Home Sotalol Initiation for the Management of Atrial and Ventricular Arrhythmias Using Remote Electrocardiographic Monitoring (JCEP February 2025)-Article: Home Sotalol Initiation for the Management of Atrial and Ventricular Arrhythmias Using Remote Electrocardiographic Monitoring

Article: Home Sotalol Initiation for the Management of Atrial and Ventricular Arrhythmias Using Remote Electrocardiographic Monitoring

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The study investigates the safety and feasibility of initiating sotalol—a class III antiarrhythmic drug—at home using the Kardia Mobile 6L device for remote ECG monitoring, compared to the traditional inpatient initiation. Sotalol is used to manage atrial and ventricular arrhythmias, but it risks QT interval prolongation, which can cause dangerous arrhythmias. Traditionally, it requires inpatient monitoring due to these risks.<br /><br />This retrospective study was conducted at OhioHealth Riverside Methodist Hospital from September 2020 to June 2023 and involved 263 patients undergoing outpatient sotalol initiation. Outcomes were compared to a cohort of 28 patients who started sotalol in the hospital. The outpatient group included diverse demographics and socioeconomic backgrounds.<br /><br />Results indicated that the outpatient initiation was mostly successful, with high adherence; 98.9% of patients completed the process, and 98.1% successfully submitted ECGs on the first day. Few adverse events were noted, with a low incidence of significant QT prolongation and similar discontinuation rates to inpatients. Those discontinuing often cited bradycardia and fatigue as reasons. The patients' sotalol doses were adjusted based on remote ECG readings monitored by a pharmacist. Mortality and major adverse events during the 90-day follow-up were minimal.<br /><br />Overall, the study suggests that home initiation of sotalol with remote monitoring is both feasible and safe, with advantageous adherence levels and cost implications. The findings indicate a potential shift in practice towards outpatient initiation protocols, driven by pharmacist-led models and technological advances in remote monitoring, offering convenience without compromising safety. Further research comparing outpatient initiation with conventional methods could solidify these findings and support broader implementation.

Keywords

sotalol

remote ECG monitoring

atrial arrhythmias

ventricular arrhythmias

QT interval prolongation

outpatient initiation

Kardia Mobile 6L

pharmacist-led models

OhioHealth Riverside Methodist Hospital

retrospective study