Abstract

Loading oral sotalol for atrial fibrillation (AF) requires 3 days, frequently in-hospital, to achieve steady state. The FDA approved loading with intravenous (IV) sotalol through model-informed development, without patient data.We present results of the first multicenter evaluation of this recent labeling for IV sotalol.The Prospective Evaluation Analysis and Kinetics of IV Sotalol (PEAKS) Registry was a multicenter observational registry of patients undergoing elective IV sotalol load for atrial arrhythmias. Outcomes, measured from hospital admission until first outpatient follow-up, included adverse arrhythmia events, efficacy, and length of stay.Among 167 consecutively enrolled patients, 23% were female, the median age was 68 (IQR: 61,74), and the median CHA2DS2-VASc was 3 (IQR 2,4). Overall, 99% were admitted for sotalol initiation (1% for dose escalation), with a target oral sotalol dose of either 80 mg bid (85[51%]) or 120 mg bid (78[47%]); 62 patients (37%) had an estimated creatinine clearance <90 mL/min. On presentation, 40% of patients were in sinus rhythm whereas 26% underwent cardioversion prior to sotalol infusion. In two patients, sotalol infusion was stopped for bradycardia or hypotension. In six subjects, sotalol was discontinued prior to discharge due to QTc prolongation (3), bradycardia (1), or recurrent atrial arrhythmia (2). The mean length of stay was 1.1 days and 95%(n=159) were discharged within 1 night.Intravenous sotalol loading is safe and feasible for atrial arrhythmias, with low rates of adverse events, and yields shorter hospitalizations. More data are needed on the minimal duration required for monitoring in-hospital.

View details for DOI 10.1016/j.hrthm.2024.02.046

View details for PubMedID 38417598