility of causing further arrythmia while Bisoprolol is more cardiac specific, but I would ask him to explain his logic if I were you.

[Samazeuilh2 in reply to oscarfox49]

He simply said that Bidoprolol was “safer” than Sotalol for with those with CAD. But the price to pay might well be more AF.

[Ducky2003 in reply to oscarfox49]

Soltalol also has antiarrythmic properties which may be the issue with CAD.

[Ppiman]

I know that I wasn't allowed to take sotalol as I had some measurements of electrical heart activity that could have been made worse by it. It seems it's losing favour as it has a wide range of effects, some making arrhythmias worse ("pro-arrhythmic"). I would ask for the doctor's reasoning but trust their judgment. I think with all heart drugs, it is a matter of the doctor's knowledge, experience and judgment as they have such a wide range of effects and the heart is such a variable and individual organ.

Steve

[Samazeuilh2 in reply to Ppiman]

I’m sure he is correct. I’m just concerned that Bisoprolol won’t keep the PAF at bay as successfully as the Sotalol which has worked fairly well. I wouldn’t find permanent or persistent AF easy to cope with.

[Ppiman in reply to Samazeuilh2]

I can well imagine your fears, especially if your AF is very symptomatic. I wonder whether your GP wouldn't have enough knowledge and experience to be able to help? Mine seems to be very aware of arrhythmia issues and I trust him a great deal.

Steve

[JOY2THEWORLD49]

Hi

Both are BBs but Bisoprolol is now recommended for aFs.

I wasnt controlled by Bisoprolol stil had a H/R rest day of 120 on 10mg Bisoprolol.

It was a change and intro to CCB Diltiazem that got me controlled which is so important.

Only a specialist will try you on CCB.

Drs tend to up dosage rather than change you.

Bisoprolol is used for asthmatics for AF as it does not interfere with breathing. I had awful trouble with Metroprolol.

I am now on since Dec last year 120mg Diltiazem am and Bisoprolol 2.5 mg Night.

BP now 123/72. H/R Day rest 77-88 and night 47 - always stays there.

You can always go back to it but a specialist knows best.

cheri JOY. 73. (NZ)

[Windlepoons]

I can understand your concerns. I'm on Sotalol, which works for me. It was a long road to finding a treatment that suited me, having had bad side effects from bisoprolol, then metaprolol and then flecainide. 🤗

[Mazza23]

I have taken bisoprolol for nine years believe it is also a beta blocker

[SamuelJB]

I am on Sotalol since Feb 2021 Asymptomatic Afib is controlled also on Rljquis for Rick management. I too would not want to change back to other beta blockers. Monitored regularly by Cardiologist side effect do limit physical ability but it’s a great trade off. Suggesting reduction of dose from 80mg again cautious. Hope they find the best drug control for you given the CAD issue which I was never aware of. Keep well.