PSVT and Sotolol

[tom_h]

I'm a healthy, 60 y/o male with a near lifelong history of PSVT.  In recent years, the episodes have gone from one every few months to once every couple of weeks.  I've been on 100mg of Metoprolol daily, but my doctor has changed me over to 160mg Sotolol.  I am concerned after reading the information about this drug.  Shortly after taking the first dose, I experienced an episoide that was difficult to convert.  I use Valsalva to convert it.   Are my concerns valid, or should I continue to take the new medication.  Also, I would carry the metrprolol with me, and would chew a 50mg dose if I experienced an episode of PSVT.  Can I also do this with Sotalol?  Thanks.

[tom_h]

Thanks for the quick response.  Yes, Valsalva finally slowed it after 10 minutes of trying.  This event occured, as many do, as I was  just sitting on my sofa watching TV.  The switch to Sotalol was done following my complaint to him about the frequent number of PVC clusters I've been experiencing lately.  An EKG was done at the office, and in the short test time, one was recorded.  The remainder of the strip appeared "very normal".  However, he decided to try the new drug for a while.  A stress test last year also recorded a number of PVC's during high exertion levels, but the cardiologist declared I was in excellent shape for an "old guy", and sent me on my way without changing my medication.  So I believe the switch to Sotalol was made not becasue of my more frequent PSVT's, but because of my complaining of the skipped beats.  I'ts interesting to note that the PVC's seem to be seasonal in nature, appearing in the warm months of summer, and subsiding almost completely during the winter.   I guess I am fortunate in that my GP is also a pulmonary specialist, seeing general patients I guess to fill his schedule in are relatively small town hospital. But I was concerned about starting this new drug after reading the precautions of the need to be closely monitored for 3 days when starting it. I am not.  I am about to take my second dose of the Sotalol, although I am doing so with great reservations.

[is_something_wrong]

Hello.

None of us are doctors and we can't provide any advice about medications. I have some thoughts, though.

If your doctor believes your SVT is stress / adrenaline induced, and for that reason wants to use a beta blocker (like metoprolol), I don't understand the switch to Sotalol. Sotalol is a beta blocker, but is also a so-called antiarrhythmic drug (class III) and can have significant side effects such as ventricular arrhythmias.

Did the Valsalva work to convert it? This was somewhat unclear. If it worked, you had a SVT. If not, there was possibly a VT and you should inform your doctor immediately.

If you have a normal QT time on EKG, Sotalol is rarely dangerous. Anyway, this is something a medical professional and preferrably a cardiologist or internist should consider, and it is (at least in my country) very uncommon that a GP initiates treatment with antiarrhythmic meds.

You should NOT change your medications without consulting your doctor, but if a GP initiated this treatment, you should seek a second opinion, preferrably with a cardiologist or internist.

If you get sustained runs that can't be converted with Valsalva, you should visit the ER immediately.