Sotalol Dosing and Outcomes Among Patients Undergoing Intravenous Loading for Atrial Arrhythmias—A PEAKS Registry Substudy

Abstract

Background

Sotalol is used for the maintenance of sinus rhythm among patients with atrial fibrillation. However, there is discretion regarding dosing of chronic therapy, and the target oral dose dictates infusion doses for intravenous sotalol loading. To date, use and outcomes by dose are not well-described.

Methods

In the Prospective Evaluation Analysis and Kinetics of IV Sotalol (PEAKS) Registry, we analyzed outcomes among patients undergoing elective IV sotalol load for atrial arrhythmias (AT/AF). Baseline characteristics, changes in ECG parameters, in-hospital adverse events, and arrhythmia outcomes were compared based on target oral dose (80 mg vs. 120 mg).

Results

Among 163 total patients, 85 (52%) of patients underwent loading anticipating target oral dose of 80 mg, compared with 78 (48%) for 120 mg. Those targeting 80 mg were older (median age 70 vs. 66, p < 0.001), with similar proportion female (24% vs. 21%, p = 0.71), and without significant differences in comorbidities or renal function. Patients targeted for 80 mg were less frequently kept in-hospital for 2 oral doses after intravenous infusion (45% vs. 89%, p < 0.001). There were no significant differences in rates of sinus rhythm or adverse events during loading.

Conclusions

Selection of target oral sotalol dose (120 vs. 80 mg) does not appear to be driven by patient characteristics, and may represent an opportunity for improved treatment. In-hospital adverse events are low overall without differences between dose.

Trial Registration

Clinicaltrials. gov # NCT05247320.