Safety of outpatient commencement of sotalol.

Autor:	Kamsani SH; Centre for Heart Rhythm Disorders, University of Adelaide, Adelaide, South Australia, Australia.; Department of Cardiology, Royal Adelaide Hospital, Adelaide, South Australia, Australia.; National Heart Institute, Kuala Lumpur, Malaysia., Middeldorp ME; Centre for Heart Rhythm Disorders, University of Adelaide, Adelaide, South Australia, Australia.; Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands., Chiang G; Centre for Heart Rhythm Disorders, University of Adelaide, Adelaide, South Australia, Australia., Stefil M; Centre for Heart Rhythm Disorders, University of Adelaide, Adelaide, South Australia, Australia.; Department of Cardiology, Royal Adelaide Hospital, Adelaide, South Australia, Australia., Evans S; Centre for Heart Rhythm Disorders, University of Adelaide, Adelaide, South Australia, Australia.; Department of Cardiology, Royal Adelaide Hospital, Adelaide, South Australia, Australia., Nguyen MT; Department of Cardiology, Royal Adelaide Hospital, Adelaide, South Australia, Australia., Shahmohamadi E; Centre for Heart Rhythm Disorders, University of Adelaide, Adelaide, South Australia, Australia., Zhang JQ; Centre for Heart Rhythm Disorders, University of Adelaide, Adelaide, South Australia, Australia., Roberts-Thomson KC; Centre for Heart Rhythm Disorders, University of Adelaide, Adelaide, South Australia, Australia.; Department of Cardiology, Royal Adelaide Hospital, Adelaide, South Australia, Australia., Emami M; Centre for Heart Rhythm Disorders, University of Adelaide, Adelaide, South Australia, Australia.; Department of Cardiology, Royal Adelaide Hospital, Adelaide, South Australia, Australia., Young GD; Centre for Heart Rhythm Disorders, University of Adelaide, Adelaide, South Australia, Australia.; Department of Cardiology, Royal Adelaide Hospital, Adelaide, South Australia, Australia., Sanders P; Centre for Heart Rhythm Disorders, University of Adelaide, Adelaide, South Australia, Australia.; Department of Cardiology, Royal Adelaide Hospital, Adelaide, South Australia, Australia.
Jazyk:	angličtina
Zdroj:	Heart rhythm O2 [Heart Rhythm O2] 2024 May 17; Vol. 5 (6), pp. 341-350. Date of Electronic Publication: 2024 May 17 (Print Publication: 2024).
DOI:	10.1016/j.hroo.2024.05.003
Abstrakt:	Background: Inpatient monitoring is recommended for sotalol initiation. Objective: The purpose of this study was to assess the safety of outpatient sotalol commencement. Methods: This is a multicenter, retrospective, observational study of patients initiated on sotalol in an outpatient setting. Serial electrocardiogram monitoring at day 3, day 7, 1 month, and subsequently as clinically indicated was performed. Corrected QT (QTc) interval and clinical events were evaluated. Results: Between 2008 and 2023, 880 consecutive patients who were commenced on sotalol were evaluated. Indications were atrial fibrillation/flutter in 87.3% (n = 768), ventricular arrhythmias in 9.9% (n = 87), and other arrhythmias in 2.8% (n = 25). The daily dosage at initiation was 131.0 ± 53.2 mg/d. The QTc interval increased from baseline (431 ± 32 ms) to 444 ± 37 ms (day 3) and 440 ± 33 ms (day 7) after sotalol initiation ( P < .001). Within the first week, QTc prolongation led to the discontinuation of sotalol in 4 and dose reduction in 1. No ventricular arrhythmia, syncope, or death was observed during the first week. Dose reduction due to asymptomatic bradycardia occurred in 3 and discontinuation due to dyspnea in 3 within the first week. Overall, 1.1% developed QTc prolongation (>500 ms/>25% from baseline); 4 within 3 days, 1 within 1 week, 4 within 60 days, and 1 after >3 years. Discontinuation of sotalol due to other adverse effects occurred in 41 patients within the first month of therapy. Conclusion: Sotalol initiation in an outpatient setting with protocolized follow-up is safe, with no recorded sotalol-related mortality, ventricular arrhythmias, or syncope. There was a low incidence of significant QTc prolongation necessitating discontinuation within the first month of treatment. Importantly, we observed a small incidence of late QT prolongation, highlighting the need for vigilant outpatient surveillance of individuals on sotalol. Competing Interests: Dr Emami reports that the 10.13039/501100001786University of Adelaide has received on his behalf consulting fees from 10.13039/100004374Medtronic and 10.13039/100007497Biosense Webster. Dr Sanders reports having served on the advisory board of Medtronic, Abbott Medical, Boston Scientific, PaceMate, and CathRx. Dr Sanders reports that the 10.13039/501100001786University of Adelaide has received on his behalf lecture and/or consulting fees from Medtronic, Boston Scientific, and 10.13039/100000046Abbott Medical. Dr Sanders reports that the 10.13039/501100001786University of Adelaide has received on his behalf research funding from Medtronic, Abbott Medical, 10.13039/100008497Boston Scientific, and MicroPort. All other authors have no disclosures. (Crown Copyright © 2024 Published by Elsevier Inc. on behalf of Heart Rhythm Society.)
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu