Efficacy and safety of oral sotalol in early infancy

Sotalol, a nonselective beta blocking agent with additional Class III activity has been shown to be extremely effective in the treatment of supraventricular tachycardias in adults and children. Little information is available on its use in infants. From August, 1985 to April, 1990, 18 infants, 2 months of age or less, were treated with oral sotalol for supraventricular arrhythmias. Their age ranged from a few hours to 2 months, mean 5 weeks, at the start of treatment. Weights were between 2.58-5 kg, mean 3.9 kg and dosage 2-4 mg/kg/24 hrs given in two equal doses, 12 hourly. Sixteen infants had structurally normal hearts, one had multiple cardiac rhabdomyomas, and one was postoperative Mustard procedure for transposition of the great arteries. Thirteen of 18 infants had reentrant forms of supraventricular tachycardia, six of these had overt preexcitation. Two infants had chaotic atrial tachycardia, two atrial flutter, and one with ectopic atrial tachycardia. Previous antiarrhythmic therapy had been unsuccessful in 12 patients. All infants, except one with chaotic atrial tachycardia, were successfully controlled with sotalol. Ten infants discontinued therapy between the ages of 7 and 18 months as it was felt to be no longer necessary. Mean duration of treatment was 12.8 months. Three had recurrences of their arrhythmia and were again successfully controlled by sotalol. Mild sinus bradycardia occurred in all infants. No other side effects were noted. Sotalol is an effective, safe drug for the treatment of supraventricular tachycardias in early infancy.