静脉注射索他洛尔预防室性心律失常的安全性和可行性。

IF 2.1 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS
Abhinav Sehgal, Arati Gangadharan, Herman A Carneiro, Graham Peigh, Jessica Charron, Graham Lohrmann, Mahmoud Elsayed, Jayson Baman, Anna Pfenniger, Kaustubha Patil, Alexandru Chicos, Rishi Arora, Susan S Kim, Albert Lin, Rod Passman, Bradley P Knight, Nishant Verma
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引用次数: 0

摘要

背景:美国食品药品管理局(FDA)最近批准了为期 1 天的索他洛尔负荷方案,静脉注射索他洛尔减少了口服索他洛尔时必须住院 3 天的时间。最近有几项研究表明,对房性心律失常患者进行静脉负荷治疗是安全可行的。然而,有关室性心律失常患者静脉注射索他洛尔的可行性和安全性的数据却很少。本研究旨在评估静脉注射索他洛尔预防室性心律失常的安全性、可行性和住院时间(LOS):方法:对2021年8月至2023年12月期间在西北大学接受静脉注射索他洛尔负荷治疗和口服索他洛尔治疗室性心律失常或静脉注射索他洛尔负荷治疗房性心律失常的所有患者进行回顾性分析。比较了因室性心律失常接受索他洛尔负荷/起始治疗(静脉注射与口服)的患者和因室性心律失常接受静脉注射索他洛尔负荷治疗与因房性心律失常接受静脉注射索他洛尔负荷治疗的患者的基线特征、索他洛尔起始/负荷治疗的成功率、心率(HR)和QT/QTc的变化、安全性和LOS:共有28名患者因室性心律失常接受了索他洛尔负荷/起始治疗(静脉注射15人,口服13人),41名患者因房性心律失常接受了静脉注射索他洛尔负荷治疗。室性心律失常组患者的充血性心力衰竭病史和左室射血分数等基线特征较差。与口服索他洛尔治疗室性心律失常或静脉注射索他洛尔治疗房性心律失常相比,静脉注射索他洛尔治疗室性心律失常的成功率没有明显差异(86.7% vs. 92.3% vs. 90.2%,p = 0.88)。静脉注射索他洛尔治疗室性心律失常后的ΔQTc与静脉注射索他洛尔治疗室性心律失常后的ΔQTc(46.4 ± 29.2 ms vs. 8.9 ± 32.6 ms,p = 0.004)和静脉注射索他洛尔治疗房性心律失常后的ΔQTc(46.4 ± 29.2 ms vs. 24.0 ± 25.1 ms,p = 0.018)相比有明显增加。静脉输注索他洛尔治疗室性心律失常后的ΔHR 与开始服用 PO 索他洛尔治疗室性心律失常后的ΔHR 和静脉输注索他洛尔治疗房性心律失常后的ΔHR 相似(- 7.5 ± 8.7 bpm vs. - 8.5 ± 13.9 bpm vs. - 8.3 ± 13.2 bpm,p = 0.87)。在因QTc延长(6.7% vs. 1.7% vs. 2.4%,p = 0.64)和心动过缓(13.3% vs. 7.7% vs. 9.8%,p = 0.88)而停药方面,静脉注射索他洛尔治疗室性心律失常、口服索他洛尔治疗室性心律失常和静脉注射索他洛尔治疗房性心律失常之间没有明显差异。没有出现低血压、危及生命的室性心律失常、心力衰竭或死亡病例。与开始使用 PO 索他洛尔治疗室性心律失常相比,静脉注射索他洛尔负荷治疗的住院时间明显更短(1.1 ± 0.36 天 vs. 4.2 ± 1.0 天,p 结论:静脉注射索他洛尔负荷治疗室性心律失常似乎是可行的:静脉注射索他洛尔治疗室性心律失常是可行且安全的,可缩短住院时间。尽管室性心律失常组的合并症增加,静脉输注索他洛尔后 QTc 间期延长,但与室性心律失常用 PO 开始输注索他洛尔和房性心律失常用静脉输注相比,在成功完成负荷或不良后果方面没有显著差异。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Safety and feasibility of intravenous sotalol loading for the prevention of ventricular arrhythmias.

Safety and feasibility of intravenous sotalol loading for the prevention of ventricular arrhythmias.

