Outpatient intravenous sotalol load to replace 3-day admission oral sotalol load

Abstract

Atrial arrhythmias, such as intraatrial reentrant tachycardia (IART) or atrial fibrillation, are commonly seen in older adults and in those with palliated congenital heart disease. With appropriate monitoring, especially at the time of initiation, sotalol can be a safe and effective medication to treat atrial arrhythmias.1 Unfortunately, owing to its proarrhythmia risk, sotalol initiation typically requires a 3-day hospitalization to monitor for significant QT lengthening or arrhythmias. Intravenous (IV) sotalol has been approved for the acute treatment of arrhythmias, for the replacement of oral sotalol in those who are unable to take oral medication, and for recurrent atrial arrhythmias. Although IV sotalol is not currently approved by the United States Food and Drug Administration to replace an oral sotalol load, the IV formulation rapidly reaches a steady state, potentially allowing patients to transition quickly to oral dosing at a therapeutic steady state. This novel IV sotalol load could decrease the length of hospital admission, decrease overall admission cost, and improve patient satisfaction. We describe the first use of a single-dose IV sotalol load with an outpatient observation period to replace the multiple-day oral sotalol load admission. This was completed in an adult with congenital heart disease, a history of recurrent atrial arrhythmias, and psychiatric comorbidities.