Unlabelled: Atrial tachyarrhythmias are a chronic long-term hazard in patients with congenital heart disease (CHD). These arrhythmias contribute to ventricular dysfunction, heart failure can contribute to sudden death. We performed a prospective study of oral sotalol for the conversion of atrial tachyarrhythmias in adults and adolescents with congenital heart disease and stable hemodynamics.
Methods: Patients were admitted and given oral sotalol in an inpatient, monitored setting. The initial dose was targeted at 2 mg/kg. Antiarrhythmic drugs other than digoxin were stopped.
Results: Nineteen patients were enrolled. The average patient age was 20 years (12-39). Four had atrial ectopic tachycardia (AET) and 15 had atrial reentry tachycardia (IART). Nine had Fontan physiology. Permanent pacing therapies had failed to restore sinus or paced rhythm consistently in 6 patients. Overall 16 of 19 atrial tachyarrhythmias (84%) converted with single dose oral sotalol. AET converted to sinus or paced rhythm in 3/4 patients and IART in 13/15 patients. The average times to conversion were 98 and 145 min, respectively. Two patients required pacemakers due to sinus bradycardia. One patient had a lethal thromboembolic event 2 days after conversion.
Conclusions: Oral sotalol offers an effective alternative to direct current cardioversion in adults and adolescents with CHD and hemodynamically stable atrial tachyarrhythmias. Conversion with sotalol at ~2 mg/kg generally occurred within 2 h. Vigilance for thromboembolism must be maintained as well as caution for those with bradycardia without pacemakers in this patient population. There are theoretical and practical advantages of sotalol over cardioversion.
Download full-text PDF |
Source |
|---|---|
| http://dx.doi.org/10.1016/j.ijcard.2008.04.060 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Population Pharmacokinetics and Pharmacodynamics of Sotalol Following Expedited Intravenous Loading in Patients With Atrial Arrhythmias.
CPT Pharmacometrics Syst Pharmacol
January 2025
Division of Clinical Pharmacology, Department of Pediatrics, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, Utah, USA.
Sotalol, a class III antiarrhythmic agent, is used to maintain sinus rhythm in patients with atrial fibrillation or atrial flutter (AFIB/AFL). Despite its efficacy, sotalol's use is limited by its potential to cause life-threatening ventricular arrhythmias due to QT interval prolongation. Traditionally, sotalol administration required hospitalization to monitor these risks.
View Article and Find Full Text PDFBackground: This study investigated drug-drug interactions in patients with atrial fibrillation taking both a direct oral anticoagulant (DOAC) and an antiarrhythmic drug.
Methods And Results: Using data from the National Health Insurance database (2012-2018), we identified 78 805 patients with atrial fibrillation on DOACs, with 24 142 taking amiodarone, 8631 taking propafenone, 2784 taking dronedarone, 297 taking flecainide, 177 taking sotalol, and 42 772 on DOACs alone. Patients with bradycardia, heart block, heart failure, mitral stenosis, prosthetic valves, or incomplete data were excluded.
Informing the risk assessment related to lactation and drug exposure: A physiologically based pharmacokinetic lactation model for pregabalin.
CPT Pharmacometrics Syst Pharmacol
November 2024
Department of Pharmaceutics, Center for Pharmacometrics and Systems Pharmacology, College of Pharmacy, University of Florida, Orlando, Florida, USA.
Article Synopsis
- Breastfeeding is crucial for childhood development, but there’s limited knowledge on the risks of infant drug exposure through human milk, highlighting the need for better understanding in clinical decision-making.
- A study expanded a lactation modeling framework using pregabalin to simulate drug transfer into human milk, incorporating adult and pediatric pharmacokinetics to examine infant exposure.
- Results from the modeling showed that with a maternal dose of 150 mg twice daily, there was an estimated relative infant dose of about 7%, with peak infant plasma concentrations occurring in the first two weeks of life.
Spontaneous pre-excited supraventricular tachycardias in a Labrador Retriever.
J Vet Cardiol
August 2024
Clinica Veterinaria Malpensa, Viale Marconi, 27, 21017, Samarate, VA, Italy; College of Veterinary Medicine, Cornell University, 930 Campus Road, 14853, Ithaca, NY, USA.
A four-year-old Labrador Retriever was presented for intermittent tachycardia. The electrocardiogram showed sinus rhythm conducted with ventricular pre-excitation and short runs of orthodromic atrioventricular reciprocating tachycardia. Four months later, the rhythm degenerated into a symptomatic sustained tachycardia, suspected to be pre-excited atrial fibrillation, a potentially life-threatening rhythm in the presence of an accessory pathway with a short refractory period.
View Article and Find Full Text PDFSafety of outpatient commencement of sotalol.
Heart Rhythm O2
June 2024
Centre for Heart Rhythm Disorders, University of Adelaide, Adelaide, South Australia, Australia.
Article Synopsis
- Inpatient monitoring is traditionally recommended when starting sotalol, but this study aimed to evaluate the safety of initiating it in an outpatient setting.
- The study reviewed 880 patients who started sotalol, mostly for atrial fibrillation, and monitored their QTc intervals over time to assess for significant prolongation and other clinical events.
- Findings indicated that outpatient initiation of sotalol is generally safe, with minimal serious adverse effects and a low rate of QTc prolongation, although ongoing monitoring and follow-up are essential.
Want AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!