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njm5876, May 28,  2019  9:04am EST

extremely low HR since starting Sotalol

My husband was recently diagnosed with paroxysmal Afib ( March 2019)  He is scheduled for ablation July 15. Husband's normal resting HR is 50-60 --highest with Afib episode was 168.  His symptoms were some chest pressure, heart flip-flopping with fatigue.

  EP doc had him start taking Multaq for 2 weeks, no help at all.  He changed him to Sotalol 6 days ago. His HR is now down in the low 40's possibly lower as the monitor we have at home doesn't register lower than 40.  He has been exhausted since starting Sotalol- he takes 160 mg/day.  It has caused him some stomach related issues - I have noticed some shortness of breath - more fatigued than before.  He actually seems to be feeling worse on the meds than without. He is to go tomorrow to have an EKG -I am hoping he will let them know how he has been feeling the last week.  The husband has been down in the dumps and grumpy since taking Sotalol.  

EP says he also has tachy-brady syndrome..but says we need to tackle the AFib before the bradycardia.  

I think he needs to come off the Sotalol but since I am not a medical pro I may have it wrong.  I just want something to help him to feel better NOT make him worse.

Thanks for listening!! 

  • Gene157
    Gene157, May 28,  2019  12:08pm EST

    Unfortunately a very common side effect of Sotalol especially if you have a low heart rate to begin with as do I. But it is very effective and safe. I have been on Sotalol for app 15 years at 2x 80mg and that keept me mostly out of AF for years with some short flare ups. In time the body will adapt somewhat.Lowering the dose may not do much good all around. Just hang in there and wait untill your ablation and hope for a sooner date. And be advised that you may need more than one.


    My present regimen has kept me AF free, it is 2x 40mg Sotalol and 2x 150mg Propafenone. Very low doses of each that would not do any good if taken alone. Resting HR is 55 to 65 now, was as low as 40.

    I had an abllation as well as the Maze, neither helped much.

    Good Luck.



  • Patio
    Patio, May 28,  2019  6:37pm EST

    I, too,  am tachy-brady and was diagnosed in the fall of 2017. I was put on several rate medications and finally flecainide was added to convert me from a long attack of afib and aflutter (12days at that point...and not on blood thinner long enough for electro cardioversion, pretty ugly). The further slowing of my heart made me a living zombie, and very depressed. After many failed efforts to keep me out of afib, my EP removed all rate meds and began Tikosyn. I wanted to avoid ablation given risks, low success rate with older females, and atypical aflutter, regular aflutter, and afib. (Read the Skeptical Cardiologist Blog on Ablation this month).

    That was 15 months ago and I have only had four minor events since then, the longest, one hour in the first two weeks. I take nothing but the Tikosyn and of course Eliquis, and I am finally back to 18 holes of golf, shopping, and walking my two and a half miles a day. I have my life back.  My point is speak up. Your husband’s good quality of life is still possible. There are different routes to it, however.  And ablation is not the only answer, often it is not an answer at all. I read here all the time about people happy that their ablation worked and they only take this rate medication and flecainide or sotalol....and only have so many episodes. That is not a successful ablation in my world.  Anyhow, don’t give up and don’t accept that lowering heart rate. Their are other answers. Best  of luck.  Patio

  • MellanieSAF
    MellanieSAF, May 29,  2019  12:19pm EST


    Regarding the blog you mention, here are some things he says that I'm not in agreement with:

    He indicates that amiodarone is safe and effective, and almost treats it as being benign! What?

    "In my opinion, most AF patients are best served by a cardiologist who has a special interest in atrial fibrillation..." 
    "This does not need to be an electrophysiologist..." 
    "I have a ton of respect for the EP doctors I work with and send patients to but I think that when it comes to doing invasive, risky procedures the decision should be based on a referral/recommendation from a cardiologist who is not doing the procedure."

