Paroxysmal Atrial Fibrillation(PAF): Sotalol and hospitalization to start it--anyone done this?

Hi Obtuse -
Is there any pattern to your arrhythmia, like a trigger? Or does this go on all the time? I get tachycardia and other arrhythmias after eating certain foods. The question is what is causing this problem.

Appreciate the responses, sorry I've been off line mostly.

Paroxysmal AFib is the kind that comes and goes. Before I started the atrial fibrillation episodes, and before the Amiodarone, the pattern had to do with 3 things: psychological stress level, coffee, alchohol. In fact, as someone else here or elsewhere on line said: The best way to bring on an AFib episode is to have 3 shots of double espresso, chased by a double shot of Jack Daniels. :} I found that coffee is probably the biggest trigger, but state of mind and mental and bodily tension can be a part of it. My AFib episodes (pre-Amiodarone) were dramatic, my heart would go out of rhythm into a somewhat chaotic state, felt like a fish flopping inside my chest.

The Dr. that I have now, is the 3rd opinon Dr., he's a specialist in AFib at U. of Penn with a very good track record. The issue with the amiodarone is that it is so strong and after 4-5 years of use (I'm at that point) commonly is toxic and affects eyes, lungs, liver, kidneys and skin. The last 2 opinons all felt that given my overall health and condition of the heart muscle ('very strong heart muscle and no artherosclerosis') for my age (64) that he wants to try the Sotalol type Beta Blockers before going to RF Ablation. It is far less toxic than amiodarone and in a good number of patients works well to control my kind of A FIb.

I've still had no luck finding out what is involved in that 3 day in-patient, anyone's experience with it.
Thanks for any and all input/help.
I go into hospital Dec 15.

Great to hear from you Wotan (aka Robert) :} :

The blockers I tried in the past were Toprol and another one in the same class I don't remember. Also used Diltiazem, a calcium channel blocker. They either sedated me (zomby land) or didn't stop the Afib.

This new one is -- I believe -- somewhat new on the scene, it's Sotalol. What I'm on now is amiodarone, a very powerful rhythmic drug but with too many side-effects after long-term use. The Sotalol is usually tried before the Amiodarone, thus my concerns after getting a second and third opinion, the last 2 saying that I was too young and not appropriate profile for Amiodarone.

I love coffee so almost always drink decaf. As for stress -- well, yes, that's a bit more of a challenge. I do use some breathing and self-hypnosis stuff (also called self-induced progressive relaxation). It's a matter of being more mindful of what different parts of the body -- esp. breathing-- are doing, and trying get them to calm down. I also learned some neat 'tricks' in some Cognitive Behavioral Therapy materials as to ways to first notice and then with practice catch the tendency to tense up, go ballistic, whatever. All this can be approached via basic Yoga stuff as well.

As for RF Ablation, I won't go invasive unless all else fails meds-wise.

Take care and thanks for getting back to me. OO

Hi OO---& thanks for your answer to my response-

Yes...pacemakers are ONLY for really serious conditions....(Venticular tachychardias )---

Anyway--just "hang in" there---Like me...I'll bet you'll feel better when the Holidays are over-!

Regards--Robert

Hi there,

From New Zealand.

I’m a new member here (first post) and came across this site via Google.

As you’ve already guessed, we get this beastly PAF south of the equator too.

I’m a 66 year old male and was first diagnosed with PAF in 1996.

Back then attacks were regular and the doctors tried Atenolol and then Sotalol, finally biting the bullet and putting me on 200mg Amiodarone daily in 2004, after I wound up in Hospital three times in two weeks. In my case Atenolol and Sotalol could best be described as useless. 

Now, I still get PAF but not on a regular basis. Most of these attacks take place at about 3am in the morning and I just wake up with the little bird flapping around in my chest.

But here’s the bit that might help someone else.

A very young doctor from Edinburgh was over here working in the local hospital when I had one of these attacks. She prescribed a drug called Metoprolol 47.5mg and that returned the heart to Sinus Rhythm in about 2 hours. Since then (2005) I’ve taken 22.75mg daily and if I feel the heart start to run like an old V8 with a carburettor full of water, I take another.

Now most of the Cardiologists I’ve seen over here look down their nose at me when I tell them this is the best drug by far when it comes to returning the heart from AF to Sinus. One young fellow even scorned it for being “old” but I assured him that I didn’t care how old the drug was, if it worked then that will do me.

So there you are, in short Atenolol and Sotalol were no help to me.
Amiodarone works well, but can be toxic and CAN have some undesirable side effects although, so far, it hasn’t with me and really I think they and I had run out of options.

But try Metoprolol if you Cardiologist doesn’t laugh you out of his surgery.

