Abstract 14784: Outcomes Associated with Implementation of an Intravenous Sotalol Initiation Protocol

Introduction: Oral sotalol initiation frequently requires a multi-day hospitalization for electrocardiographic monitoring. A one-day intravenous (IV) sotalol loading protocol was approved by the FDA in March 2020, but limited data on its clinical use currently exists. The aim of this study was to describe the outcomes of implementation of the IV sotalol initiation protocol within an integrated health system. Methods: An IV sotalol loading protocol was started in August 2021 for adult patients who were candidates for oral sotalol and had a creatinine clearance (CrCl) > 30 mL/min. Patients with a heart rate < 60 bpm or QTc > 450 ms (500 ms for those with widened QRS) were excluded. Patients with persistent atrial arrhythmias were cardioverted prior to drug infusion. IV sotalol infusion was administered in the Cardiac Recovery and Observation Unit with one-on-one nursing and was stopped for a heart rate < 50 bpm or QTc > 500 ms (550 ms for those with widened QRS). Patients were admitted for monitoring post-infusion and received two oral sotalol doses prior to discharge. Serial EKGs were performed according to protocol. Expected length of stay (LOS) with oral initiation was calculated for the same patients using CrCl. Results: A total of 27 patients (average age 66 years, 26% women) underwent IV sotalol initiation. Average LVEF was 52% and average CrCl was 91.4 ± 24.8 mL/min. Primary indication was atrial arrhythmia for 74% and ventricular arrhythmia for 26%. Sotalol loading was successfully completed in 21 (78%) patients. Adverse events interrupting sotalol load included bradycardia (5 patients, 19%) and QT prolongation (2 patients, 7%). No patients developed sustained ventricular arrhythmias. LOS for patients completing IV load was 2.3 days shorter (mean 1.0 vs 3.3, p<0.001) compared to expected LOS with oral load. Conclusions: A one-day IV sotalol loading protocol is a safe alternative to a multi-day oral sotalol initiation protocol and significantly shortens hospital LOS, potentially leading to significant cost savings.