    I don't see his post on ablation on his site, so can you share the link to it? I can hardly wait to see what he has to say about that considering that his current post says: "I’ve prepared a whole post on ablation for AF but the bottom line is that there is no evidence that ablation lowers the AF patient’s risk of dying, stroke, or bleeding. My post will dig deeper into the risks and benefits of ablation." Has he not heard of quality-of-life, and that we patients consider that more important than the things he cited? 


  • njm5876
    njm5876, May 30,  2019  8:47am EST


    The husband had an EKG yesterday.  The nurse said it looked really good. He said he thought it felt fluttery.  The doc called after the EKG. Said to take 1/2 dose of Sotalol 2 times a day. That would back his dosage to 80 mg daily.  Hopefully, this will let the heart rate come up to a functional level.  HR was still low last night (41).  Prior to this med, his normal heart rate was in the 50-60 range, normal for him but considered low/bradycardia by the EP.  Sotalol has dropped his heart rate into the 40's and lower. Some times it has been so low it doesn't register on our BP cuff at home. The hope was the med would control his Afib and make him feel better but he is definitely feeling worse!!  He does have an RF ablation scheduled for July 15.  Not sure how having this low-level heart rate is going to make him feel by then.  He didn't have the shortness of breath & was less tired before starting Sotalol.  It is hard to watch him go downhill on a med that is supposed to help him feel better.

    The husband isn't sure if it is helping the fast heart rate. He says it is all running together so he doesn't know when he is in Afib and when it is PVC - PAC or when it is none of them/  Doc says he has paroxysmal AFib along with PVC and PAC.  The husband has episodes daily but it is getting harder for him to tell when they stop.  I believe part of that is from the Sotalol, it has lowered his heart rate so it is always in the low 40's  The husband hit the trifecta.

    Since I don't have AFib PVC or PAC I am trying to understand if there is a difference in how they are felt. Husband says sometimes he feels 'the beat is in the stomach area, other times it feels higher --just below his collar bone.  He gets frustrated because he isn't able to describe the feeling. Now he is saying it all runs together and he isn't' able to tell the difference.  Before the Sotalol he could distinguish the feelings. Is this a common occurrence with Afib or just my husband?  The uncertainty is hard on both of us. We are supposed to leave for a vacation in 4 days but I am wondering if we shouldn't cancel it. Why go fishing when you don't feel like getting out of bed?  

    I do have a question that may seem very dumb at this point.  Are Irregular heartbeat and AFIB the same?  Husband says that Afib is when top parts beats too fast --while irregular heartbeat is the skipped or missed beats he is feeling.  I am confused since I was under the impression they were the same, just different names.  

    Thank  you all for listening.

  • AHAASAKatie
    AHAASAKatie, May 30,  2019  9:09am EST

    njm5876, I am glad that the ekg was good, but very sorry to read that your husband continues to feel worse. That must be so hard. Please know that we are here to listen and support you. Best Katie

  • Gene157
    Gene157, May 30,  2019  2:16pm EST

    What is missing here, is he in AF or sinus? The fact that the Dr. reduced the Sotalol and that the HR is that low indicates that he is most likely in sinus mode. There are some inexpensive blood pressure meters that indicate if the pulse is not regular. Also look at a copy of the ECG, it will tell you what it diagnosed in plain english. Always take a copy home with you and Google what you do not yet understand. But focus on websites like the Cleveland Clinic and the likes of WIKI.

    Quote:The husband had an EKG yesterday.  The nurse said it looked really good. End of quote.

    I just want to cry when I read that, it is so common.

    I have a Holter type recorder made by DIMETEK  and used it on/off over 6 years. My C Dr. loves the print outs I  show him because there is no guessing. Beats telling the DR. that I just felt bad. Because in my case at least THEIR HOLTER NEVER FOUND A THING. That is the problem with paroxysmal AFIB, and unfortunately sooner or later it will be back. I bought a recorder because I once was in the same boat that you are in.

