Abstract 8868: High-Dose Sotalol is Safe and Effective in Neonates and Infants with Refractory Supraventricular Tachyarrhythmias
Introduction: Sotalol is used for supraventricular tachycardia (SVT) in neonates and infants. However, few studies have evaluated safety and efficacy of therapy in this age group; especially high-dose regimens (∼150 mg/m2/day). The purpose of the present study was to test the hypothesis that high-dose sotalol is safe and effective for the treatment of refractory supraventricular tachycardia in neonates and infants.
Methods: A retrospective review of 78 patients receiving sotalol as inpatients at our institution from 2001 to 2008, who had failed another antiarrhythmic, was performed. Holter monitoring was reviewed to assess efficacy of therapy. Efficacy was defined as suppression of SVT to no more than rare, nonsustained episodes or clinically acceptable rate control of SVT. Electrocardiograms (n= 864) were reviewed by two pediatric cardiologists. Corrected QT intervals were calculated at baseline and throughout therapy.
Results: Median patient age at the time of initiation of sotalol was 24 days (range: 3-728 days). Forty-eight (62 %) patients were neonates, thirty (38 %) were female and thirty-five (45 %) had congenital heart disease. Three patients died during hospitalization from causes unrelated to antiarhythmic therapy (empyema, Gram negative sepsis, respiratory failure). The median sotalol dosage was 152 mg/m2/day (range: 65 to 244 mg/m2/day). The commonly used age factor nomogram dosing would have resulted in mean dosage of 57 mg/m2/day compared with mean dosage of 157 mg/m2/day in our cohort. Sixty-seven patients (89 %) were successfully controlled on sotalol: sotalol monotherapy (n = 51); sotalol in combination with beta-blocker (propranolol or metoprolol, n = 11); sotalol in combination with digoxin (n = 4); sotalol + flecainide (n = 2). Eight patients failed sotalol therapy and required transition to: flecainide (n = 2); or amiodarone (n = 6). No proarrhythmia occurred. No patients experienced significant prolongation of the QT interval; defined as increase to greater than 500 ms. Patients were hospitalized for 16 ± 4 days after sotalol initiation prior to discharge.
Conclusions: High-dose sotalol is safe and effective in controlling refractory SVT in neonates and infants and may allow for rapid control of complex refractory arrhythmias.
- © 2010 by American Heart Association, Inc.