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[Suicide attempt with sotalol: a proarrhythmic intoxication].

T G V Cherpanath¹, F E A Geisler, B J M van der Meer

¹Amphia Ziekenhuis, locatie Molengracht, Breda. t.g.cherpanath@amc.uva.nl

Nederlands Tijdschrift Voor Geneeskunde

|November 1, 2007

Summary

Sotalol overdose, a rare cause of cardiac arrest, can lead to dangerous heart rhythm problems like torsade de pointes. Prompt treatment with pacing and medications can successfully manage this severe drug intoxication.

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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.