[Suicide attempt with sotalol: a proarrhythmic intoxication].

Area of Science:

• Cardiology
• Clinical Toxicology
• Pharmacology

Background:

• Sotalol is a beta-blocker and antiarrhythmic agent with known proarrhythmic potential.
• Intoxication with sotalol can result in significant cardiac complications, including life-threatening arrhythmias.
• Cardiac arrest is a critical medical emergency requiring immediate and comprehensive resuscitation efforts.

Observation:

• A 62-year-old male presented with cardiac arrest following a suicide attempt.
• Post-resuscitation, the patient developed sinus bradycardia with marked QT prolongation, leading to recurrent torsade de pointes.
• Diagnostic data confirmed sotalol intoxication as the underlying cause.

Findings:

• The patient experienced severe proarrhythmic effects from sotalol, manifesting as torsade de pointes.
• Treatment involved temporary transvenous overdrive pacing and administration of glucagon, milrinone, and norepinephrine.
• The patient's condition improved, and he was discharged in good health.

Implications:

• Sotalol intoxication, though rare, carries substantial morbidity and mortality risks.
• Effective management necessitates counteracting the proarrhythmic effects of sotalol.
• Proarrhythmic events can occur even at therapeutic sotalol levels, highlighting the need for vigilant monitoring.