Managing acute supraventricular tachycardia and the role of intravenous sotalol

The initial approach to stable supraventricular tachycardia (SVT) in children is either adenosine or vagal maneuvers. While automatic tachycardias do not respond to such an approach, even reentrant arrythmias will fail to terminate with adenosine or vagal maneuvers. Little consensus exists on the ideal second line antiarrhythmic medication for stable SVT. This article reviews the current approach to stable SVT and early pediatric studies using intravenous (i.v.) sotalol. The development of i.v. sotalol has spawned enthusiasm for a novel antiarrhythmic for refractory reentrant SVT and other automatic atrial tachycardias. Retrospective pediatric multicenter studies have shown an excellent conversion (50-90%) of refractory SVT with a single dose of i.v. sotalol; generally, over 30 min. Cautioned should be exercised using i.v. sotalol in patients with ventricular dysfunction and dose adjustments need to be made based on creatinine clearance. In addition, i.v. sotalol has shown promising early results in slowing the ventricular rate in postoperative junctional ectopic tachycardia faster than i.v. amiodarone. Intravenous sotalol has shown promising results in refractory pediatric SVT. Protocol driven dosing with the help of hospital pharmacists should be established before i.v. sotalol is prescribed. Future prospective studies especially in postoperative patients, neonates and patients with congenital heart disease are needed.