The Arrhythmogenicity of Sotalol and its Role in Heart Failure: A Literature Review

Abstract

According to the American Heart Association (AHA), approximately six million adults have been afflicted with heart failure (HF) in the United States in 2020 and are more likely to have sudden cardiac death accounting for approximately 50% of the cause of mortality. Sotalol is a nonselective β-adrenergic receptor antagonist with class III antiarrhythmic properties that has been mostly utilized for atrial fibrillation treatment and suppressing recurrent ventricular tachyarrhythmias. The use of sotalol in patients with left ventricular (LV) dysfunction is not recommended by the American College of Cardiology (ACC) or AHA as studies are inconclusive with conflicting results regarding safety. This article aims to review the mechanism of action of sotalol, the β-blocking effects on heart failure, and provide an overview of clinical trials on sotalol use and its effects in patients with heart failure. Small and large scale clinical trials have been controversial and inconclusive about the use of sotalol in heart failure. Sotalol has been shown to reduce defibrillation energy requirements and reduce shocks from implantable cardioverter-defibrillators. TdP is the most life-threatening arrhythmia that has been documented with sotalol use and occurs more commonly in women and HF patients. Thus far, mortality benefits have not been demonstrated with sotalol use and larger multicenter studies are required going forward.