Sotalol-induced delayed ventricular repolarization in man

Sotalol is the only beta-adrenergic blocking agent, that has been shown to produce delayed repolarization following acute administration. In this study an intravenous injection of 40–100 mg sotalol was given to eight patients with chronic atrial fibrillation. One patient was reverted to sinus rhythm, while the other patients were electro-converted 2 h after the injection. Three patients still in sinus rhythm 24 h later received chronic treatment for at least 12 weeks. They maintained sinus rhythm throughout the study. Identical electrophysiological investigations were performed after the acute injection and after chronic treatment. Following acute administration, sotalol produced a consistent increase in the ventricular repolarization time as measured from refractory periods and monophasic action potential duration, the change being of the magnitude of 13 to 17%. After chronic treatment the three remaining patients still showed an increase in the ventricular repolarization time, but no conclusions can be made from these few observations. However, the study confirms the existence of a class III mode of action at the cellular level following intravenous sotalol injections of40–100 mg in man.