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Suggest Treatment For Paroxysmal Episodes Of Atrial Fibrillation
Question: Hello,
I need help and opinion on treatment of Lone A-fib with Sotalol AF
I was diagnosed with paroxysmal A-fib (based on ECG done in emergency room in XXXXXXX 2013). I am 66 yr old female, 5’7” and 140 lbs., physically fit and strong. Currently, have no other health problems (ECG’s, blood pressure, sugar, etc. are normal) and do not take any medications (except for 81mg aspirin daily for blood thinning). Had serious treatment in 2000 for an inoperable cancer (cisplatin chemo + radiation).
My A-fibs are symptomatic. They appear to be adrenergic type. Episodes are strong (from feeling dizzy to fainting) lasting from 1 to 4hs. Sitting down helps somewhat, but at the pick of an event, lying down (flat) is necessary to dissipate fainting. Episode frequency: 2012-13 once a year, 2014 twice a year, 2015 once every 2 month or less). After an episode culminates (short period of almost total blackout) my heart usually will come back to normal. I can resume any chore or sport (I am still an aggressive downhill skier!).
May 2015: I just had a second round of tests done (nuclear stress, echocardiogram, arterial duplex and carotid duplex) – all normal, and as described by the doctor “good, very good”. E-cardio device (halter) showed only one 30-second episode of A-fib (heart rate of 160 bpm) after 3weeks of monitoring. This event I did not even noticed, probably because it was so short.
I was prescribed Sotalol AF 80mg 2x a day (for continuous use – 11refills projected) . I was told there are no other medications to control my A-fib on “as it happens basis”. I am hesitant to take Sotalol on continuously since I fill okay and my A-fibs are infrequent. I found on NICE, UK web site that there is what they call “pill-in-the-pocket” approach, among other drugs listing Sotalol. It appears, this is what I could /would like to do to shorten/control my A-fib. My cardiologist did not want to engage in any discussion nor gave me any explanation. Please help.
I need help and opinion on treatment of Lone A-fib with Sotalol AF
I was diagnosed with paroxysmal A-fib (based on ECG done in emergency room in XXXXXXX 2013). I am 66 yr old female, 5’7” and 140 lbs., physically fit and strong. Currently, have no other health problems (ECG’s, blood pressure, sugar, etc. are normal) and do not take any medications (except for 81mg aspirin daily for blood thinning). Had serious treatment in 2000 for an inoperable cancer (cisplatin chemo + radiation).
My A-fibs are symptomatic. They appear to be adrenergic type. Episodes are strong (from feeling dizzy to fainting) lasting from 1 to 4hs. Sitting down helps somewhat, but at the pick of an event, lying down (flat) is necessary to dissipate fainting. Episode frequency: 2012-13 once a year, 2014 twice a year, 2015 once every 2 month or less). After an episode culminates (short period of almost total blackout) my heart usually will come back to normal. I can resume any chore or sport (I am still an aggressive downhill skier!).
May 2015: I just had a second round of tests done (nuclear stress, echocardiogram, arterial duplex and carotid duplex) – all normal, and as described by the doctor “good, very good”. E-cardio device (halter) showed only one 30-second episode of A-fib (heart rate of 160 bpm) after 3weeks of monitoring. This event I did not even noticed, probably because it was so short.
I was prescribed Sotalol AF 80mg 2x a day (for continuous use – 11refills projected) . I was told there are no other medications to control my A-fib on “as it happens basis”. I am hesitant to take Sotalol on continuously since I fill okay and my A-fibs are infrequent. I found on NICE, UK web site that there is what they call “pill-in-the-pocket” approach, among other drugs listing Sotalol. It appears, this is what I could /would like to do to shorten/control my A-fib. My cardiologist did not want to engage in any discussion nor gave me any explanation. Please help.
Brief Answer:
Following advice...
Detailed Answer:
Hi and thank you for asking!
I read your query and understood your concerns.
After reviewing your history and the medical data you provided, my opinion is that you have paroxysmal episodes of atrial fibrillation (i.e you will do unexpected episodes of atrial fibrillations that come and go on their own, but most of the time you will remain in normal sinusal rhythm).
Since the frequency of paroxysmal atrial fibrillation is increased in up to six episodes per year and on your Holter monitoring was noted an asymptomatic episode, you should be put on constant antiarrhythmic therapy and sotalol is one of the best choice to do that.
Sotalol has few side effects and is helpful on controlling atrial fibrillation episodes. My suggestion in your case will be to continue with sotalol on a daily bases and to use "pill in the pocket" (propafenon) approach in case of atrial fibrillation episodes. However since Propafenon may have unwanted side effects including life threatening arrhythmias you should discuss with your doctor about its use.
Moreover if you were my patient I would recommend to add anticoagulation to your therapy in order to reduce the risk of pulmonary embolism and stroke. One of the major complications of patients with frequent paroxysmal episodes (more than 4 episodes per year) is stroke and anticoagulation is recommended in your case.
Hope this will be of help!
Wish you health!
Dr. Shehu
p.s: If you have other questions about your heart and overall health, don't hesitate to ask me again.
Following advice...
Detailed Answer:
Hi and thank you for asking!
I read your query and understood your concerns.
After reviewing your history and the medical data you provided, my opinion is that you have paroxysmal episodes of atrial fibrillation (i.e you will do unexpected episodes of atrial fibrillations that come and go on their own, but most of the time you will remain in normal sinusal rhythm).
