Sotalol Continuous Infusions in Critically Ill Neonates and Children

Introduction: Sotalol is a class III antiarrhythmic. In hemodynamically unstable patients, a continuous infusion may be preferred over intermittent intravenous sotalol to reduce the risk of hypotension and bradycardia. However, there is a paucity of literature regarding sotalol continuous infusions. The purpose of this study was to describe the use of sotalol continuous infusions in critically ill neonates and children.


Methods: This was a retrospective case series of patients < 18 years of age from 1/1/2018 to 2/28/2025 who received a sotalol continuous infusion for >12 hours. Data collection included demographics, arrhythmia type, presence of congenital heart disease, sotalol dosing and duration, concomitant antiarrhythmics adverse events [bradycardia (defined as less than 100 beats/min in neonates and less than 50 beats/min in infants and children), prolonged QTc (defined as greater than 480 ms), and significant QTc prolongation (defined as greater than 550 ms)]. The primary objective was to identify the median dose and duration of sotalol continuous infusions. Secondary objectives included identifying drug interactions and adverse events with sotalol. Descriptive statistics were performed.


Results: Fourteen patients were included. The age range for these patients was 0.33-192 months. Eight patients had supraventricular tachycardia, and six patients had atrial tachycardia. Six patients had congenital heart disease. Sotalol was initiated most commonly as a third-line antiarrhythmic, and eight patients received a loading dose of sotalol prior to the continuous infusion. The median initial dose was 52.5 mg/m2/day and ranged from 23-85 mg/m2/day. The median infusion duration was 293 hours and ranged from 25.3-2129.2 hours. Three patients required a dose reduction for an adverse event; one patient required the addition of vasopressors. All patients were on concomitant antiarrhythmics.


Conclusions: Sotalol was initiated most commonly as a third-line anti-arrhythmic. There was variability between patients for the dosing and duration of sotalol. Four patients required dose adjustments or other interventions for an adverse event. Overall, larger studies evaluating continuous infusion sotalol in children and neonates is needed.