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The safety and efficacy of sotalol in the management of acute atrial fibrillation: a retrospective case control study

Chris Sawh and Shabnam Rashid

Objective: The European Society of Cardiology, American Heart Association and the American College of Cardiology guidelines on atrial fibrillation (AF) 2006 state that Sotalol should not be used in acute AF. We assessed the safety and efficacy of sotalol in acute AF when compared to other anti-arrhythmic drugs (ADD). Methods: A single centre retrospective observational study on 300 patients admitted with acute AF over a 12 months period. Study drugs used were sotalol, amiodarone, flecainide, propafenone or disopyramide for rhythm control. Digoxin, beta blockers, verapamil, diltiazem were prescribed for rate control. Rates of cardioversion to sinus rhythm, readmission rates due to AF, all cause readmissions, mortality rates due to sudden cardiac death and all-cause mortality was recorded over a 2 year follow up period. For paired data, the Wilcoxon matched-pairs signed- ranks or paired t-test were used. For unpaired data, Fisher’s exact test was used. Results: 120 patients were discharged on sotalol. The mean total dose used was 169.2 mg daily. Cardioversion to sinus rhythm on discharge occurred in 68% in the rhythm control group versus 42% for rate control group (p<0.001). Sotalol had a significantly higher cardioversion rate regardless of the dose when compared to amiodarone (p=0.036) however, there were similar readmission rates for AF. Four patients died acutely in hospital, none were on sotalol. Compared to all drugs sotalol had the lowest mortality rates (p=0.001). Mortality rates were lower in patients who received the higher dose of sotalol; 7.4% for patients who received a total of 320 mg daily versus 11.8% in those who received 160 mg daily. Conclusion: Sotalol is as safe and effective as other anti-arrhythmic drugs; in fact it was significantly more effective than amiodarone in this cohort. All AAD\\\\\\\\\\\\\\\'s demonstrated a significant improvement in cardioversion rates and a significantly lower mortality rate than rate controlling drugs.