Since the frequency of paroxysmal atrial fibrillation is increased in up to six episodes per year and on your Holter monitoring was noted an asymptomatic episode, you should be put on constant antiarrhythmic therapy and sotalol is one of the best choice to do that.
Sotalol has few side effects and is helpful on controlling atrial fibrillation episodes. My suggestion in your case will be to continue with sotalol on a daily bases and to use "pill in the pocket" (propafenon) approach in case of atrial fibrillation episodes. However since Propafenon may have unwanted side effects including life threatening arrhythmias you should discuss with your doctor about its use.
Moreover if you were my patient I would recommend to add anticoagulation to your therapy in order to reduce the risk of pulmonary embolism and stroke. One of the major complications of patients with frequent paroxysmal episodes (more than 4 episodes per year) is stroke and anticoagulation is recommended in your case.
Hope this will be of help!
Wish you health!
Dr. Shehu
p.s: If you have other questions about your heart and overall health, don't hesitate to ask me again.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Hello Doctor Shehu,
Thank you very much for your answer. My follow-up question is:
In your opinion, is Sotalol treatment curative or somewhat curative? Is there a chance that taking it for some time (say, several months or a year) may stabilize my heart? Could it decrease a number or intensity of incidents? If this was a case, would I have to continue this medication?
I have read that there were some studies done with Sotalol concluding there was not much difference or effect for patients with paroxysmal Afib. Also, it mentioned that some patients experienced increase in number of episodes. I did not find the actual report of these trials, just read the commentary. Have you heard about studies like this?
I understand that paroxysmal Afib with no underlying heart decease cannot be “cured”(I am excluding surgical procedures like ablation, etc.) and the approach is to improve “quality of life” + blood thinners to minimize risk of stroke, etc. Thus, the question in my mind is what actually Sotalol does and what is its purpose. What does it mean "controlling afib episodes"? Bottom line, what is the point of taking it? Can I stop it at some time if it does not do me any good? Will stopping it make more harm?
Please understand I am not against taking medications, any medications. I had my share and I am grateful because I am still alive. But if I have to take Sotalol for the rest of my life I would like to know why. Thank you so much for helping me and I am looking forward to your reply.
Jolanta
Thank you very much for your answer. My follow-up question is:
In your opinion, is Sotalol treatment curative or somewhat curative? Is there a chance that taking it for some time (say, several months or a year) may stabilize my heart? Could it decrease a number or intensity of incidents? If this was a case, would I have to continue this medication?
I have read that there were some studies done with Sotalol concluding there was not much difference or effect for patients with paroxysmal Afib. Also, it mentioned that some patients experienced increase in number of episodes. I did not find the actual report of these trials, just read the commentary. Have you heard about studies like this?
I understand that paroxysmal Afib with no underlying heart decease cannot be “cured”(I am excluding surgical procedures like ablation, etc.) and the approach is to improve “quality of life” + blood thinners to minimize risk of stroke, etc. Thus, the question in my mind is what actually Sotalol does and what is its purpose. What does it mean "controlling afib episodes"? Bottom line, what is the point of taking it? Can I stop it at some time if it does not do me any good? Will stopping it make more harm?
Please understand I am not against taking medications, any medications. I had my share and I am grateful because I am still alive. But if I have to take Sotalol for the rest of my life I would like to know why. Thank you so much for helping me and I am looking forward to your reply.
Jolanta
Brief Answer:
Following advice.
Detailed Answer:
Hi back,
I would like to say that actual studies shows that:
- sotalol use will reduce the number and intensity of atrial fibrillation episodes.
- and it will avoid atrial fibrillation recurrence in up to 50% of cases.
By doing so sotalol use may stabilize your rhythm and in rare cases you may stop taking it.
Yes it's true that propafenon ("pill in the pocket" tablets) is more effective on avoiding atrial fibrillation recurrence, but it also has more side effects. It should be taken only with your cardiologist guidance.
I don't want to make comment about treatment medications based on internet comments. The study i know evaluate the efficacity of sotalol versus other anti arrhythmic medications (see section above ).
You may contact another cardiologist for a second opinion. The best option to stabilise you is ablation therapy that you refuse to do.
You may stop safely anti arrhythmic treatment:
- if it's ineffective on controlling the rhythm,
- because of the side effects,
- if you don't want to take it anymore
However before stopping it, you should discuss with your doctor, how to stop the medication.
Hope this was of help!
Wish you health!
Dr. Shehu
Following advice.
Detailed Answer:
Hi back,
I would like to say that actual studies shows that:
- sotalol use will reduce the number and intensity of atrial fibrillation episodes.
- and it will avoid atrial fibrillation recurrence in up to 50% of cases.
By doing so sotalol use may stabilize your rhythm and in rare cases you may stop taking it.
Yes it's true that propafenon ("pill in the pocket" tablets) is more effective on avoiding atrial fibrillation recurrence, but it also has more side effects. It should be taken only with your cardiologist guidance.
I don't want to make comment about treatment medications based on internet comments. The study i know evaluate the efficacity of sotalol versus other anti arrhythmic medications (see section above ).
You may contact another cardiologist for a second opinion. The best option to stabilise you is ablation therapy that you refuse to do.
You may stop safely anti arrhythmic treatment:
- if it's ineffective on controlling the rhythm,
- because of the side effects,
- if you don't want to take it anymore
However before stopping it, you should discuss with your doctor, how to stop the medication.
Hope this was of help!
Wish you health!
Dr. Shehu
Note: For further queries related to coronary artery disease and prevention, click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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