I am 66 and active and 13 months after my first ablation, I got Afib again. Now I need to decide between a second ablation or a more serious anti arrhythmia drug, Tikosyn or Sotalol with 2 nights hospital monitoring. I would go for the ablation if it was the last one, but it’s not guaranteed. Dr. says once get past initial monitoring for either drug, then should be okay except monitoring for kidney function 1-2 times per year.
Any one have experience or thoughts for my decision?
Thank you
Michael
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M987
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The mention of tykosin suggests to me you are in USA as it isn't permitted here in UK so the answer is more difficult. Here in UK we don't pay for treatment (other than by tax) so repeat ablations are a no cost option to a patient. I would go for it but for you it may be more difficult.
Tikosyn seems more popular in the US than Solatol. What about daily Flecainide? I only mention it because it has worked well for me and others and doesn't require a hospital stay if you qualify. For ablation, I'd consider Pulse Field Ablation (PFA). Safer and quicker than RF or Cryo. Available now in UK and Europe at selected medical centers. Should be available in the US in 1-2 years.
BTW I'm also from the USA. Are you referring to Pulse Field Ablation? Yes, its being offered in the UK and Europe ahead of the USA, for the normal FDA oversight issues. That said, given the wait for ablations in the NIH, plus that its only offered now in a few select centers, I'd venture that the average USA afib patient that qualifies will end up getting PFA sooner.
We tried flecanide which had previously worked for me, but after getting persistent Afib, a stress test showed some arrhythmia problems at higher activity
you mentioned Sotalol and Tykosin , which means you have a background of CAD, keep the risk factors under strict control and it is up to you to try either of the two and see what happens. PFA is currently offered at Austin Texas under Dr. Natale. It is offered even for persistent Afib. Call them to know the details criteria for PFA. Otherwise RF with Dr. Natale is another option too. He is the best of the best in US. All of these options think over it but don’t wait too long. Best wishes.
You are referring to Natale's trial for PFA, which I believe is no longer enrolling. At the moment, PFA is not being offered anywhere in the US, out of trail. Best estimates are 1-2 years before it will be available. Many are offered Sotalol or Tykosin without a background of CAD. Yes, Natale has a great reputation and followers, but I passed on him because he ablates significantly more than with a normal PVI which some studies suggest may be counter productive.
I talked to Shanon three weeks ago for my two years follow up. The trial is still ongoing and they even take persistent Afib. Give them a call . As I said they did PFA for PVI only, the remaining rogue sources, Natale still uses RF. He ablates whatever sources he could find in one procedure. I like his process. I am still SR after two years for just one ablation.
I would consider looking up Dr. Wolf HoustonTexas. You can see his videos on YouTube. I really like his approach to healing Afib. I have had two failed Ablations and won't consider a third. I only have proximal afib, but when I do it's a bastard. I'm getting the procedure in Sept. That's the earliest available.
I will and look at Dr. Wolf's videos on YouTube. I actually, after years of trying to figure out why I was getting bouts of Afib finally figured it had to be a connection between Afib and the Vagus nerve since it was always caused by my positioning, like lying down, sitting down and leaning my body to the right. Without a doubt the Vagus nerve is responsible for my Afib. I knew a year before finding Dr. Wolf and when I met with him I knew this was my last option to rid myself of this terrible disease. The worst thing about Afib is it controls your life. I'm always thinking it might happen at any time and that's the nightmare. I'm lucky because I convert into sinus within 4 to 5 hours, but it's 5 hours of hell. I'll let you know.
I’ve had five ablations, four done here in Albuquerque at Lovelace Heart. Needing a cardioversion to get back into rhythm after just two weeks since the last one; so considering going to sotolol as well. Consult is coming up soon. Don’t believe the hype from those claiming to have found the perfect doc to do the job. Just find a good EP you trust. Remember that nerves DO regenerate so whether or not an ablation is successful depends as much on your unique physiology as it does the EP’s skill.
I am not sure that Sotalol would be described as a 'serious drug' in the sense that it has been about for decades and is pretty well tolerated by most people. Though it is not viewed in some quarters as a very 'modern drug'. It depends also on what the size of the dose you are being described.
Just to reassure you, I am someone of 77, post ischaemic stroke (3 years), who was prescribed Sotalol 80 mg back in 1995, which I have always found best taken in two 40 mg doses morning and evening. (The stroke was not connected to the sotalol and was the result of not taking an effective anticoagulant, just a small dose of aspirin daily). I am now told I have 'permanent AF' but my symptoms are very well controlled by the same dose of Sotalol I have taken for 25 years, apart from a very short session after the stroke on Amiodarone which I found horrendous. In terms of side effects and general health I find Sotalol no problem at all and I am unaware of any serious side effects given the enormous number of people who take this for BP and arrhythmia.
At present I walk up a very steep 25 m slope (the side of an earth dam) twice every day without having to stop, and I also dog walk in the forest for 45 minutes each day.
It is my understanding that even if we have a 'successful ablation', and seem to be back in sinus rhythm, life expectancy is no worse nor any better than someone whose AF is controlled by such a rate control drug.
