911-36 Safety and Efficacy of Sotalol in Drug Refractory Atrial Fibrillation/Flutter

Abstract

The clinical efficacy and safety of oral Sotalol in patients (pts) with refractory atrial fibrillation/flutter (AF) has not been widely examined. We evaluated 31 pts with chronic (8 pts) or paroxysmal (23 pts) AF, 20 males, mean age 61 ± 8 yrs, LV ejection fraction was < 40 in 11 pts, coronary artery disease in 11 pts, cardiomyopathy in 5 pts, valvular heart disease in 3 pts, no structural heart disease in 12 pts. All pts had failed multiple 2.7 (range 1 – 4) antiarrhythmic drug trials. Oral Sotalol therapy was commenced during AF in 15 pts and in sinus rhythm in 16 pts and was titrated to maximally tolerated or effective levels. All pts underwent 24 hr Holter monitor prior to discharge. Sotalol resulted in conversion to sinus rhythm in 12 of 15 (80%) pts. 2 pts had recurrent AF. and 1 pt developed side effects while in the hospital. 28 pts were discharged on a mean dose of 220 mg daily (range 80 – 320). During followup of 8.2 mas (range 2 – 20) there were no sudden or cardiac deaths. None of the pts demonstrated proarrhythmia on Holter monitor. 4 pts (12%) had recurrence of AF. Sotalol was discontinued in 3 pts (S%) due to side effects. 22 of 31 pts (71%1 were free of recurrent AF and side effects during followup. (1) Sotalol is effective, safe and well tolerated for acute conversion of AF to sinus rhythm as well as maintenance of sinus rhythm. (2) Incidence of adverse effects including proarrhythmia is low in this pt population. (3) Effective dose of Sotalol for control of AF seems to be lower than for ventricular tachycardia.