Protocol Development and Initial Experience With Intravenous Sotalol Loading for Atrial Arrhythmias

Area of Science:

• Cardiology
• Electrophysiology
• Pharmacology

Background:

• Oral sotalol is a standard class III antiarrhythmic for maintaining sinus rhythm in atrial fibrillation (AF).
• The FDA recently approved intravenous (IV) sotalol loading, primarily based on modeling data.
• There is a need to describe protocols and clinical experience with IV sotalol loading for AF and atrial flutter (AFL).

Purpose of the Study:

• To describe an institutional protocol for IV sotalol loading in adult patients with AF and AFL.
• To report the initial clinical experience and outcomes of patients treated with IV sotalol loading.
• To assess the feasibility, safety, and tolerability of IV sotalol loading for atrial arrhythmias.

Main Methods:

• Retrospective review of patients treated with IV sotalol for AF/AFL at the University of Utah Hospital (September 2020 - April 2021).
• Eleven patients received IV sotalol for initial loading or dose escalation.
• Data collected included QTc intervals, hospitalization duration, cardioversion success, adverse events, and long-term therapy persistence.

Main Results:

• Mean QTc interval increased post-infusion (mean change 42ms) but no patient discontinued medication.
• Hospitalization duration was short (1-4 nights), with 9/11 patients undergoing electrical cardioversion.
• No adverse events occurred during infusion or within 6 months post-discharge; 73% maintained therapy.

Conclusions:

• A streamlined protocol for IV sotalol loading was successfully implemented for atrial arrhythmias.
• Initial experience suggests IV sotalol loading is feasible, safe, and well-tolerated, potentially reducing hospitalization.
• Further data are needed to support broader use of IV sotalol across diverse patient populations.