Background: Sotalol, a class III antiarrhythmic drug (AAD) is conventionally initiated in an inpatient setting guided by QTc monitoring. The emergence of cell phone-compatible home ECG monitoring devices, like AliveCor's Kardia Mobile 6L® (KM6L®), allows accurate measurement of QT intervals outside the hospital environment. This study aimed to evaluate the safety, feasibility, and patient adherence to a protocol-driven, pharmacist-led outpatient sotalol initiation using KM6L®, in comparison to inpatient sotalol initiation.

Methods: Patients undergoing outpatient sotalol initiation (263) through an outpatient AAD clinic at a tertiary care facility from September 1, 2020 to June 16, 2023 were retrospectively reviewed and compared with 28 age- and gender- matched inpatient sotalol initiations.

Results: The outpatient cohort comprised of 179 males (68%), age 69+/-10 years, CHA2DS2-VASc score of 3.48+/-1.43, baseline 12-lead QTc of 440.77+/-33.42 msec and a LVEF of 57.4+/-9.23%. Outpatients were started on a median dose of sotalol 120(80-160) mg twice a day (120 mg dose; n=227, 86.3%) and ended also at a median dose of 120(60-160) mg twice a day (120 mg dose; n=217, 82.5%). The majority (98.9%; 260/263) of patients completed the 3-day sotalol outpatient initiation. No significant QTc prolongation was observed during the outpatient initiation period. There were similar sotalol discontinuation rates within 30 days of initiation between the inpatient versus outpatient cohorts (7% versus 8%; p>0.9).

Conclusions: Outpatient initiation of sotalol through a protocol-driven, pharmacist-led anti-arrhythmic clinic is feasible and safe with high adherence rates in diverse range of patients utilizing personal remote ECG recordings.

Editor-in-Chief
Kalyanam Shivkumar, MD, PhD, FACC
 
CME Editor
Kenneth A. Ellenbogen, MD, FACC

Author
Mahmoud Houmsse, MD, FACC


Important Dates
Date of Release: February 24, 2025
Term of Approval/Date of CME/MOC Expiration: February 23, 2026