I was diagnosed with AFIB about 8 years ago. The only medication that kind of worked was SOTALO, a Beta Blocker.

My Cardiologist decided to give me a cryoablation which worked. Unfortunately a while back I was diagnosed with SSS. My pauses aren't quite long enough yet for a PM. (although my cardiologist left that decision up to me) However he said that when I get the PM, he would put me back on Sotalol. I was wondering if anybody else that has a PM is on a Beta Blocker? To me it sounds as if the PM should do the job that Sotalol supposedly does.


Sotalol - dual action beta blocker for rate and rhythm control of an arrhythmia

by Gemita - 2021-05-26 09:10:53

Hello Silverfox,

The pacemaker can really help with pausing, slowing of heart rhythm and heart rate, but it does little to fix an arrhythmia like Afib or to control a high heart rate, so we may still need medication.  Only a pacemaker with a Defibrillator can stop (temporarily) a high heart rate/arrhythmia, or an ablation.  A rate control medication like a beta blocker or calcium channel blocker or an anti arrhythmic med like Flecainide, Tikosyn, may also be able to control/treat an arrhythmia.  But AF is usually not curable unfortunately although can be well controlled.

I see you have had a cryoablation, so I am uncertain whether you are still getting short episodes of Afib which is possible and that is why your doctors said you might still need Sotalol (?to control heart rate, blood pressure or treat any other heart condition you may have)?

I am on a beta blocker (Bisoprolol) and have a dual lead pacemaker for SSS (tachy brady syndrome, pausing, syncope).  I have to stay on Bisoprolol because I still get episodes of AFib at extremely high heart rates and without a beta blocker these could get dangerously high.  My pacemaker takes care of the slowing, pausing, beats and usually prevents me from having a fainting episode, unless my blood pressure crashes during an AFib episode.  My beta blocker Bisoprolol takes care of my rapid heart rates when in AFib.

Good luck with your pacemaker decision

Beta blocker and pacemaker

by Theknotguy - 2021-05-26 11:05:41


I have the situation where I have a lot of afib.  Two EP's and one cardiologist have agreed that I'm not a good candidate for a mechanical ablation.  The doctors had me on Sotalol to slow my heart and slow down or even stop the afib.  Unfortunately the Sotalol worked too well and not only did it stop my afib, it also stopped my heart.  Not a good situation and I ended up with a pacemaker.  

I'm on Metoprolol now to slow my heart and limit my afib.  Unfortunately the amount of Metoprolol I need would slow my heart to below a life sustaining level.  The pacemaker is used to bring my heart up to a "normal" speed.  Consequently I lead a good life.  

It's common in the heart world to do what I described above.  It's fortunate they can do that because if you go back prior to the 1960's people in my situation would have just died.  In my case I can have the pacemaker or I can die.  Simple. 

I hope they can continue to help you.

Beta blocker

by AgentX86 - 2021-05-26 12:52:30

I would guess that 70% of us are on a beta blocker, of some sort.   As Gemita said, sotalol is a beta blocker (a drug ending in "lol" is a beta blocker) and an antiarrhythmic.  A fairly strong antiarrhthmic, rather high on the ladder of antiarrhythmics. 

No, beta blockers do exactly the opposite of what a pacemaker does.  A beta blocker's purpose is to slow down the heart.  A pacemaker's job is to make it go faster.  Slowing down the heart keeps it in check so it doesn't go dangerously fast during an arrhythmia event, or maybe even head it off.  A pacemaker's purpose is to put a floor on how slow the heart can go.  It's often the case that to get a high enough dose of the beta blocker to be useful for arrhythmias that it sumultaneously surpresses the heart rate to dangerous levels.  The pacemaker doesn't let this happen.  They can often give much higher doses of the beta blocker.

As I said above sotalol is fairly high up the antiarrhythmia drug ladder.  The higher up the list the more toxic the drug.  Sotalol is no different.  It has some serious side effects.  According to my EP, it's what caused my asystoles and it's the reason that I have a PM. 


by Silverfox - 2021-05-26 19:04:34

Thank you everyone.

I never really had a rapid heart rate. It was more erratic than anything. Early beats, late beats, etc. The Holter test a few months ago confirmed that I do not have AFIB anymore but SSS. I'm carefully monitoring the pauses so that I'm prepared for when they reach about 5 seconds that the next call is to my cardiologist. 

My cardiologist told me that a mega dose of Sotalol was probably in order, then the PM make sure my heart rate wouldn't bottom out.

