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Feasibility and Safety of IV Sotalol Loading in Patients With AF
Quick Takes
- Rapid loading of sotalol using an IV starter regimen is feasible and safe compared with the conventional oral loading protocols.
- The overall benefit of IV loading seems to be multifold, including lower overall costs in the IV loading arm, and the patient’s ability to go home and get back to work quickly.
- These data support a practice shift from conventional 3-day PO loading to 1-day IV sotalol loading.
Study Questions:
What is the feasibility and safety of intravenous (IV) rapid loading of sotalol in patients with atrial arrhythmias requiring sotalol loading?
Methods:
The investigators conducted DASH-AF, a prospective, nonrandomized, multicenter, open-label trial consisting of patients who underwent IV sotalol loading dose to initiate rapid oral therapy for atrial arrhythmias. IV dose was calculated based on the target oral dose as indicated by baseline QTc and renal function. Patients’ QTc (in sinus) was measured via electrocardiography at 15-minute intervals and after IV loading completion. Patients were discharged 4 hours after first oral dose. All patients were monitored via mobile cardiac outpatient telemetry for 72 hours. The control group was composed of patients admitted for the traditional 5 oral (PO) doses. Safety outcomes were assessed in both groups.
Results:
One hundred twenty patients from three centers were enrolled from 2021 to 2022 in the IV loading group (compared with type of atrial fibrillation (AF)–matched and renal function–matched patients in the conventional PO loading cohort). This study demonstrated no significant change in ΔQTc in both groups, with a significantly lower number of patients requiring dose adjustment in the IV arm compared with the PO arm (4.1% vs. 16.6%; p = 0.003). This led to potential cost savings of up to $3,500.68 per admission.
Conclusions:
The authors report that rapid IV sotalol loading in AF/atrial flutter patients for rhythm control is feasible and safe compared with conventional oral loading with significant cost reduction.
Perspective:
The DASH-AF study suggests that rapid loading of sotalol using an IV starter regimen is feasible and safe compared with the conventional oral loading protocols. The overall benefit of IV loading seems to be multifold, including significantly lower overall costs in the IV loading arm due to savings in hospitalization and associated health care resource utilization, and the patient’s ability to go home and get back to work quickly. These data support a practice shift from conventional 3-day PO loading to 1-day IV sotalol loading. However, caution is recommended in light of the nonrandomized nature of the study and relatively small sample size, which may under-represent possible complications, and larger prospective studies are indicated.
Clinical Topics: Arrhythmias and Clinical EP, Prevention, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias
Keywords: Arrhythmias, Cardiac, Atrial Fibrillation, Atrial Flutter, Cost Savings, Electrocardiography, Outpatients, Patient Discharge, Secondary Prevention, Sotalol, Telemetry
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