IV Sotalol Use in Pediatric and Congenital Heart Patients: A Multicenter Registry Study

• Type of Material: Article
• Authors: Lindsay E Malloy-Walton, Children`s Mercy Hospital, Kansas City; Nicholas H Von Bergen, University of Wisconsin, Madison; Seshadri Balaji, Oregon Health and Science University; Peter Fischbach, Emory University; Jason M Garnreiter, Saint Louis University; Yukiko S Asaki, University of Utah; Jeffrey P Moak, Children`s National Health System; Luis A Ochoa, University of Iowa; Philip M Chang, University of Florida; Hoang H Nguyen, Rush University; Akash R Patel, UCSF Benioff Children's Hospital; Christa Kirk, Seattle Children's Hospital; Ashely K Sherman, Children`s Mercy Hospital; Jennifer N Avari Silva, Washington University; Philip Saul, West Virginia University
• Language: English
• Date: 2022-05-03
• Publisher: WILEY
• Publication Version: Final Published Version
• Copyright Statement: © 2022 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.
• License: Creative Commons Attribution-NonCommercial 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1161/JAHA.121.024375
• Title of Journal or Parent Work: JOURNAL OF THE AMERICAN HEART ASSOCIATION
• Volume: 11
• Issue: 9
• Start Page: e024375
• End Page: e024375
• Grant/Funding Information: An unrestricted grant from Alta Thera was given to participating sites. The authors acknowledge the support and approval of the Pediatric and Congenital Electrophysiology Society (PACES).
• Keywords: pediatrics; supraventricular tachycardia; Cardiac & Cardiovascular Systems; Science & Technology; Cardiovascular System & Cardiology; Life Sciences & Biomedicine; IV sotalol; INTRAVENOUS SOTALOL
• Research Categories: Health Sciences, Medicine and Surgery

Abstract

BACKGROUND: There is limited information regarding the clinical use and effectiveness of IV sotalol in pediatric patients and patients with congenital heart disease, including those with severe myocardial dysfunction. A multicenter registry study was designed to evaluate the safety, efficacy, and dosing of IV sotalol. METHODS AND RESULTS: A total of 85 patients (age 1 day–36 years) received IV sotalol, of whom 45 (53%) had additional congenital cardiac diagnoses and 4 (5%) were greater than 18 years of age. In 79 patients (93%), IV sotalol was used to treat supraventricular tachycardia and 4 (5%) received it to treat ventricular arrhythmias. Severely decreased cardiac function by echocardiography was seen before IV sotalol in 7 (9%). The average dose was 1 mg/kg (range 0.5–1.8 mg/kg/dose) over a median of 60 minutes (range 30–300 minutes). Successful arrhythmia termination occurred in 31 patients (49%, 95% CI [37%– 62%]) with improvement in rhythm control defined as rate reduction permitting overdrive pacing in an additional 18 patients (30%, 95% CI [19%–41%]). Eleven patients (16%) had significant QTc prolongation to >465 milliseconds after the infusion, with 3 (4%) to >500 milliseconds. There were 2 patients (2%) for whom the infusion was terminated early. CONCLUSIONS: IV sotalol was safe and effective for termination or improvement of tachyarrhythmias in 79% of pediatric patients and patients with congenital heart disease, including those with severely depressed cardiac function. The most common dose, for both acute and maintenance dosing, was 1 mg/kg over ~60 minutes with rare serious complications.