Implementation of an intravenous sotalol initiation protocol: Implications for feasibility,safety, and length of stay |
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Authors: | Albert Y. Liu MD Jessica Charron MSN ACNP Dana Fugaro MSN Scott Spoolstra BSN Rachel Kaplan MD MS Graham Lohrmann MD Xu Gao MD MS Hawkins Gay MD MPH Rod Passman MD MSCE Susan Kim MD Albert C. Lin MD Alexandru Chicos MD Rishi Arora MD Kaustubha Patil MD Anna Pfenniger MD PhD Bradley P. Knight MD Nishant Verma MD MPH |
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Affiliation: | 1. Division of Cardiology, Northwestern University, Chicago, Illinois, USA;2. Division of Cardiology, Bluhm Cardiovascular Institute, Northwestern Memorial Hospital, Chicago, Illinois, USA;3. Division of Cardiology, Medical University of South Carolina, Charleston, South Carolina, USA |
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Abstract: | Introduction Oral sotalol initiation requires a multiple-day, inpatient admission to monitor for QT prolongation during loading. A 1-day intravenous (IV) sotalol loading protocol was approved by the United States Food and Drug Administration in March 2020, but limited data on clinical use and administration currently exists. This study describes implementation of an IV sotalol protocol within an integrated health system, provides initial efficacy and safety outcomes, and examines length of stay (LOS) compared with oral sotalol initiation. Methods IV sotalol was administered according to a prespecified initiation protocol to adult patients with refractory atrial or ventricular arrhythmias. Baseline characteristics, safety and feasibility outcomes, and LOS were compared with patients receiving oral sotalol over a similar time period. Results From January 2021 to June 2022, a total of 29 patients (average age 66.0 ± 8.6 years, 27.6% women) underwent IV sotalol load and 20 patients (average age 60.4 ± 13.9 years, 65.0% women) underwent oral sotalol load. The load was successfully completed in 22/29 (75.9%) patients receiving IV sotalol and 20/20 (100%) of patients receiving oral sotalol, although 7/20 of the oral sotalol patients (35.0%) required dose reduction. Adverse events interrupting IV sotalol infusion included bradycardia (seven patients, 24.1%) and QT prolongation (three patients, 10.3%). No patients receiving IV or oral sotalol developed sustained ventricular arrhythmias before discharge. LOS for patients completing IV load was 2.6 days shorter (mean 1.0 vs. 3.6, p < .001) compared with LOS with oral load. Conclusion IV sotalol loading has a safety profile that is similar to oral sotalol. It significantly shortens hospital LOS, potentially leading to large cost savings. |
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Keywords: | antiarrhythmic drugs atrial fibrillation atrial flutter intravenous sotalol premature ventricular contractions quality improvement ventricular tachycardia |
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