I have no problems with kidney function or any other organ and I have regular routine blood tests for all these things.
The only negative feedback I have had is with a new cardiologist who told me to change to Nebivolol but was unable to give me any real reason for his recommendation, other than saying 'We don't use Sotalol any more' which I know is not true, as another cardiologist approved of my changing back to it from Amiodarone.
Of course, I only have personal experience and no specialist medical knowledge, but on the basis of my experience I would say that you have nothing to fear from Sotalol in the doses I take, and if your physician approves this as a way of keeping your AF in control.
I have been on Sotalol for several years now following a cardioversion and it has kept me in normal heart rhythm. I haven't found any adverse effects, apart from some reddening on my feet but other users have had problems, so the doctors suggestion of two days in hospital is a wise precaution.
I am a 75-year-old male living in Canada and experienced my first AFib event, that I was aware of, in late July 2022 while cycling. It lasted several days, and I experienced most of the classic AFib symptoms, including an irregular and racing heart rate, night sweats, etc. After finally realising, and admitting to myself, that something was wrong, I checked into our local Emergency Department and after chemical cardioversion normal sinus rhythm was re-established. Initially I was prescribed the anti-coagulant Apixaban and Metoprolol as a Rhythm Control drug. I found Metoprolol very challenging, with feelings of weakness, shortness of breath, extremely low energy, and I could not cycle or walk for any distance at all, and even with light exercise, soreness in my calves. It also did not, at the dosage I was on, entirely prevent AFib events.
After meeting with a Cardiologist, he switched me to Sotalol, with the result that the AFib I was experiencing at the time of our consult was corrected within 2 days of switching to Sotalol. In November 2022, for a short period I came off Sotalol to try a “Pill in the Pocket” regime, utilising Metoprolol and Flecainide, which was unsuccessful. Three AFib episodes within a 5-day period persuaded both my Cardiologist and I, that was not the route to follow at that time, and I went back on a 80mg dose of Sotalol twice a day. That has since been lowered to 40mg twice a day. I have been on that dose of Sotalol along with Apixaban (Eliquis) since then. I have had a consult with an Electro Physiologist who suggested I was not a candidate, at this time for an Ablation. I will be having a meeting with my Cardiologist soon, and that recommendation will be reviewed, I am leaning towards pushing for an Ablation, as is my Cardiologist.
I continue to take Sotalol, and I monitor myself with a Kardia once or twice a day and have on a small number of occasions returned a “Possible AFIB” reading, although I have not been experiencing any physical symptoms. When that happens, and with the blessing of my cardiologist, I increase my Sotalol dose to 80 mg, until I get two consecutive Kardia readings of “Normal Sinus Rhythm”. The events have, to date, always been very brief in nature. It probably took my body a week to adjust to Sotalol, but I have not experienced any of the side effects that I was experiencing with Metoprolol. I am back cycling, although perhaps not as hard as pre AFib, and walking/hiking up to a couple of hours at a time.
For me Sotalol has been a blessing. Having said that, I am only one person, and I suspect others will have had different experiences, just as we all seem to experience AFib differently. I will also mention that I was predisposed to trying Sotalol after reading the case study of Jason Agosta in “The Haywire Heart” by Chris Case, John Mandrola, and Leonard Zinn.
Hey, are you still on Sotalol? I don't have AF, but I have extra beats and skips of the heart, and it seems that the rhythm is irregular at times. I had an ablation 3 years ago. It was atrial tachycardia (220 pulse). I don't feel like it anymore. such tachycardia has returned. However, I now have SVES and VES heart skips (I had it before the ablation), suffocation when the heart starts to beat irregularly. It bothers me a lot. I am currently on Bisoprolol 2.5 mg once a day. It does not help me. to give me Sotalol because he says that Sotalol can cause dangerous arrhythmias. I don't know what to do.
Big thanks to all who took time to share thoughts and experiences. Good to know many have had good experiences with Sotalol which my dr indicated is a less expensive option to tikosun. I’m on Medicare in the US and the cost of my first ablation was around $250.
I’m thinking I should give my EP the second chance at the ablation since it’s known that many patients do need a second to increase their success. Probably best to do it while I am younger. And save the drug option for when ablations or other procedures are riskier as I get older.
I am 70 and pretty active. I have been on Tykosin (Dofetilide gen.) for 5 years trying to avoid ablation. For most of that time it has worked well for normal sinus rhythm. I started at 250mg and after three years went up to 500 mg as I needed stronger dose for normal rhythm. Oddly enough they tried to start me at 500mg but was too much and went down to 250mg. Never had any problems with Tykosin save a little dizziness occasionally. Might have to do the ablation now with continued use of Tykosin as normal rhythm comes and goes. I was told I needed to be on Tykosin before and after ablation hence the 2 day "load" hospital stay. I would recommend the Tykosin as it has helped me maintain normal sinus rhythm for 5 years without an ablation. Blessings to you and your journey.
Best Regards...Gary P Ohio USA
PS...I am also on Medicare/Medicaid and have been on the generic Dofetilide most of the time and my insurance had no issues and I have 0 co-pay.
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