Mortality and ventricular arrhythmias in patients on d,l-sotalol for rhythm control of atrial fibrillation: A nationwide cohort study.

Abstract

BACKGROUND:

Use of d,l-sotalol for rhythm control in patients with atrial fibrillation (AF) has raised safety concerns. Previous randomized studies are few and not designed for mortality outcome.

OBJECTIVE:

The purpose of this study was to compare the incidences of mortality and ventricular arrhythmias in AF patients treated with d,l-sotalol for rhythm control vs matched control patients treated with cardioselective beta-blockers.

METHODS:

This population-based cohort study included AF patients from the Swedish National Patient Registry (2006-2017) who underwent rhythm control after a second cardioversion. Incidence rates (IRs) and adjusted hazard ratios (aHRs) for mortality and a composite endpoint of cardiac arrest/death and ventricular arrhythmias were calculated for the overall cohort and a 1:1 propensity score matched cohort of d,l-sotalol vs beta-blocker treatment.

RESULTS:

Among patient treated with d,l-sotalol (n = 4987) and beta-blocker (n = 27,078) (mean follow-up 458 days), all-cause mortality was lower in patients treated with d,l-sotalol: IR 1.21; 95% confidence interval 0.95-1.52 vs 2.42 (2.26-2.60) deaths per 100 patient-years; aHR 0.66 (0.52-0.83). The difference in mortality persisted in the propensity score matched comparison (n = 4953 in each group): aHR 0.63 (0.48-0.86). No differences were observed in the composite outcome: IR in propensity cohorts 2.13 (1.78-2.52) vs 2.07 (1.73-2.53) events per 100 years; aHR 1.01 (0.78-1.29).

CONCLUSION:

There was no excess mortality with d,l-sotalol compared with cardioselective beta-blockers in patients undergoing rhythm control treatment for AF after a second cardioversion. Our results indicate that the risk associated with d,l-sotalol treatment for AF can be mitigated by careful patient selection and strict adherence to follow-up protocols.

• Authors: Hanna Lenhoff, Hans Järnbert-Petersson, Borje Darpo, Per Tornvall, Mats Frick
• Journal: Heart rhythm (Heart Rhythm) Vol. 20 Issue 11 Pg. 1473-1480 (11 2023) ISSN: 1556-3871 [Electronic] United States
• PMID: 37598987 (Publication Type: Journal Article)
• Copyright: Copyright © 2023 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

Chemical References

• Sotalol
• