Practical considerations in the use of sotalol for ventricular tachycardia and ventricular fibrillation

Sotalol is a unique antiarrhythmic drug that combines beta-blocking effects with actions to prolong action potential duration. The net effect is a drug that is efficacious in the management of ventricular tachyarrhythmias. Although sotalol has effects on both heart rate and QT interval, these effects do not help predict the antiarrhythmic efficacy of the agent. Changes in QT dispersion may, however, prove to be relevant to both the antiarrhythmic effects and the arrhythmogenic effects of sotalol. Thus, although sotalol may occasionally cause torsades de pointes, this complication may be predictable and clinically controllable. Sotalol is well tolerated, and it may be used, with caution, in some patients with impaired myocardial contractile performance, despite its beta-blocking action. Sotalol has an important indication for the management of ventricular tachyarrhythmias.