Presenter Status
Fellow
Abstract Type
Clinical Research
Primary Mentor or Principal Investigator
Emily R Backes
Presentation Type
Oral Presentation
Start Date
13-5-2026 12:30 PM
End Date
13-5-2026 12:45 PM
Abstract Text
Background: Sotalol is an antiarrhythmic with both class II and III properties, available intravenously since 2015. While its use in adults is well-documented, there is limited pediatric data. It has been used in pediatric patients for various supraventricular and ventricular tachycardias. Although early reports suggest intravenous sotalol is safe and effective in children, available data remain limited.
Objectives/Goal: The primary purpose of this study is to characterize changes in hemodynamic parameters with the administration of intravenous sotalol. Additional aims were also to determine how frequently arrhythmias terminated after the initial dose.
Methods/Design: This single-center retrospective study included pediatric patients under 18 who received intravenous sotalol for the first time between January 2020 and January 2025. Those over 18 years of age, those who were not in an intensive care unit when the initial dose was given, and those who received mechanical circulatory support were excluded. Data collected included age, congenital heart disease (CHD) status, univentricular circulation, electrophysiologic diagnosis, sotalol dose, dose discontinuation, corrected QT (QTc) interval change, and arrhythmia termination. Hemodynamic variables, including heart rate, mean arterial pressure, pulse oximetry, near infrared spectroscopy (cerebral and renal), central venous pressure, and vasoactive-inotropic score, were recorded at multiple hourly time points (1 hour before to 8 hours after dosing). Termination of arrhythmia with the initial intravenous dose was defined as those in whom sinus rhythm was restored after the initial dose, as well as those in whom the rate decreased enough to facilitate pacing. Hemodynamic data were analyzed using the Friedman test, and longitudinal changes were assessed with a linear mixed effects model.
Results: The study included 112 patients with a mean age of 31.3 months. Of these, 60 (53.6%) had CHD and 15 (13.3%) had univentricular circulation. Sotalol was discontinued early in 1 (0.9%) patient. Of the 111 patients who received a complete dose, 66 (59%) were in active arrhythmia and 45 (41%) were not. Of the 66 patients with active arrhythmias when receiving sotalol, 46 (70%) experienced arrhythmia termination or rate improvement with ability to pace. Heart rate significantly decreased from baseline at all time points (p< 0.01), with a 16% reduction within 2 hours and an 18% reduction at 8 hours. Arterial saturation increased by 1-1.4% at 6-8 hours (p< 0.05). Mean arterial pressure, cerebral near infrared spectroscopy, renal near infrared spectroscopy, central venous pressure, and vasoactive inotrope score did not significantly change over time. These findings remained after multivariable analyses and were not influenced significantly by other variables. The baseline QTc interval was 420.7 ± 65.4 ms and increased to 441.1 ± 46.7 ms post-dose (p< 0.01). Other hemodynamic variables showed no significant change.
Conclusions: Intravenous sotalol was associated with stable short-term hemodynamic parameters in critically ill pediatric patients, supporting its safe use in the intensive care setting.
Intravenous sotalol in pediatric intensive care patients with and without congenital heart disease: hemodynamic effects
Background: Sotalol is an antiarrhythmic with both class II and III properties, available intravenously since 2015. While its use in adults is well-documented, there is limited pediatric data. It has been used in pediatric patients for various supraventricular and ventricular tachycardias. Although early reports suggest intravenous sotalol is safe and effective in children, available data remain limited.
Objectives/Goal: The primary purpose of this study is to characterize changes in hemodynamic parameters with the administration of intravenous sotalol. Additional aims were also to determine how frequently arrhythmias terminated after the initial dose.
Methods/Design: This single-center retrospective study included pediatric patients under 18 who received intravenous sotalol for the first time between January 2020 and January 2025. Those over 18 years of age, those who were not in an intensive care unit when the initial dose was given, and those who received mechanical circulatory support were excluded. Data collected included age, congenital heart disease (CHD) status, univentricular circulation, electrophysiologic diagnosis, sotalol dose, dose discontinuation, corrected QT (QTc) interval change, and arrhythmia termination. Hemodynamic variables, including heart rate, mean arterial pressure, pulse oximetry, near infrared spectroscopy (cerebral and renal), central venous pressure, and vasoactive-inotropic score, were recorded at multiple hourly time points (1 hour before to 8 hours after dosing). Termination of arrhythmia with the initial intravenous dose was defined as those in whom sinus rhythm was restored after the initial dose, as well as those in whom the rate decreased enough to facilitate pacing. Hemodynamic data were analyzed using the Friedman test, and longitudinal changes were assessed with a linear mixed effects model.
Results: The study included 112 patients with a mean age of 31.3 months. Of these, 60 (53.6%) had CHD and 15 (13.3%) had univentricular circulation. Sotalol was discontinued early in 1 (0.9%) patient. Of the 111 patients who received a complete dose, 66 (59%) were in active arrhythmia and 45 (41%) were not. Of the 66 patients with active arrhythmias when receiving sotalol, 46 (70%) experienced arrhythmia termination or rate improvement with ability to pace. Heart rate significantly decreased from baseline at all time points (p< 0.01), with a 16% reduction within 2 hours and an 18% reduction at 8 hours. Arterial saturation increased by 1-1.4% at 6-8 hours (p< 0.05). Mean arterial pressure, cerebral near infrared spectroscopy, renal near infrared spectroscopy, central venous pressure, and vasoactive inotrope score did not significantly change over time. These findings remained after multivariable analyses and were not influenced significantly by other variables. The baseline QTc interval was 420.7 ± 65.4 ms and increased to 441.1 ± 46.7 ms post-dose (p< 0.01). Other hemodynamic variables showed no significant change.
Conclusions: Intravenous sotalol was associated with stable short-term hemodynamic parameters in critically ill pediatric patients, supporting its safe use in the intensive care setting.