Good Luck

On 1/25, I had what I thought was a panic attack brought on by severe heartburn. I treated the heartburn and 12 days later ended up in the ER with a heart rate of 176 and SVT. (Knowing what I know now, I am almost certain that the initial episode was also SVT.) The episodes continued sporadically after that; I wore a heart monitor for seven days, which recorded other episodes, and yesterday I went in for an EP study and RF ablation.

After two solid hours of the EP trying to stimulate my heart into SVT, both electrically and chemically, there was nothing. Because he could not get the heart to naturally go SVT, he could not map it and therefore could not ablate the problem. So, it's a bad news/good news deal, with the good news being that he said since they went to such measures to trigger it and nothing happened, maybe my chances of it happening again are slim. Only time will tell.

He said he thought it was atrial tachycardia, and a little research online leads me to believe that I have the PAF kind since the rest of my heart is in very good condition. Because I initially thought my problem was heartburn-related, I stopped drinking coffee and totally modified my diet (all to no avail, since I still had episodes). I'm currently on zoloft and will receive another heart monitor for another seven days, and then we'll decide how to proceed. I'm only 46, so too young to start on a constant regimen of heart medications. I'm hoping to work very hard on mind-over-matter, reducing stress, sticking with my diet and just generally trying to convince myself that even though I didn't have an ablation, my heart is all fixed. Not sure that'll work, but I'm going to try! Otherwise, we'll try another ablation maybe this time without sedation so that I'm not quite so relaxed.

In case you're wondering, it really wasn't a bad procedure. I was definitely fully aware of everything but not in any pain; it was uncomfortable toward the end when the pain meds started to wear off a bit, but it was nothing that caused me to freak out (which is what they were hoping it would do!!). I had only some tenderness in the groin area where the catheter was inserted, but I'm up and walking around now practically pain-free. If I continue to have episodes, I won't hesitate to have the procedure again.

[Status-Follow-up]
--
Sotalol update: It's 2 months on 80mg morning and night and I'm doing great. Not even close to any rhythm changes in situations where normally I'd feel something not right. My resting pulse is about 60 and BP is pretty much text book 130/70. For the first month I did get light headed when I exerted myself, but that's gone now. I've done various kinds of things (light housework, lifting and moving boxes etc) and no dizzyness.

Also, I'm watching to see how long it takes for the Amiodarone to purge completely from my system. I know this because the Amiodarone makes my skin hyper sensitive to sunlight (can burn in 5 minutes) and I have weird itching episodes. At 3 months out from stopping, I still get slight burn but it fades and still do have itching episodes though. Dr said it takes AT LEAST 6 months for all of the Amiod. to get out of all the cells and organs!

AND, I'm able to drink more caffeine coffee without triggering anything. (This helps with the slight sedative effect of the sotalol in the morning. I switch to decaf after lunch and keep it to 3 cups total a day (well, my 3 cups is actually 6 cups as my mug is rather large).

So, unless there is a breakthrough to AFib I'm not considering the RF Ablation now.

And finally, would always appreciate others with similar dx and experience to share here what their experiences have been -- never know when having your story out there on the Internet can end up helping someone down the line.

Thanks for the post Jay.

In my experience with PAF the last 10 years I'd say that stress and fatigue are definitely factors. Before Sotalol a common sequence would be I come home from a stressful work day, exhausted. As I lay down to watch TV in the evening quite often on such days I'd have breakthrough. So, I'd support the idea that stress and fatique can be precursors or factors. As for sotalol, I'm only on it a few months and have had not one break-through that I'm aware of. I do hope others on Sotalol can provide their own experiences as well. Good luck.

Hello Jay. You're welcome.

Ah, rat poison -- I had terrible time with it (bleeding eye, bruising, never able to keep levels right, and thank God I stopped it. As for the ablation, do you know of someone personally who had it done? Their results? I'm also looking for data on the morbidity rate for RF ablations for PAF (or AF). Maybe that would be another good thread to start. When I have the time I'll see if that's already here on the board but if you know anything would love to hear it, as I'm considering it if the Sotalol doesn't work over time.

As for your hospital stay -- I can relate, based on my long stay after my spinal fusion: some night shifts seem to forget completely that people are sleeping nearby, or, sadly, could care less. I must say that during my recent 3 day for the Sotalol I had a great experience, with the night shifters being as good -- or better -- as the first 2 shifts. It was at the Philadelphia VA, which uses U Penn doctors. So, this vet is not complaining, in fact I sing their praises as far as how they've treated me over the years.

What was your specialty when you were a practicing Dr., just curious?

I just wanted to post and say hello. I am a 38 yo female who has PAF and also Inappropriate Sinus Tach along with SVT and AT.

