Elsevier

American Heart Journal

Volume 130, Issue 4, October 1995, Pages 791-797
American Heart Journal

Clinical investigation
Sotalol for refractory arrhythmias in pediatric and young adult patients: Initial efficacy and long-term outcome

https://doi.org/10.1016/0002-8703(95)90079-9Get rights and content

Abstract

Sotalol is an antiarrhythmic medication that has properties of both a β-blocker and a class III agent and has been used safely and effectively to treat arrhythmias of multiple mechanisms in pediatric patients. The purpose of this study was to review our institutional experience with sotalol in 45 patients with refractory arrhythmias and determine their long-term outcome. Patients responded to sotalol with 80% efficacy and a 22% incidence of adverse side effects. The mean sotalol dose was 116 mg/m2/day, and the average duration of therapy was 15.2 months. In spite of 80% efficacy, only 22% of patients remained on sotalol long-term. Sotalol was discontinued most commonly for either spontaneous resolution of disease or definitive cure by radiofrequency ablation. Other reasons for discontinuation of effective therapy included adverse side effects and arrhythmia control with either an antitachycardia pacemaker or another medication. One patient died while taking sotalol, but this case was considered a failure of treatment rather than an adverse side effect. Of the patients who still receive therapy, several have complex structural heart disease and require a combination of therapies, including sotalol, for adequate rhythm control.

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    Of the 5 patients with AEs on sotalol at 1-year follow-up, 2 were still on sotalol therapy, 1 was on flecainide therapy, 1 was on no antiarrhythmic therapy, and 1 underwent ablation 2 months after initial inpatient discharge (Table 5). This study supports the finding that sotalol is a safe and effective agent for the treatment of supraventricular and ventricular arrhythmias in the pediatric population.7,10,11 The major findings in this study included the following: first, the AE rate was 3%, including hemodynamically stable bradycardia and a statistically, but not clinically, significant change in QTc during sotalol initiation when corrected for QRS duration; second, none of the patients who had AEs required emergent intervention and none suffered from ventricular arrhythmias; third, all patients with AEs had congenital heart disease and were concomitantly on QT-prolonging agents; and finally, sotalol was acutely effective (defined as control of arrhythmia permitting discharge to outpatient follow-up) in 82% of patients, similar to that of previous studies in pediatric populations.10,12–14

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Supported by the Sean Roy Johnson Memorial Fund. Dr. Saul was supported by Clinical Investigator Award K08-HL02380-03 from the National Institutes of Health.

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