Abstract 12333: Intravenous Sotalol for Adenosine Refractory Supraventricular Tachycardia

Introduction: For re-entrant supraventricular tachycardia (SVT) that is refractory to adenosine, options of intravenous (IV) anti-arrhythmics for acute conversion are limited. IV sotalol has become more readily available, but experience in children with adenosine refractory SVT is limited. Hypothesis: IV sotalol is safe and effective for acute termination of adenosine refractory re-entrant SVT. Methods: A retrospective study of all pediatric patients receiving IV sotalol for SVT from 2016-2021, that had previously failed to convert with adenosine administration was performed. SVT consisting of orthodromic reciprocating tachycardia were included, all other supraventricular arrhythmias were excluded. Patient demographics, presence of congenital heart disease (CHD), arrhythmia type, efficacy of IV sotalol use and adverse effects were evaluated. For patients that failed to convert after the administration of adenosine a 1 mg/kg IV bolus of sotalol was given over 1 hour. Complete efficacy was defined as SVT terminating with IV sotalol bolus, partial efficacy was defined as adenosine converting SVT during or after the sotalol bolus, when adenosine had previously failed to convert SVT. Results: A total of 20 separate SVT events were treated with IV sotalol in 19 patients (53% male). Wolff-Parkinson-White syndrome was present in 5/19 patients (26%), and 9/19 patients (47%) had associated CHD. Patients had a median age of 0.24 yrs (IQR 0.03-6.86 yrs), median weight 4.30 kg (IQR 3.61 - 25.55 kg). Ventricular function prior to IV sotalol use was mildly or moderately depressed in 5/19 (26%) patients. Of the 20 events 5 (25%) were during the acute post-operative period. A single IV sotalol bolus was effective in converting adenosine refractory SVT in 19/20 (95%) events, with 16/20 (80%) having complete efficacy and 3/20 (15%) with partial efficacy. Median time to conversion was 0.5 hours (IQR 0.3-0.98 hours). No patient experienced an adverse effect during IV sotalol bolus. Conclusions: IV sotalol is a safe and effective antiarrhythmic option for acute conversion of adenosine refractory SVT.