I had an ablation attempt in June of last year to correct the SVT and AT. Durning the procedure everything was going great and I was told they had found the areas that were misfiring and they were getting ready to ablate. Next thing I knew I woke up in recovery very confused as to why they were looking at my chest and not my legs where they had placed the catheters. I was in the procedure room for over 4 hours. I was told that during the ablation I went into AFIB with a rate of over 600bpm. They attempted to chemically convert me but was unsucessful. They then used cardioversion with the defib. I was defibbed 4xs to convert me back. At that time the decision was made to abort the procedure as it was also found that I had too many areas misfiring and some very close to the sinus node. I was told they would have to damage too much of my heart to ablate. They were looking at my chest because the defib had produced some wicked burns on my chest and back. I had all the fun of recovery and no benefit from the procedure. I walked like a duck for a few weeks. I was very sore from the cardioversion felt like someone had kicked me multiple times in the chest and stomach area.

After the ablation attempt I was put on a couple of medications. Verapamil and Flecanide were the first combo tried. I was still having break through episodes of AFIB and IST. I ended up getting bruises and other things so the decision was made to pull me off. They then tried another combo which did not help as I still had break through episodes with rates of 170-212.
In August of 2009 they decided to put me on Sotalol 80mg 2xs a day. I was put in the hospital which was a breeze. The hospital I go to is like a hotel and I was able to walk around and go outside for walks as long as I let them know I was leaving. I was on a wireless heart monitor so they could see what was going on. I got my first dose of Sotalol that night and 2 hours later I had my EKG. After each dose they waited 2 hours then gave me an EKG. While at first my resting rate was still in the 120s-150s it slowly started to come down. They watched me for 3 days and I was released. My resting rate now sits around 60-65 and somedays in the 80s. I was put on a Holter monitor and a 30 day event monitor as I was still having break through episodes. The Sotalol is controlling my AFIB episodes as I have not had one since August. I am still having IST. A simple walk from one room to another or a trip up the stairs and my rate is up near 200 without doing anything. I was put on Lopressor and Sotalol combo in November. I found Lopressor to be too hard to tolerate and it wasn't controlling the IST episodes. So now we are at a point that we must decided whether to give me another drug in combo with the Sotalol or if maybe increasing my Sotalol dose will help me. It was also mentioned that there is a possibility they may lower my heart rate even further with drugs and use a pacemaker to pace it back to normal speed. I wont know what is going on until the first of April when I see my electrophysiologist.

I had a small surgery on Tuesday. During the recovery I was told my EKG is now showing damage to my heart and that it looks like I have had 2 myocardial Infarctions recently. I am scheduled for an echo soon and I will discuss with my doctor whether or not this is a false blip on the EKG or if I have really had 2 silent heart attacks recently. I just saw my regular Cardiologist last week before my surgery and he did not mention it but did make an appointment for me to see the electrophysiologist 3 months sooner than planned and called for the echo so now I wonder if he is confirming before worrying me. I also have Mytral Valve Prolaspe with regur. but it is not that bad so we just watch it.

It is nice to see other people who are on Sotalol. When I was first put on it there was no information from actual people on it. It now appears that it is being used more. I am pretty happy on the Sotalol. I have no bad side effects compared to other heart drugs I have been on. If it wasn't for the IST I would totally have my rate controlled. Once I get the IST under control I will be a happy camper.

Take Care.

HealthyLife,

Atrial fibrillation that occurs infrequently is called paroxysmal atrial fibrillation. Symptoms may come and go, lasting for a few minutes to hours and then stopping on their own.

Though the cause of atrial fibrillation is often unknown, possible causes include:

• An overactive thyroid or other metabolic imbalance
• Damage or microscopic abnormalities in the muscles of the atria (upper heart chambers)
• Abnormalities within heart cells
• Abnormal electrical properties of groups of heart cells
• Emphysema or other lung diseases
• Sleep apnea and other sleep disturbances
• Exposure to heart stimulants, such as caffeine, tobacco or alcohol
• Rapidly firing triggers (hot spots) — often located in the veins that return blood from the lungs to the heart (pulmonary veins) — that cause the atria to fibrillate

I hope this gives you food for thought. 

Kindly,

Kitt

Hi all. I'm a little late to the party but I had a question for the collective.

52 year old male. Diagnosed in 1998. No heart problems other than Lone AFIB. Episodes are semi-random averaging 2 a month for 12 hours at a time (that's an average). A little uncomfortable but completely functional during the bouts.

My regular doc moved and I had to get a new one recently--actually a Physician's Assistant. She has perscribed Solatol 80mg 2x a day for my Lone AFIB. From what I've read here and all over the Internets is that a 3 day hospital stay is required. Not for me. She just called in the script. When I ask questions, she can't answer them and I got a referral to a cardiologist. First appointment available in 3 months.

I'm not taking this stuff until someone other than a PA can answer my questions.

The question is: is it still considered dangerous not to get the hospital monitoring?

Thanks.