Implementation of an intravenous sotalol initiation protocol: Implications for feasibility, safety, and length of stay

Albert Y. Liu, Jessica Charron, Dana Fugaro, Scott Spoolstra, Rachel Kaplan, Graham Lohrmann, Xu Gao, Hawkins Gay, Rod Passman, Susan Kim, Albert C. Lin, Alexandru Chicos, Rishi Arora, Kaustubha Patil, Anna Pfenniger, Bradley P. Knight, Nishant Verma*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

2 Scopus citations

Abstract

Introduction: Oral sotalol initiation requires a multiple-day, inpatient admission to monitor for QT prolongation during loading. A 1-day intravenous (IV) sotalol loading protocol was approved by the United States Food and Drug Administration in March 2020, but limited data on clinical use and administration currently exists. This study describes implementation of an IV sotalol protocol within an integrated health system, provides initial efficacy and safety outcomes, and examines length of stay (LOS) compared with oral sotalol initiation. Methods: IV sotalol was administered according to a prespecified initiation protocol to adult patients with refractory atrial or ventricular arrhythmias. Baseline characteristics, safety and feasibility outcomes, and LOS were compared with patients receiving oral sotalol over a similar time period. Results: From January 2021 to June 2022, a total of 29 patients (average age 66.0 ± 8.6 years, 27.6% women) underwent IV sotalol load and 20 patients (average age 60.4 ± 13.9 years, 65.0% women) underwent oral sotalol load. The load was successfully completed in 22/29 (75.9%) patients receiving IV sotalol and 20/20 (100%) of patients receiving oral sotalol, although 7/20 of the oral sotalol patients (35.0%) required dose reduction. Adverse events interrupting IV sotalol infusion included bradycardia (seven patients, 24.1%) and QT prolongation (three patients, 10.3%). No patients receiving IV or oral sotalol developed sustained ventricular arrhythmias before discharge. LOS for patients completing IV load was 2.6 days shorter (mean 1.0 vs. 3.6, p <.001) compared with LOS with oral load. Conclusion: IV sotalol loading has a safety profile that is similar to oral sotalol. It significantly shortens hospital LOS, potentially leading to large cost savings.

Original languageEnglish (US)
Pages (from-to)502-506
Number of pages5
JournalJournal of cardiovascular electrophysiology
Volume34
Issue number3
DOIs
StatePublished - Mar 2023

Keywords

  • antiarrhythmic drugs
  • atrial fibrillation
  • atrial flutter
  • intravenous sotalol
  • premature ventricular contractions
  • quality improvement
  • ventricular tachycardia

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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