Expedited loading with intravenous sotalol is safe and feasible—primary results of the Prospective Evaluation Analysis and Kinetics of IV Sotalol (PEAKS) Registry

• DOI: 10.1016/j.hrthm.2024.02.046
• Publication Date: 2024-02-28T09:36:48Z
• Authors: Benjamin A. Stein...; Richard Holubkov; Thomas Deering; Christopher A. Groh; Suneet Mittal; Robert Kennedy; Parash Pokharel; Marco Perez; Salvatore Savona; Nishant Verma; Kevin Watt; Jonathan P. Piccini; T. Jared Bunch
• Keywords: Sotalol

BackgroundLoading oral sotalol for atrial fibrillation (AF) requires 3 days, frequently in-hospital, to achieve steady state. The FDA approved loading with intravenous (IV) through model-informed development, without patient data.ObjectiveWe present results of the first multicenter evaluation this recent labeling IV sotalol.MethodsThe Prospective Evaluation Analysis and Kinetics Sotalol (PEAKS) Registry was a observational registry patients undergoing elective load arrhythmias. Outcomes, measured from hospital admission until outpatient follow-up, included adverse arrhythmia events, efficacy, length stay.ResultsAmong 167 consecutively enrolled patients, 23% were female, median age 68 (IQR: 61,74), CHA2DS2-VASc (IQR 2,4). Overall, 99% admitted initiation (1% dose escalation), target either 80 mg bid (85[51%]) or 120 (78[47%]); 62 (37%) had an estimated creatinine clearance <90 mL/min. On presentation, 40% in sinus rhythm whereas 26% underwent cardioversion prior infusion. In two infusion stopped bradycardia hypotension. six subjects, discontinued discharge due QTc prolongation (3), (1), recurrent (2). mean stay 1.1 days 95%(n=159) discharged within 1 night.ConclusionsIntravenous is safe feasible arrhythmias, low rates yields shorter hospitalizations. More data are needed on minimal duration required monitoring in-hospital.