Background: The use of intravenous (IV) sotalol loading following recent U.S. Food and Drug Administration (FDA) approval of a 1-day loading protocol has reduced the obligatory 3-day hospital stay for sotalol initiation when given orally. Several studies have recently demonstrated the safety and feasibility of IV loading for patients with atrial arrhythmias. However, there is a paucity of data on the feasibility and safety of IV sotalol loading for patients with ventricular arrhythmias. This study aims to assess the safety, feasibility, and length of stay (LOS) outcomes of IV sotalol loading for the prevention of ventricular arrhythmias.

Methods: A retrospective analysis was performed of all patients undergoing IV sotalol loading and oral sotalol initiation for ventricular arrhythmias, or IV sotalol loading for atrial arrhythmias between August 2021 and December 2023 at Northwestern University. Baseline characteristics, success of sotalol initiation/loading, changes in heart rate (HR) and QT/QTc, safety, and LOS were compared between patients undergoing sotalol loading/initiation for ventricular arrhythmias (IV vs. PO) and between patients undergoing IV sotalol loading for ventricular arrhythmias vs. for atrial arrhythmias.

Results: A total of 28 patients underwent sotalol loading/initiation for ventricular arrhythmias (N = 15 IV and N = 13 PO) and 41 patients underwent IV sotalol loading for atrial arrhythmias. Baseline characteristics of congestive heart failure history and left ventricular ejection fraction were worse in the ventricular arrhythmias group. There was no significant difference in the successful completion of IV sotalol loading for ventricular arrhythmias compared to oral sotalol initiation for ventricular arrhythmias or IV sotalol loading for atrial arrhythmias (86.7% vs. 92.3% vs. 90.2%, p = 0.88). There was a significant increase in ΔQTc following IV sotalol infusion for ventricular arrhythmias compared to following PO sotalol initiation for ventricular arrhythmias (46.4 ± 29.2 ms vs. 8.9 ± 32.6 ms, p = 0.004) and following IV sotalol infusion for atrial arrhythmias (46.4 ± 29.2 ms vs. 24.0 ± 25.1 ms, p = 0.018). ΔHR following IV sotalol infusion for ventricular arrhythmias was similar to ΔHR following PO sotalol initiation for ventricular arrhythmias and ΔHR following IV sotalol infusion for atrial arrhythmias (- 7.5 ± 8.7 bpm vs. - 8.5 ± 13.9 bpm vs. - 8.3 ± 13.2 bpm, p = 0.87). There were no significant differences in discontinuation for QTc prolongation (6.7% vs. 1.7% vs. 2.4%, p = 0.64) and bradycardia (13.3% vs. 7.7% vs. 9.8%, p = 0.88) between IV sotalol loading for ventricular arrhythmias, PO sotalol initiation for ventricular arrhythmias, and IV sotalol loading for atrial arrhythmias. There were no instances of hypotension, life-threatening ventricular arrhythmias, heart failure, or death. Length of stay was significantly shorter for IV sotalol loading compared to PO sotalol initiation for ventricular arrhythmias (1.1 ± 0.36 days vs. 4.2 ± 1.0 days, p < 0.0001).

Conclusion: IV sotalol loading appears feasible and safe for use in ventricular arrhythmias and results in a decreased length of stay. Despite increased comorbidities and greater increase in QTc interval following IV sotalol infusion in the ventricular arrhythmias group, there were no significant differences in successful completion of loading or adverse outcomes when compared to PO sotalol initiation for ventricular arrhythmias and IV loading for atrial arrhythmias.

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来源期刊
CiteScore
4.30
自引率
11.10%
发文量
320
审稿时长
4-8 weeks
期刊介绍: The Journal of Interventional Cardiac Electrophysiology is an international publication devoted to fostering research in and development of interventional techniques and therapies for the management of cardiac arrhythmias. It is designed primarily to present original research studies and scholarly scientific reviews of basic and applied science and clinical research in this field. The Journal will adopt a multidisciplinary approach to link physical, experimental, and clinical sciences as applied to the development of and practice in interventional electrophysiology. The Journal will examine techniques ranging from molecular, chemical and pharmacologic therapies to device and ablation technology. Accordingly, original research in clinical, epidemiologic and basic science arenas will be considered for publication. Applied engineering or physical science studies pertaining to interventional electrophysiology will be encouraged. The Journal is committed to providing comprehensive and detailed treatment of major interventional therapies and innovative techniques in a structured and clinically relevant manner. It is directed at clinical practitioners and investigators in the rapidly growing field of interventional electrophysiology. The editorial staff and board reflect this bias and include noted international experts in this area with a wealth of expertise in basic and clinical investigation. Peer review of all submissions, conflict of interest guidelines and periodic editorial board review of all Journal policies have been established.
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