Atrial tachycardias in young adults and adolescents with congenital heart disease: conversion using single dose oral sotalol.
Atrial tachyarrhythmias are a chronic long-term hazard in patients with congenital heart disease (CHD). These arrhythmias contribute to ventricular dysfunction, heart failure can contribute to sudden death. We performed a prospective study of oral sotalol for the conversion of atrial tachyarrhythmias in adults and adolescents with congenital heart disease and stable hemodynamics.


METHODS
Patients were admitted and given oral sotalol in an inpatient, monitored setting. The initial dose was targeted at 2 mg/kg. Antiarrhythmic drugs other than digoxin were stopped.


RESULTS
Nineteen patients were enrolled. The average patient age was 20 years (12-39). Four had atrial ectopic tachycardia (AET) and 15 had atrial reentry tachycardia (IART). Nine had Fontan physiology. Permanent pacing therapies had failed to restore sinus or paced rhythm consistently in 6 patients. Overall 16 of 19 atrial tachyarrhythmias (84%) converted with single dose oral sotalol. AET converted to sinus or paced rhythm in 3/4 patients and IART in 13/15 patients. The average times to conversion were 98 and 145 min, respectively. Two patients required pacemakers due to sinus bradycardia. One patient had a lethal thromboembolic event 2 days after conversion.


CONCLUSIONS
Oral sotalol offers an effective alternative to direct current cardioversion in adults and adolescents with CHD and hemodynamically stable atrial tachyarrhythmias. Conversion with sotalol at ~2 mg/kg generally occurred within 2 h. Vigilance for thromboembolism must be maintained as well as caution for those with bradycardia without pacemakers in this patient population. There are theoretical and practical advantages of sotalol over cardioversion.
Rao
Sri O
SO
Children's Hospital San Diego and University of California San Diego, San Diego, CA, USA. jperry@chc-pa.org
Boramanand
Nicole K
NK
Burton
David A
DA
Perry
James C
JC
D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D000889:Anti-Arrhythmia Agents / Q000008:administration & dosage* / Q000009:adverse effects; D001282:Atrial Flutter / Q000188:drug therapy* / Q000209:etiology; D002648:Child; D006330:Heart Defects, Congenital / Q000150:complications*; D006801:Humans; D011446:Prospective Studies; D013015:Sotalol / Q000008:administration & dosage* / Q000009:adverse effects; D013612:Tachycardia, Ectopic Atrial / Q000188:drug therapy* / Q000209:etiology*; D016896:Treatment Outcome; D055815:Young Adult
D000889:Anti-Arrhythmia Agents; D013015:Sotalol