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Sotalol versus amiodarone for postoperative junctional tachycardia following congenital heart surgery

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

      Abstract:

      Background

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

      Objective

      To evaluate the safety of efficacy of IV sotalol for postoperative JET and compare outcomes with IV amiodarone.

      Methods

      Retrospective single center study of all patients who received IV sotalol or IV amiodarone for postoperative JET at Texas Children’s Hospital from 12/2015 to 12/2020. Data included antiarrhythmic efficacy, hemodynamics, and adverse effects. Successful JET control was defined as a decrease in JET rate to <170 bpm (or 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 [age 71 days (IQR 17-221)] received IV amiodarone (n=20) or IV sotalol (n=12) 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 bpm per hour) than after an amiodarone bolus (8 bpm per hour) (p<0.01); no heart rate difference was seen after 24 hours. Amiodarone infusion was stopped early due to hypotension/bradycardia in two patients; this was not required in any patients receiving sotalol.

      Conclusions

      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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