Sotalol use in heart failure lacks demonstrated mortality benefits and carries a risk of Torsades de Pointes, despite reducing defibrillation energy requirements and ICD shocks.
Does sotalol improve outcomes in patients with heart failure?
Sotalol may reduce ICD shocks in heart failure patients but carries a significant risk of Torsades de Pointes without demonstrated mortality benefits, supporting current guidelines that do not recommend its routine use in left ventricular dysfunction.
ABSTRACT: According to the American Heart Association, approximately 6 million adults have been afflicted with heart failure in the United States in 2020 and are more likely to have sudden cardiac death accounting for approximately 50% of the cause of mortality. Sotalol is a nonselective β-adrenergic receptor antagonist with class III antiarrhythmic properties that has been mostly used for atrial fibrillation treatment and suppressing recurrent ventricular tachyarrhythmias. The use of sotalol in patients with left ventricular dysfunction is not recommended by the American College of Cardiology or American Heart Association because studies are inconclusive with conflicting results regarding safety. This article aims to review the mechanism of action of sotalol, the β-blocking effects on heart failure, and provide an overview of clinical trials on sotalol use and its effects in patients with heart failure. Small- and large-scale clinical trials have been controversial and inconclusive about the use of sotalol in heart failure. Sotalol has been shown to reduce defibrillation energy requirements and reduce shocks from implantable cardioverter-defibrillators. Torsades de Pointes is the most life-threatening arrhythmia that has been documented with sotalol use and occurs more commonly in women and heart failure patients. Thus far, mortality benefits have not been demonstrated with sotalol use and larger multicenter studies are required going forward.
Augustin et al. (Thu,) conducted a review in Heart failure. Sotalol was evaluated. Sotalol use in heart failure lacks demonstrated mortality benefits and carries a risk of Torsades de Pointes, despite reducing defibrillation energy requirements and ICD shocks.