Sotalol in treatment of pediatric cardiac arrhythmias

There is limited experience on sotalol use in the management of childhood arrhythmias. This study reviews the results of our experience with oral sotalol for treatment and prevention of tachyarrhythmias in children.

The records of 62 patients (27 female, 35 male, mean age: 8.5+/-5.3 years) treated with sotalol for supraventricular or ventricular arrhythmias from 1994 to 1999 at our institution were reviewed. Demographic, clinical, echocardiographic, electrocardiographic (ECG), ambulatory ECG and electrophysiologic variables were collected.

Forty-two (63.6%) patients had re-entrant supraventricular tachycardia, eight patients (12.9%) had atrial tachycardia, one patient (1.6%) had junctional ectopic tachycardia, four patients (6.5%) had ventricular tachycardia, and seven patients (11.3%) had complex ventricular arrhythmias, as evidenced by surface or ambulatory ECG records; or revealed during the electrophysiological study. The mean sotalol dose was 3.9+/-1.2 mg/kg per day. In 15.5+/-13.9 months of sotalol use 50% (n=31) had complete relief of symptoms and/or arrhythmia and 29% (n=18) had partial relief. Sotalol was ineffective in 20% (n=13). Sotalol was more effective in re-entrant type supraventricular tachycardias (P=0.012). Sotalol was the first choice in 35.5% of patients. The sotalol therapy was initiated in inpatient settings in 40.3% (25 patients). Complications due to sotalol were seen in six patients (five patients developed bradycardia/pauses, and one patient had torsades de pointes) for which the sotalol dose was modified. In patients with sick sinus syndrome, a pacemaker was implanted and in another patient sotalol was stopped.

Sotalol, being an effective and safe drug particularly in children, is a good therapeutic alternative for the preventive treatment of childhood tachyarrhythmias.