The Lead Episode 25: A Discussion of Feasibility and Safety of Intravenous Sotalol Loading in Adult Patients With Atrial Fibrillation (DASH-AF)-JACC: Clinical Electrophysiology 2023

JACC: Clinical Electrophysiology 2023

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A trial called DASH-AF (Feasibility and Safety of Intravenous Sotalol Administered as a Loading Dose to Initiate Oral Sotalol Therapy in Adult Patients With Atrial Fibrillation) evaluated the safety and feasibility of intravenous (IV) sotalol loading in adult patients with atrial fibrillation (AF). Sotalol is commonly used for maintaining normal sinus rhythm in patients with AF and treating life-threatening ventricular arrhythmias. The trial aimed to assess whether IV sotalol loading could achieve steady-state plasma levels and maximum QTc prolongation within 6 hours, instead of the traditional 5-dose oral titration.<br /><br />The trial consisted of 120 patients who underwent IV sotalol loading dose to initiate rapid oral therapy for atrial arrhythmias. The IV dose was calculated based on the target oral dose indicated by baseline QTc and renal function. Patients' QTc was measured via electrocardiography at intervals and after IV loading completion. They were discharged 4 hours after the first oral dose and monitored for 72 hours via mobile cardiac outpatient telemetry. Safety outcomes were assessed, including the need for dose adjustment. <br /><br />The trial demonstrated that IV sotalol loading was feasible and safe, with no significant changes in QTc in both groups and a lower number of patients requiring dose adjustments in the IV group compared to the oral group. This led to potential cost savings of up to $3,500.68 per admission. The study suggests that rapid IV sotalol loading for rhythm control in patients with AF is a viable alternative to the conventional oral loading protocol, with significant cost reduction.

Keywords

DASH-AF

intravenous sotalol

safety

feasibility

atrial fibrillation

ventricular arrhythmias

QTc prolongation

oral titration

rapid oral therapy

cost reduction