Transition from Sotalol to Dronederone

[BobRBob]

I have been on Sotalol for over a year to control my a-fib. Recently, I've started to have breakthroughs and my cardiologist has prescribed Dronederone (Multaq) in place of the Sotalol. He has also referred me to an EP to investigate an ablation. My question relates to the transition from Solalol to Dronederone. My cardiologist told me to just switch from one drug to the other with no taper and no overlap. I'm wondering if anyone here has done this transition. The Sotalol is a beta blocker and it comes with a warning to not suddenly stop taking it. Of course, this warning assumes no alternate drug therapy in it's place but I'm still concerned that I may develop tachycardia or some other condition upon withdrawal of the Sotalol even though I've switched to the Dronederone. My pharmacist agrees that this is the correct approach but I'm a little afraid at this point to just do it. Has anyone here had this experience? Dronederone is not a beta blocker.

[BobRBob]

After almost 6 days in a-fib, I converted back to NSR yesterday in the afternoon. Hope it holds. We'll see. I'll enjoy it while it lasts.

[LindaTX]

I personally have not had any side effects on coumadin (warfarin).  My chad score was 1 but I'm pretty sure it was because of the a-fib episodes.  If they are longer than 24 hrs they say it's very possible for clots to form. I was against going on coumadin...I've been on it 1&1/2 yrs now. I guess it depends on how long and how often your episodes are.  Like I said, my Dr was pretty insistent. On those meds I quoted, I had the hospital send me what is supposed to be a full copy of my medical records from the ablation, I hope it includes everything.  I have to say it doesn't seem real detailed.

[BobRBob]

Linda, what was your CHADS2 score when your EP told you to go on Coumadin? My score is zero which is why I'm just on Asprin. Hopefully, this is safe. I really do worry about the risk of stroke but there are risks with Coumadin as well so it's a balancing act. Maybe I should tell my Cardio that I want to go onto Coumadin. Are there any side effects? Seems all these drugs do something bad while doing their thing.

[LindaTX]

One time when I was approaching 4 days in a-fib, my electrophysiologist sat me down and said I could go on coumadin right then or I could sit back and wait for a stroke.  Taking coumadin has been easy and I do feel more protected from having a stroke. I can't remember how long you've been dealing with a-fib but you may have reached to end of the road wih the anti-arrhythmic drugs.  Eventually they all stop working. I used them for probably 11 yrs all total.  Ok, I think these are what they used to sedate me. Isuprel, Protamine, and I think I saw Propofol (the Michael Jackson drug). My last year of this journey I was having weekly episodes of 24-36 hrs but I was not on any meds at all.

I was only in sinus rhythm for 24 hrs and then back into perpetual a-flutter. I'll stick to the Multaq and see what happens, maybe it hasn't taken full effect yet.  But I don't think i could take another marathon episode of this crap.

[BobRBob]

Linda, regarding your ablation, what sedative did they use to knock you out?

[BobRBob]

No, they said I had been in a-fib too long to risk an electro-conversion as I'm not on Warfarin. I have the option of starting Warfarin now and getting converted in 3 weeks if I'm still in a-fib by then. I also wonder if there's any point. Won't I just go back into a-fib the next day or whatever? I don't understand how I could go so quickly from total control with Sotalol to no control on any of the drugs tried in a few weeks. The Metoprolol seems ok at the low dose I'm on although I'm not clear yet on what it's doing. My heart rate was too high in a-fib on the Dronederone alone when active. It would run at 120 or so just walking around. The Metoprolol is supposed to lower my active rate to something more reasonable. Hope it works. I'm getting a Holter monitor tomorrow to assess the situation over a 48 hour period. My blood pressure is good - nice and low for most of the day and night. I learned that watching the bedside monitor in the hospital overnight and most of the day yesterday as there wasn't much else to do. That's good to know.

As I said before, my a-fib is hardly detectable at rest at this point. The Dronederone has a very calming effect and smooths it out vs the lumpy and bumpy shirt shakers that I was having while still on the Sotalol. I guess this means the drug is doing something good.

As for shopping around for a good EP, I'm really not sure how to approach that in Canada. Our health care system is so different from the US. There is no marketplace for services and no easy information available about individual doctors and their success records. I really have to trust my cardiologist to make an informed referral. If anyone reading this has any advice to me on how to research the issue I'm all ears and thanks in advance.

And here's to a successful outcome for both you and Pete. I am following and watching your progress with much interest and wish you both the best in your quest for healthy hearts!