Intravenous Sotalol in the Young: Safe and Effective Treatment With Standardized Protocols

Objectives: This study assessed the safety and efficacy of novel and standardized protocols for the use of intravenous (IV) sotalol in pediatric patients.

Background: Acute arrhythmia treatments in children remain limited. IV sotalol is a new option but pediatric experience is limited. There is no standardized protocol for rapid infusion during acute arrhythmias. This study assessed a single center’s initial experience with IV sotalol in young patients, describing a protocol for rapid infusion for acute treatment, and reviewed the safety and efficacy of maintenance dosing.

Methods: This is a retrospective study of all patients who received IV sotalol at Rady Children’s Hospital. Demographics, arrhythmia, hemodynamics, and effects of IV sotalol were assessed.

Results: Thirty-seven patients received IV sotalol from December 2015 to December 2018. Group 1 (n = 26) received sotalol for acute therapy and group 2 (n = 11) received a maintenance dose of sotalol after successful cardioversion with alternate therapies. The groups had similar demographics. Group 1 included patients with atrial flutter (n = 16), patients with supraventricular tachycardia (SVT) (n = 9), and patients with atrial ectopic tachycardia (AET) (n = 1). All 9 patients with SVT (100%) converted to sinus rhythm after failure to convert using adenosine. Median administration time was 15 min, the median dose was 30 mg/m², and mean time to cardioversion was 14 min. Group 2 median infusion time was 120 min, the median dose was 54 mg/m²/day, and all patients maintained sinus rhythm. No patients required cessation for adverse effects previously described for IV sotalol.

Conclusions: IV sotalol was safe and effective for acute and maintenance therapy in young patients. In acute patients, 30 mg/m² over 15 min converted most patients. IV sotalol adds a valuable option to IV therapies in the young.