I treied numerous drugs when I was first diagnosed with AFIB but the only one that worked for me was Sotalol. When I started experiencing problems running, I assumed my AFIB was back. That's when I had the Holter done and SSS was confirmed.


by AgentX86 - 2021-05-26 23:02:01

How long are your pauses?  Five seconds is the normal dividing line between PM/no PM.  Longer is very serious.  Syncope is somewhere you don't want to go.

Monitoring pauses isn't all that easy.  Pauses tend to happen at night during deep sleep.  The Holter, depending on the test length, will give a good idea of the pauses but it'll probably have to be done rather frequently, now that it's known that you're having pauses.  It's not going to get better and may degrade quickly.


by Gemita - 2021-05-27 04:51:34

Silverfox, you say you have never had a rapid heart rate, only erratic beats.   You then say your AFib no longer appears to be occurring, so my question to you is "why do you need a potential future mega dose of Sotalol"?  Low dose perhaps to keep AFib from returning or to try to control your erratic beats or any other arrhythmias you might have, but a future mega dose without a high heart rate or any signs of returning AFib would seem overkill to me? 

In any event, Sotalol at any dose may make the slide into SSS more likely and then you would most definitely need that pacemaker to stop your heart rate from pausing and falling to dangerously low levels.  So what is the sensible solution, unless you have some other reason for needing Sotalol?   

By the way all anti arrhythmic/heart rate control meds, especially at mega doses have the potential to worsen erratic beats (ectopic beats) for many of us.  I have personally found a pausing, slowing heart beat can be a major arrhythmia trigger.  A pacemaker can be an effective treatment by keeping the heart beat steady and the heart rate higher.  Good luck



by Silverfox - 2021-05-27 08:14:02


I had the Holter test a few months ago for 24 hours. It found the longest pause was 2.6 seconds just after I woke up in the morning.

As I've mentioned previously, I have a great Polar Heart Rate Monitor that I use in conjunction with a fantastic app that not only shows my EKG, it plots the intervals between heart beats.

Last week during sleep I had 2 pauses that were 3.2 and 3.4 seconds in length.

I don't know if that's a trend of the pauses getting longer or just an anomaly?

Believe me, there is no way I want to get close to 5 seconds. 


by AgentX86 - 2021-05-27 14:33:27

Pauses are a rather interesting things.  A pause of one second isn't a pause at all.  It's a 60bpm heart beat.  A pause ot two seconds is perhaps a 60bpm heart rate with a skipped beat.  Above that and there are many different scenarios.  A Holter can tell exactly what's' going on (pause, slow heart rate, combination, or even asystole).  A watch can't do any of it, even if they are perfect which they're not even close (I certainly wouldn't trust my life to one).  Since you only had a Holter for 24hrs, there isn't an abundance of data, either, only that you had a minor pause.  Usually a cardiologist (or EP) would do a longer Holter test to gather more data.

You're unlikely to get any real interest in your pauses until three seconds and nothing alarming to anyone, but perhaps you, until five seconds.  Up until that point, it's not all that dangerous but beyond that point there are all sorts of risks, as you know.  That's the reason longer Holter tests are needed.  It's a random even't they're trying to find so a long sample time is needed.

I had been having three second pauses for a year or more (documented by several Holters, varying from 24hrs to a week).  Then a near-syncope event put me in the hospital.  They found nothing, partially because they ignored what they saw (a five secaond pause that they chalked up to me sleeping on an EKG lead).  I was discharged with an event monitor that I was to wear for a month.  Three days later I got the call at 3:00AM...

Anyway, I'd be pushing (hard) for more frequent and longer Holter tests.  You can use your watch as "evidence" for the need for this but it's not likely a watch, any watch, will get anyone's attention.  It might be interesting to you but is unlikely to get anyone else excited.

At even 2.6s with only a 24hr Holter is enough to look harder, IMO.  Of course it could be an insurance thing.  They do have (AI) rules for approving procedures.  The "rules" are flexible and apealable, which is why you have to push your doctors.



by Silverfox - 2021-05-27 19:19:58

My monitor is actually a Polar H10 strap. It's been deemed the most acurate heart rate monitor available. I believe what it's telling me is quite acurate.

I have an appointment next week with my GP and I will be taking a lot of the data I gleaned from the app to him for his comments. I'll be interested to see if he thinks the data has some merit.


by AgentX86 - 2021-05-27 22:03:50

I certainly wouldn't trust my life to it but your choice.

Your GP is not the one to be talking to about this.  The discussion will be next to useless.  You need an EP.

You know you're wired when...

You have a little piece of high-tech in your chest.

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