Effectiveness of oral sotalol for treatment of pediatric arrhythmias
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P Maragnès1, M Tipple, A Fournier
1Division of Pediatric Cardiology, Sainte-Justine Hospital, Montréal, Quebec.
Insights
Oral sotalol effectively treated various pediatric arrhythmias, showing a 79% success rate in patients with supraventricular reentrant tachycardia and atrial ectopic tachycardia. This beta blocker demonstrated good tolerability in young patients.
Area of Science:
- Pediatric Cardiology
- Clinical Pharmacology
- Cardiac Electrophysiology
Background:
- Sotalol, a beta-blocker with Class III antiarrhythmic activity, has limited reported use in pediatric populations.
- Pediatric arrhythmias often require effective and safe therapeutic options.
Purpose of the Study:
- To evaluate the efficacy and safety of oral sotalol in pediatric patients with various cardiac arrhythmias.
- To assess sotalol's effectiveness across different types of supraventricular and ventricular tachycardias in children.
Main Methods:
- A cohort of 66 pediatric patients (9 days to 24 years) received oral sotalol, alone or with digoxin.
- Patients had diagnoses including supraventricular reentrant tachycardia, atrial flutter, atrial ectopic tachycardia, and ventricular tachycardia.
- Treatment outcomes were assessed over a mean duration of 13.3 months.
Main Results:
- Overall treatment success rate was 79%.
- Highest efficacy was observed in supraventricular reentrant tachycardia (89%) and atrial ectopic tachycardia (85.5%).
- Sotalol showed lower efficacy in ventricular tachycardia (17% complete control) but reduced arrhythmia burden in 50% of patients; 89% experienced no adverse effects.
Conclusions:
- Oral sotalol is an effective and well-tolerated treatment for a range of pediatric arrhythmias, particularly supraventricular tachycardias.
- Sotalol represents a valuable therapeutic option for managing cardiac arrhythmias in pediatric patients, including infants.
- Further research may explore optimizing sotalol use in refractory cases like ventricular tachycardia.
Abstract:
Sotalol is a beta blocker with class III activity. Few investigators have reported its use in pediatric patients. From August 1985 to May 1990, 66 patients (mean age 8.7 years; range 9 days to 24 years), including 14 infants aged less than 3 months, were treated with oral sotalol alone (n = 46) or in association with digoxin (n = 20). Supraventricular reentrant tachycardia was present in 38 patients (20 with documented preexcitation), atrial flutter in 10 and atrial ectopic tachycardia in 7. Three patients had other types of supraventricular tachycardia. Tachycardia was of ventricular origin in 6 patients and both of supraventricular and ventricular origin in the remaining 2. Mean dose of oral sotalol was 135 mg/m2/day given in 2 doses. Congenital heart disease was present in 28 patients, 14 with previous cardiac surgery, mostly at the atrial level. Prior treatment with 1 or more antiarrhythmic agent had been unsuccessful in 83% of patients. Mean duration of treatment was 13.3 months (range 2 months to 5 years). Overall, treatment was successful in 79% of cases. Highest rate of success was observed in patients with supraventricular reentrant tachycardia with or without preexcitation (89%) and in those with atrial ectopic tachycardia (85.5%). Atrial flutter could be controlled in 60% of cases. Sotalol seemed less effective in ventricular tachycardia with a complete control of the arrhythmia being achieved in only 17%; however, it decreased the number of runs of ventricular tachycardia and the number of ventricular premature complexes in 50% of patients. There were no adverse effects in 89% of patients.(ABSTRACT TRUNCATED AT 250 WORDS)