Atrial tachycardias in young adults and adolescents with congenital heart disease: conversion using single dose oral sotalol.

Author(s): Rao SO, Boramanand NK, Burton DA, Perry JC

Affiliation(s): Children's Hospital San Diego and University of California San Diego, San Diego, CA, USA. jperry@chc-pa.org

Publication date & source: 2009-08-21, Int J Cardiol., 136(3):253-7. Epub 2008 Jul 23.

Publication type: Clinical Trial

Atrial tachyarrhythmias are a chronic long-term hazard in patients with congenital heart disease (CHD). These arrhythmias contribute to ventricular dysfunction, heart failure can contribute to sudden death. We performed a prospective study of oral sotalol for the conversion of atrial tachyarrhythmias in adults and adolescents with congenital heart disease and stable hemodynamics. METHODS: Patients were admitted and given oral sotalol in an inpatient, monitored setting. The initial dose was targeted at 2 mg/kg. Antiarrhythmic drugs other than digoxin were stopped. RESULTS: Nineteen patients were enrolled. The average patient age was 20 years (12-39). Four had atrial ectopic tachycardia (AET) and 15 had atrial reentry tachycardia (IART). Nine had Fontan physiology. Permanent pacing therapies had failed to restore sinus or paced rhythm consistently in 6 patients. Overall 16 of 19 atrial tachyarrhythmias (84%) converted with single dose oral sotalol. AET converted to sinus or paced rhythm in 3/4 patients and IART in 13/15 patients. The average times to conversion were 98 and 145 min, respectively. Two patients required pacemakers due to sinus bradycardia. One patient had a lethal thromboembolic event 2 days after conversion. CONCLUSIONS: Oral sotalol offers an effective alternative to direct current cardioversion in adults and adolescents with CHD and hemodynamically stable atrial tachyarrhythmias. Conversion with sotalol at ~2 mg/kg generally occurred within 2 h. Vigilance for thromboembolism must be maintained as well as caution for those with bradycardia without pacemakers in this patient population. There are theoretical and practical advantages of sotalol over cardioversion.