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Sotalol versus amiodarone for postoperative junctional tachycardia after congenital heart surgery

Published:November 18, 2021DOI:https://doi.org/10.1016/j.hrthm.2021.11.021

      Background

      Junctional ectopic tachycardia (JET) is a common arrhythmia after congenital heart disease surgery. There is variability in the choice of antiarrhythmic therapy, with amiodarone used commonly. Intravenous (IV) sotalol is a newly available agent that may be useful for JET.

      Objective

      The purpose of this study was to evaluate the safety and efficacy of IV sotalol for postoperative JET and compare outcomes with IV amiodarone.

      Methods

      This is a retrospective single-center study of all patients who received IV sotalol or IV amiodarone for postoperative JET at Texas Children’s Hospital from December 15, 2015, to December 15, 2020. Data included antiarrhythmic efficacy, hemodynamics, and adverse effects. Successful JET control was defined as a decrease in JET rate to <170 beats/min (or decrease by >20%), or conversion to sinus rhythm, with persistent control over 24 hours without requiring alternative antiarrhythmics or mechanical support.

      Results

      A total of 32 patients (median age 71 days; interquartile range 17–221 days) received IV amiodarone (n = 20 [62%]) or IV sotalol (n = 12 [38%]) for postoperative JET. Amiodarone was successful in treating JET in 75% of cases; sotalol was successful in 83%. The JET rate decreased faster over the first 90 minutes after a sotalol bolus (25 beats/min per hour) than after an amiodarone bolus (8 beats/min per hour) (P < .01); no heart rate difference was seen after 24 hours. Amiodarone infusion was discontinued early because of hypotension/bradycardia in 2 patients; this was not required in any patients receiving sotalol.

      Conclusion

      For children with postoperative JET, both IV sotalol and amiodarone are safe and efficacious. IV sotalol may lead to a faster improvement in heart rate.

      Graphical abstract

      Keywords

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      References

        • Moak J.P.
        • Arias P.
        • Kaltman J.R.
        • et al.
        Postoperative junctional ectopic tachycardia: risk factors for occurrence in the modern surgical era.
        Pacing Clin Electrophysiol. 2013; 36: 1156-1168
        • Hoffman T.M.
        • Bush D.M.
        • Wernovsky G.
        • et al.
        Postoperative junctional ectopic tachycardia in children: incidence, risk factors, and treatment.
        Ann Thorac Surg. 2002; 74: 1607-1611
        • Jafari-Fesharaki M.
        • Scheinman M.M.
        Adverse effects of amiodarone.
        Pacing Clin Electrophysiol. 1998; 21: 108-120
        • Walsh E.P.
        • Saul J.P.
        • Sholler G.F.
        • et al.
        Evaluation of a staged treatment protocol for rapid automatic junctional tachycardia after operation for congenital heart disease.
        J Am Coll Cardiol. 1997; 29: 1046-1053
        • Laird W.P.
        • Snyder C.S.
        • Kertesz N.J.
        • Friedman R.A.
        • Miller D.
        • Fenrich A.L.
        Use of intravenous amiodarone for postoperative junctional ectopic tachycardia in children.
        Pediatr Cardiol. 2003; 24: 133-137
        • Mandapati R.
        • Byrum C.J.
        • Kavey R.E.
        • et al.
        Procainamide for rate control of postsurgical junctional tachycardia.
        Pediatr Cardiol. 2000; 21: 123-128
        • Saul J.P.
        • Scott W.A.
        • Brown S.
        • et al.
        Intravenous amiodarone for incessant tachyarrhythmias in children: a randomized, double-blind, antiarrhythmic drug trial.
        Circulation. 2005; 112: 3470-3477
        • Anderson J.L.
        • Prystowsky E.N.
        Sotalol: an important new antiarrhythmic.
        Am Heart J. 1999; 137: 388-409
        • Valdés S.O.
        • Miyake C.Y.
        • Niu M.C.
        • et al.
        Early experience with intravenous sotalol in children with and without congenital heart disease.
        Heart Rhythm. 2018; 15: 1862-1869
        • Borquez A.A.
        • Aljohani O.A.
        • Williams M.R.
        • Perry J.C.
        Intravenous sotalol in the young: safe and effective treatment with standardized protocols.
        JACC Clin Electrophysiol. 2020; 6: 425-432
        • Li X.
        • Zhang Y.
        • Liu H.
        • Jiang H.
        • Ge H.
        • Zhang Y.
        Efficacy of intravenous sotalol for treatment of incessant tachyarrhythmias in children.
        Am J Cardiol. 2017; 119: 1366-1370
        • Valdés S.O.
        • Landstrom A.P.
        • Schneider A.E.
        • Miyake C.Y.
        • de la Uz C.M.
        • Kim J.J.
        Intravenous sotalol for the management of postoperative junctional ectopic tachycardia.
        HeartRhythm Case Rep. 2018; 4: 375-377
        • Warnes C.A.
        • Liberthson R.
        • Danielson G.K.
        • et al.
        Task Force 1: the changing profile of congenital heart disease in adult life.
        J Am Coll Cardiol. 2001; 37: 1170-1175
        • Raja P.
        • Hawker R.E.
        • Chaikitpinyo A.
        • et al.
        Amiodarone management of junctional ectopic tachycardia after cardiac surgery in children.
        Br Heart J. 1994; 72: 261-265
        • Perry J.C.
        • Fenrich A.L.
        • Hulse J.E.
        • Triedman J.K.
        • Friedman R.A.
        • Lamberti J.J.
        Pediatric use of intravenous amiodarone: efficacy and safety in critically ill patients from a multicenter protocol.
        J Am Coll Cardiol. 1996; 27: 1246-1250
        • Arvind B.
        • Kothari S.S.
        • Juneja R.
        • et al.
        Ivabradine versus amiodarone in the management of postoperative junctional ectopic tachycardia: a randomized, open-label, noninferiority study.
        JACC Clin Electrophysiol. 2021; 7: 1052-1060
        • Maghrabi K.
        • Uzun O.
        • Kirsh J.A.
        • Balaji S.
        • Von Bergen N.H.
        • Sanatani S.
        Cardiovascular collapse with intravenous amiodarone in children: a multi-center retrospective cohort study.
        Pediatr Cardiol. 2019; 40: 925-933
        • Mackin C.
        • DeWitt E.S.
        • Black K.J.
        • et al.
        Intravenous amiodarone and sotalol impair contractility and cardiac output, but procainamide does not: a Langendorff study.
        J Cardiovasc Pharmacol Ther. 2019; 24: 288-297
        • Peralta A.O.
        • John R.M.
        • Gaasch W.H.
        • Taggart P.I.
        • Martin D.T.
        • Venditti F.J.
        The class III antiarrhythmic effect of sotalol exerts a reverse use-dependent positive inotropic effect in the intact canine heart.
        J Am Coll Cardiol. 2000; 36: 1404-1410
        • Lloyd E.A.
        • Charles R.G.
        • Gordon G.D.
        • et al.
        Beta-blockade by sotalol in early myocardial infarction decreases ventricular arrhythmias without increasing left ventricular volume.
        S Afr Med J. 1988; 74: 5-10