Results:

A total of 263 patients met the inclusion criteria for the outpatient sotalol loading protocol and 28 patients who underwent inpatient loading were defined as the standard of care group. The most common indication for sotalol initiation was atrial fibrillation (84.4%), of which most were paroxysmal (65.3%). Median starting sotalol doses for outpatients was 120 mg (80-160 mg) twice daily and median doses at the completion of outpatient loading was 120 mg (60-160 mg) twice daily.

The majority of patients completed the outpatient sotalol loading protocol (260/263; 98.9%). Of the three patients who did not complete the protocol, two stopped due to intolerance (dizziness and fatigue) and one patient experienced a mild QTc prolongation. Adherence to the outpatient ECG monitoring remained consistently above 95% throughout the study, except the sixth and final ECG was only transmitted by 91.3% of patients. A total of six patients died during the study period. One died 4 days after starting sotalol but was determined unlikely to be related to the sotalol. The other five deaths were non-arrhythmogenic and occurred >6 months after the initial 90-day follow-up period. Compared to inpatient initiation, sotalol doses were changed less frequently during outpatient loading (5% vs. 21.4%, p = 0.01) but discontinuation rates within 30 days of initiation were similar between groups (8% vs. 7%, p > 0.9).