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Early experience with intravenous sotalol in children with and without congenital heart disease
Santiago O Valdés1, Christina Y Miyake1, Mary C Niu2
1Lillie Frank Abercrombie Section of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas.
Insights
Intravenous sotalol effectively treats pediatric arrhythmias, including acute termination and maintenance therapy. This antiarrhythmic medication was well-tolerated in children, with no adverse events requiring discontinuation.
Area of Science:
- Pediatric Cardiology
- Electrophysiology
- Pharmacology
Background:
- Arrhythmias are common in pediatric patients.
- Limited intravenous (IV) antiarrhythmic options exist for children.
- Pediatric experience with IV sotalol is scarce.
Purpose of the Study:
- To evaluate the initial clinical experience of using IV sotalol in pediatric patients.
- To assess the efficacy and safety of IV sotalol for treating arrhythmias in children.
Main Methods:
- Retrospective study of pediatric patients who received IV sotalol.
- Evaluation of patient demographics, congenital heart disease, arrhythmia type, efficacy, and adverse effects.
- Analysis of data including age, weight, and treatment setting (acute vs. maintenance).
Main Results:
- 47 pediatric patients received IV sotalol; 85% had supraventricular arrhythmias, 15% ventricular tachycardia.
- Acute termination of active arrhythmias was achieved in 88% of treated patients.
- 83% of patients on maintenance therapy achieved arrhythmia control with sotalol monotherapy; no discontinuations due to adverse effects.
Conclusions:
- IV sotalol is an effective and well-tolerated antiarrhythmic treatment for pediatric patients.
- It serves as a valuable option for acute arrhythmia termination and maintenance therapy in children.
- No adverse effects necessitated treatment discontinuation in the study cohort.
Background:
Arrhythmias are common in the pediatric population. In patients unable to take oral medications or in need of acute therapy, options of intravenous (IV) antiarrhythmic medications are limited. Recently IV sotalol has become readily available, but experience in children is limited.
Objective:
The purpose of this study was to describe our initial experience with the use of IV sotalol in the pediatric population.
Methods:
A retrospective study of all pediatric patients receiving IV sotalol was performed. Patient demographic characteristics, presence of congenital heart disease, arrhythmia type, efficacy of IV sotalol use, and adverse effects were evaluated.
Results:
A total of 47 patients (26 (55%) male and 24 (51%) with congenital heart disease) received IV sotalol at a median age of 2.05 years (interquartile range 0.07-10.03 years) and a median weight of 12.8 kg (interquartile range 3.8-34.2 kg), and 13 (28%) received IV sotalol in the acute postoperative setting. Supraventricular arrhythmias occurred in 40 patients (85%) and ventricular tachycardia in 7 (15%). Among 24 patients receiving IV sotalol for an active arrhythmia, acute termination was achieved in 21 (88%). Twenty-three patients received IV sotalol as maintenance therapy for recurrent arrhythmias owing to inability to take oral antiarrhythmic medications; 19 (83%) were controlled with sotalol monotherapy. No patient required discontinuation of IV sotalol secondary to adverse effects, proarrhythmia, or QT prolongation.
Conclusion:
IV sotalol is an effective antiarrhythmic option for pediatric patients and may be an excellent agent for acute termination of active arrhythmias. It was well tolerated, with no patient requiring discontinuation secondary to adverse effects.
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