    There are a lot of simple, inexpensive ECG type devices on Amazon or eBay that will tell you what is going on  right now. Including some that attach to a cell phone and can tell the Dr. what is happening right now.


    Good luck



  • njm5876
    njm5876, May 31,  2019  8:34am EST

    Gene 157,

    I bought an Emay ECG monitor for home. Husband tried it 2 times, got 2 very opposite readings and has declared that it doesn't work.  We also have a BP cuff that shows heart when it is irregular. Just not if it is from the PVC PAC or Afib. Since you all are more knowledgeable in this venture than I am, if his pulse is too high or too low wouldn't that register as irregular as well?

     The hardest part of all of this is my husband is resistant to helping himself.  The Dr told him to cut his Sotalol dose to 1/2 of what he had been taking it was 80 mg  2 times a day. Now he is to take 80 mg total but instead of cutting the pills in half my husband is taking 1 in the am and nothing at night.  He took BP 4 times last night --which showed irregular 3 times out of 4.  The highest heart rate was 119 then about 1 1/2 hrs later it was down to 45 and irregular.  I plan to watch his breathing, his tiredness over the next few days to see if there is a difference.  I did talk to a nurse who was shocked that the Doc put him on Sotalol given his normal heart rate is low.  She said she would have questioned it right then.  Husband doesn't realize how close he came to having a serious complication from the overdosing.

    I wish I could get him to monitor his heart better.  The Doc would like him to do a daily monitor and then when he feels he is in Afib to do 3-4 times over the course of the episode.  Since my husband isn't in the office a lot he doesn't want to be bothered to carry the bp cuff.  I bought a pulse ox that he could use, he won't do that.  I think deep down he is very scared and doesn't want to know exactly what is happening to him.  

    Husband told me he can't tell when he is in NSR -when it is Afib or when it is just the skipped/missed beats.  I am going to try again to get him to use the Emay monitor so we can have a printout.  He is old school, doesn't ask questions of Doc if he doesn't understand anything he just goes along with what they say.  He would never have thought to ask for a printout.  The next time I go with him to Dr appt and they do tests I will ask for them.  

    Thank you ALL for your insight.  We are a couple of newbies trying to navigate a whole strange new world.  

  • Gene157
    Gene157, May 31,  2019  12:20pm EST

    Well that is not helping matters. First time administration should be in a hospital setting and the patient be monitored for 3 days. I n about 2% of patients  Sotalol can cause serious arrithmias including death. But that is history now. Sotalol median half life is 12 hours. So the Sotalol level is all over the place in 24 hours to as low as 25% of the desired level. Your husband is playing Russian Roulette here, not to mention that the dosage as taken is likely ineffective.  As mentioned before, Sotalol is a safe and effective medication, but only if properly used.

    An other measure for AF I use is pulse pressure. My BP pressure this morning was 115/70  the PP is thus 45. If the heart is in AF it is less efficient and that number drops by as much as 20 points. My pulse was 66 as I type this.


    My best wishes



  • Gene157
    Gene157, May 31,  2019  12:49pm EST
    052519 1 at rest.png.

    When using a heart monitor it is important to feed it a good clean electrical signal. I use pads like the doctor.

    Next best is to push one electrode against your chest above the heart and the other in your right palm. Find the chest location that gives the cleanest signal and do not move, even hold your breath! Using a saline solution can improve the signal quality.

    The recorder does not alter the signal, if the signal is substantially different it is most likely being used wrong.

    The enlosed sample is from the Holter device, the dot in the lower right indicates perfect sinus, with AF the dots are all over that area.



  • Gene157
    Gene157, May 31,  2019  12:55pm EST
    ScreenHunter_317 Mar. 27 16.48.jpg.

    This is a pic of the ECG device, it is not calibrated, so the data other than HR has to be used with caution.


    Note the clean signal, that can only be optained with a wired chest pad connection. Far better than using both hands.

    I have first degree heart block, so no P pulse.



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