title: Efficacy of Intravenous Sotalol for Treatment of Incessant Tachyarrhythmias in Children.
abstract: Our objective was to evaluate the efficacy and safety of intravenous (IV) sotalol in the treatment of incessant tachyarrhythmias in children with normal cardiac function. Eighty-three children admitted to hospital from October 2011 to December 2014 were treated with IV sotalol or IV sotalol plus IV propafenone. The time to conversion to sinus rhythm and maintaining sinus rhythm were evaluated. Blood pressure, heart rate, QTc, PR intervals, and rhythm were monitored; 50 patients (60%) were converted to sinus rhythm with IV sotalol; time to conversion was 12.0 ± 18.0 hours; 12 additional patients (15%) were converted with IV sotalol combined with IV propafenone; time to conversion was 13.1 ± 17.6 hours. A total of 62 patients (75%) were converted. Success rates of IV sotalol for different tachycardias were similar, whereas the time to conversion differed. The time to conversion for atrioventricular reentrant tachycardia was shorter than atrial tachycardia or atrial flutter (p <0.05). QTc prolongation (from 253 to 486 ms and from 398 ms to 500 ms) was seen in 2 patients (2%) within 48 hours after conversion. The QTc reverted to normal range at 48 and 144 hours, respectively, after withdrawal of IV sotalol. A 1 month old with atrial flutter developed bradycardia (7:1 atrioventricular conduction) 5 minutes after IV sotalol, and heart rate increased gradually after drug withdrawal. No other adverse effects were observed. In conclusion, IV sotalol can be safely and effectively used to terminate pediatric tachycardias in patients with normal cardiac function. No proarrhythmic or significant toxicities were detected. Close monitoring of QTc and heart rate is required after IV sotalol. Adding IV propafenone to IV sotalol in resistant cases enhance conversion.
authors.affiliation: Department of Pediatric Cardiology, Heart Center, The First Hospital of Tsinghua University, Medical Center, Tsinghua University, Beijing, People's Republic of China. Electronic address: li-xiaomei@mail.tsinghua.edu.cn.
authors.forename: Xiaomei
authors.initials: X
authors.lastname: Li
authors.affiliation: Department of Pediatric Cardiology, Heart Center, The First Hospital of Tsinghua University, Medical Center, Tsinghua University, Beijing, People's Republic of China.
authors.forename: Yan
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: Department of Pediatric Cardiology, Heart Center, The First Hospital of Tsinghua University, Medical Center, Tsinghua University, Beijing, People's Republic of China.
authors.forename: Haiju
authors.initials: H
authors.lastname: Liu
authors.affiliation: Department of Pediatric Cardiology, Heart Center, The First Hospital of Tsinghua University, Medical Center, Tsinghua University, Beijing, People's Republic of China.
authors.forename: He
authors.initials: H
authors.lastname: Jiang
authors.affiliation: Department of Pediatric Cardiology, Heart Center, The First Hospital of Tsinghua University, Medical Center, Tsinghua University, Beijing, People's Republic of China.
authors.forename: Haiyan
authors.initials: H
authors.lastname: Ge
authors.affiliation: Department of Pediatric Cardiology, Heart Center, The First Hospital of Tsinghua University, Medical Center, Tsinghua University, Beijing, People's Republic of China.
authors.forename: Yi
authors.initials: Y
authors.lastname: Zhang
mesh_terms: D000293:Adolescent; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000188:drug therapy; D001282:Atrial Flutter / Q000188:drug therapy; D002648:Child; D002675:Child, Preschool; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007262:Infusions, Intravenous; D008297:Male; D011405:Propafenone / Q000627:therapeutic use*; D013015:Sotalol / Q000627:therapeutic use*; D013610:Tachycardia / Q000188:drug therapy*; D013611:Tachycardia, Atrioventricular Nodal Reentry / Q000188:drug therapy; D013612:Tachycardia, Ectopic Atrial / Q000188:drug therapy; D017180:Tachycardia, Ventricular / Q000188:drug therapy; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000889:Anti-Arrhythmia Agents; D011405:Propafenone; D013015:Sotalol