New antiarrhythmic drug in pediatric use: sotalol

Sotalol is a noncardioselective beta-blocking agent with additional class III antiarrhythmic properties (action potential duration prolongation). These combined electrophysiologic effects make it a valuable drug for treating various arrhythmias. Its effectiveness for suppressing supraventricular reentrant tachycardias in children is well documented. Atrial flutter in children can be effectively managed in a high percentage of those treated. Ventricular arrhythmias in children can be adequately controlled by the administration of oral sotalol. Side effects are those typically seen during the course of treatment with a beta-blocker and lead to discontinuation of the drug in 3-6% of children. Proarrhythmia is another concern after sotalol administration. Increased ventricular ectopy, impairment of atrioventricular conduction, and suppression of sinus node activity with exacerbation of bradycardia (especially in children with sinus node dysfunction) may be found in a considerable number of treated patients, usually within a few days of sotalol initiation. Sotalol is an effective antiarrhythmic drug, but its potential side effects warrant inpatient treatment initially and close electrocardiographic monitoring.