Scientific Poster Session I - Residents and Fellows Research-in-Progress

Residents and Fellows Research in Progress
  Saturday, October 12, 2024
  11:30 AM–01:00 PM

Abstract

Introduction: Oral (PO) sotalol is indicated for maintenance of normal sinus rhythm in patients with symptomatic atrial fibrillation (AFIB) or atrial flutter (AFL). Due to the potential to induce life-threatening arrhythmias, PO sotalol is initiated in a healthcare setting that provides continuous electrocardiogram (ECG) monitoring and can provide cardiac resuscitation if necessary. This practice, referred to as “loading,” is performed over a minimum of three days. In 2020, intravenous (IV) sotalol was approved for loading prior to transitioning to PO sotalol in AFIB and AFL, potentially allowing for more rapid attainment of steady state. However, approval for this new indication is based solely on results from computer-based pharmacokinetic studies.

Research Question or Hypothesis: For patients with AFIB or AFL, will the use of IV compared to PO sotalol for loading result in similar rates of ventricular arrhythmias and QTc prolongation?

Study Design: Retrospective, single-center, cohort study of adult patients with symptomatic AFIB or AFL with a planned hospital admission for sotalol loading between June 2019 - September 2023.

Methods: The primary outcome is incidence of abnormal ECG results (composite of ventricular arrhythmias, QTc prolongation, and cardiac arrest). Secondary outcomes include individual components of the primary outcome, hospital length of stay (LOS), and 30-day readmission and mortality.

Results: 200 patients were included (IV = 36, PO = 164). No incidence of cardiac arrest was seen in either group. Hospital LOS was 1.11 days in the IV group vs 2.99 days in the PO group (p < 0.001). No difference was seen in 30-day all-cause readmission or morality rates.

Conclusion: Use of IV sotalol resulted in a no difference in cardiac arrest and a significantly shorter LOS compared to PO loading. Analysis of ventricular arrythmias and QTc prolongation, and thus the primary composite outcome, is still in progress.

Presenting Author

Madeline Gemoules PharmD
Barnes-Jewish Hospital

Authors

Carrie Cicirale PharmD, BCPS, BCCP
Barnes-Jewish Hospital

Haley Johnson PharmD, BCPS
Barnes-Jewish Hospital

Harrison Lancaster MD
Barnes-Jewish Hospital

Amanda Lonjers PharmD, BCPS
Barnes-Jewish Hospital

Taryn Mondiello PharmD, BCACP, AE-C
Barnes-Jewish Hospital

Monica Sanchez DNP
Barnes-Jewish Hospital

Sandeep Sodhi MD, MBA
Washington University School of Medicine

Amanda Tedder PharmD, BCPS
Barnes-Jewish Hospital