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Implementation of an Intravenous Sotalol Initiation Protocol: Implications for Feasibility, Safety, and Length of Stay
  • +14
  • Albert Liu,
  • Jessica Charron,
  • Dana Fugaro,
  • Scott Spoolstra,
  • Rachel Kaplan,
  • Graham Lohrmann,
  • Xu Gao,
  • Hawkins Gay,
  • Rod Passman,
  • Susan S. Kim,
  • Albert Lin,
  • Alexandru Chicos,
  • Rishi Arora,
  • Kaustubha Patil,
  • Anna Pfenniger,
  • Bradley P. Knight,
  • Nishant Verma
Albert Liu
Northwestern University Division of Cardiology

Corresponding Author:albert.liu@nm.org

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Jessica Charron
Northwestern Memorial Hospital
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Dana Fugaro
Northwestern Memorial Hospital
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Scott Spoolstra
Northwestern Memorial Hospital
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Rachel Kaplan
Medical University of South Carolina Division of Cardiology
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Graham Lohrmann
Northwestern University Division of Cardiology
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Xu Gao
Northwestern University Division of Cardiology
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Hawkins Gay
Northwestern University Division of Cardiology
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Rod Passman
Northwestern University Division of Cardiology
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Susan S. Kim
Northwestern University Division of Cardiology
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Albert Lin
Northwestern University Division of Cardiology
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Alexandru Chicos
Northwestern University Division of Cardiology
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Rishi Arora
Northwestern University Division of Cardiology
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Kaustubha Patil
Northwestern University Division of Cardiology
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Anna Pfenniger
Northwestern University Division of Cardiology
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Bradley P. Knight
Northwestern University Division of Cardiology
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Nishant Verma
Northwestern University Division of Cardiology
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Abstract

Introduction Oral sotalol initiation requires a multiple-day, inpatient admission to monitor for QT prolongation during loading. A one-day intravenous (IV) sotalol loading protocol was approved by the FDA in March 2020, but limited data on clinical use and administration currently exists. This study describes implementation of an IV sotalol protocol within an integrated health system, provides initial efficacy and safety outcomes, and examines length of stay compared to oral sotalol initiation. Methods IV sotalol was administered according to a pre-specified initiation protocol to adult patients with refractory atrial or ventricular arrhythmias. Baseline characteristics, safety and feasibility outcomes, and length of stay (LOS) were compared to patients receiving oral sotalol over a similar time period. Results From January 2021 to June 2022, a total of 29 patients (average age 66.0 ± 8.6 years, 27.6% women) underwent IV sotalol load and 20 patients (average age 60.4 ± 13.9 years, 65.0% women) underwent PO sotalol load. The load was successfully completed in 22/29 (75.9%) patients receiving IV sotalol and 20/20 (100%) of patients receiving oral sotalol, although 7/20 of the oral sotalol patients (35.0%) required dose reduction. Adverse events interrupting IV sotalol infusion included bradycardia (7 patients, 24.1%) and QT prolongation (3 patients, 10.3%). No patients receiving IV or oral sotalol developed sustained ventricular arrhythmias prior to discharge. LOS for patients completing IV load was 2.6 days shorter (mean 1.0 vs 3.6, p < 0.001) compared to LOS with oral load. Conclusion Intravenous sotalol loading has a safety profile that is similar to oral sotalol. It significantly shortens hospital LOS, potentially leading to large cost savings.
20 Sep 2022Submitted to Journal of Cardiovascular Electrophysiology
21 Sep 2022Assigned to Editor
21 Sep 2022Submission Checks Completed
21 Sep 2022Reviewer(s) Assigned
22 Nov 2022Review(s) Completed, Editorial Evaluation Pending
22 Nov 2022Editorial Decision: Revise Minor
01 Dec 20221st Revision Received