Key result
Outpatient initiation of sotalol with protocolized follow-up was safe, with no sotalol-related mortality or ventricular arrhythmias, and a 1.1% incidence of significant QTc prolongation.
Why the study?
Inpatient monitoring is recommended for sotalol initiation, but the safety of outpatient commencement remained to be evaluated.
Does outpatient commencement of sotalol reduce the risk of severe adverse events compared to expected inpatient rates in patients requiring sotalol?
Observational
Yes
Does outpatient commencement of sotalol reduce the risk of severe adverse events compared to expected inpatient rates in patients requiring sotalol?
Outpatient initiation of sotalol with protocolized ECG follow-up appears safe, with a low incidence of significant QTc prolongation and no early ventricular arrhythmias or death.
Outpatient sotalol initiation with monitoring may be feasible in select patients; hypothesis-generating and requires prospective trials before practice change.
Background: Inpatient monitoring is recommended for sotalol initiation. Objective: The purpose of this study was to assess the safety of outpatient sotalol commencement. Methods: This is a multicenter, retrospective, observational study of patients initiated on sotalol in an outpatient setting. Serial electrocardiogram monitoring at day 3, day 7, 1 month, and subsequently as clinically indicated was performed. Corrected QT (QTc) interval and clinical events were evaluated. Results: < .001). Within the first week, QTc prolongation led to the discontinuation of sotalol in 4 and dose reduction in 1. No ventricular arrhythmia, syncope, or death was observed during the first week. Dose reduction due to asymptomatic bradycardia occurred in 3 and discontinuation due to dyspnea in 3 within the first week. Overall, 1.1% developed QTc prolongation (>500 ms/>25% from baseline); 4 within 3 days, 1 within 1 week, 4 within 60 days, and 1 after >3 years. Discontinuation of sotalol due to other adverse effects occurred in 41 patients within the first month of therapy. Conclusion: Sotalol initiation in an outpatient setting with protocolized follow-up is safe, with no recorded sotalol-related mortality, ventricular arrhythmias, or syncope. There was a low incidence of significant QTc prolongation necessitating discontinuation within the first month of treatment. Importantly, we observed a small incidence of late QT prolongation, highlighting the need for vigilant outpatient surveillance of individuals on sotalol.
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Kamsani et al. (2024) conducted an observational in Patients requiring sotalol. Outpatient sotalol commencement was evaluated on Corrected QT (QTc) interval and clinical events. Outpatient initiation of sotalol with protocolized follow-up was safe, with no sotalol-related mortality or ventricular arrhythmias, and a 1.1% incidence of significant QTc prolongation.
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