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Three Part Question

In [haemodinamically stable adults with supraventricular tachycardia] is [sotalol] safe and effective at [restoring and maintaining sinus rhythm]?

Clinical Scenario

a 54 year old lady with a history of palpitations is refered to A & E by her GP, complaining of palpitations and lightheadedness. The attending registrar performs a 12 lead ECG revealing revealing a regular rhythm, an absent P wave and a narrow complex QRS with a ventricular response of >150 beats/min on the bedside monitor strip on leads II and V5. She is diagnosed with atriventricular nodal reentrant tachycardia and the valsava manoeuvre is attempted unsuccessfully. IV Adenosine is given which restores sinus rhythm but fails to maintain it as the lady relapses into the arrhthmia. A beta-blocker is then considered and the attending clinician debates which beta-blocker is more efficient at restoring and maintaining sinus rhythm.

Search Strategy

Medline using the OVID interface 1966 to June Week 4 2005
EMBASE using the OVID interface 1980 to 2005 Week 27
CINAHL using the OVID interface 1982 to June Week 4 2005
[(Tachycardia, Supraventricular/) OR (narrow complex tachycardia.mp.) OR (Tachycardia, Atrioventricular Nodal Reentry/) OR (svt.mp.)] AND [(sotalol.mp.) OR (SOTALOL/) OR (Beta-Cardone.mp.) OR (Sotacor.mp.)] AND [(limit to (humans and english language)]

Search Outcome

107 papers were obtained of which 2 were clinically relevant.

Relevant Paper(s)

Author, date and country	Patient group	Study type (level of evidence)	Outcomes	Key results	Study Weaknesses
Jordaens L et al 1991 Belgium	43 patients with spontaneous or induced supraventricular tachycardia	Multicenter double-blind placebo-controlled crossover study	Conversion to sinus rhythm	83% with sotalol vs 16% with placebo; p<0.0001	possible patient bias randomisation not explained
			adverse effects (mild to moderate)	27% with sotalol vs 16% with placebo
			post-drug infusion arrhythmia	3 patients receiving sotalol vs 1 patient receiving placebo
Sung RJ et al 1995 USA	45 patients with spontaneous or induced supraventricular tachycardia	Multicenter randomized double-blind placebo-controlled study	Termination of SVT	Sotalol (1.0 mg/kg) 67% vs placebo 14%; p<0.05	outcomes not assessed blind patient bias sample size not justified randomisation not explained
			Termination of SVT	Sotalol (1.5 mg/kg) 67% vs placebo 14%; p<0.05
			Adverse effects (hypotension and dyspnoea)	Sotalol (1.0 mg/kg) 9% vs 10% placebo; p=NS
			Adverse effects (hypotension and dyspnoea)	Sotalol (1.5 mg/kg) 10% vs 10% placebo; p=NS

Comment(s)

According to these studies, sotalol appears to be safe and effective at terminating supraventricular tachycardias. Its efficacy is comparable to to that of adenosine and some calcium antagonists. However, calcium antagonists have several limitations and caution is necessary if the patient has concurrent hypotension or previously diagnosed with Wolff-Parkinson-White Syndrome. Despite its efficacy, the use of adenosine is sometimes limited by adverse effects and early recurrence of arrhythmia.

Clinical Bottom Line

IV Sotalol is safe and effective for acute termination of supraventricular tachycardias in haemodinamically stable patients.

References

1. Jordaens L, Gorgels A, Stroobandt R, Temmerman J efficacy and Safety of Intravenous Sotalol for termination of paroxysmal Supraventricular tachycardia American Journal of Cardiology 1991; 68:35-40
2. Sung RJ, Tan HL, Karagounis L, Hanyok JJ, Falk R, Platia E, Das G, Hardy SA, and the Sotalol Multicenter Study Group Intravenous Sotalol for the termination of Supraventricular tachycardia and atrial fibrillation and flutter: A Multicenter, Double-blind, Placebo-controlled Study Aerican Heart Journal 1995; 129: 739-48