SOTALOL FOR ATRIAL TACHYCARDIAS AFTER SURGERY FOR CONGENITAL HEART-DISEASE

Atrial tachycardias, in particular atrial flutter after surgery for co ngenital heart disease, is associated with a high mortality. Treatment with various antiarrhythmic drugs and/or antitachycardia pacemakers i s not very successful. Sotalol, a Class III drug, has shown to be a pr omising drug in adults with atrial tachycardias. However, the experien ce with sotalol in children after surgery for congenital heart disease is limited. Therefore, we describe our results hei e. Between Decembe r 1990 and February 1997, 26 children with atrial tachycardias, most o f them with atrial flutter or fibrillation (n = 20), after surgery for congenital heart disease were treated with sotalol orally. The age of the children at the start of treatment n as 7.5 +/- 5.8 years (mean /- SD). The time interval between surgery and the start of atrial tach ycardia ranged from 1 day to 14.3 years (3.8 +/- 3.8 years). Conversio n to sinus rhythm was achieved in 26 out of 22 hemodynamically stable children with a. dosage of 4.0 +/- 1.6 mg/kg per day. The six children without sinus rhythm on sotalol and four hemodynamically unstable pat ients were treated prophylactically with sotalol after DC cardioversio n for their tachycardias. Two children complained of mild transient fa tigue. Heart rate decreased during therapy (95 +/- 33 vs 81 +/- 22 bea ts/min; P = 0.01). QT(c)-intervals did not change. Proarrhythmias such as torsades de pointes were not encountered. Two children with a pree xistent sick sinus syndrome showed aggravation of bradycardia and need ed pacemaker implantation. The percentage of children with a recurrenc e-free interval of 1 and 2 years was 96% and 81%, respectively, for al l atrial tachycardias, and 92% and 66% for atrial flutter. The recurre nces of atrial tachycardias during the follow-up period, which ranged from 0.1-6.1 years (2.5 +/- 1.8 years) could be treated with only an i ncrease of the dosage of sotalol in all but one patient. We conclude t hat sotalol is an effective drug for the treatment and prevention of a trial tachycardia in children after surgery for congenital heart disea se.