Journal article
Outpatient Initiation of Sotalol in Patients with Atrial Fibrillation: Utility of Cardiac Implantable Electronic Devices for Therapy Monitoring
American journal of cardiovascular drugs : drugs, devices, and other interventions, v 21(6), pp 693-700
01 Nov 2021
PMID: 34291437
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
Background Antiarrhythmic drugs are often used in the management of patients with atrial fibrillation (AF). Sotalol is conventionally initiated in the inpatient setting for monitoring efficacy and adverse effects, including QTc interval prolongation and torsades de pointes (TdP) proarrhythmia. Objective We aimed to evaluate the efficacy and safety of outpatient initiation of sotalol for the treatment of AF in a select group of patients with cardiac implantable electronic devices (CIEDs): permanent pacemakers (PPMs), implantable cardioverter defibrillators (ICDs), and implantable loop recorders (ILRs) capable of continuous rhythm monitoring remotely. Methods We conducted our clinical study in a real-world practice setting with longitudinal follow-up of the study cohort. We included adult patients with symptomatic paroxysmal and persistent AF eligible for sotalol for rhythm control strategy and who had CIEDs in our study. Patients with a known contraindication to sotalol were excluded. After making a shared management decision with patients, sotalol was initiated as an outpatient, with regular clinical encounters with patients to assess the efficacy and safety of treatment, and monitoring cardiac rhythm and QTc intervals with CIEDs utilizing their remote monitoring platforms. Results The study cohort comprised 105 patients; 38 (36%) females, mean age +/- standard deviation (SD) 73.9 +/- 10.36 years, and with a CHA(2)DS(2)-VASc score of 3.26 +/- 1.37 and left ventricular ejection fraction of 60.16 +/- 9.10%. Twenty-six (24.8%) patients were implanted with PPMs, 10 (9.5%) with dual-chamber ICDs, and 69 (65.7%) with ILRs. Over a follow-up period of 23 +/- 15 months, sotalol was continued at a steady median dose of 80 mg twice daily, 105 +/- 42 mg (mean +/- SD) in 77 (73%) patients who maintained sinus rhythm, and discontinued in 28 (27%) patients because of inefficacy or development of adverse effects. No adverse effects relating to QTc prolongation and TdP or mortality were observed during the study period. Conclusions Effective and safe outpatient initiation and maintenance of sotalol therapy is possible in select patients who have CIEDs for continuous remote monitoring and surveillance capabilities.
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Details
- Title
- Outpatient Initiation of Sotalol in Patients with Atrial Fibrillation: Utility of Cardiac Implantable Electronic Devices for Therapy Monitoring
- Creators
- Daniel A. N. Mascarenhas - Easton HospitalPraveen C. Mudumbi - Heart Rhythm SocietyBharat K. Kantharia - Hahnemann University Hospital
- Publication Details
- American journal of cardiovascular drugs : drugs, devices, and other interventions, v 21(6), pp 693-700
- Publisher
- Springer Nature
- Number of pages
- 8
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- College of Medicine
- Web of Science ID
- WOS:000675321900001
- Scopus ID
- 2-s2.0-85110636178
- Other Identifier
- 991021860755204721
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InCites Highlights
Data related to this publication, from InCites Benchmarking & Analytics tool:
- Collaboration types
- Domestic collaboration
- Web of Science research areas
- Cardiac & Cardiovascular Systems
- Pharmacology & Pharmacy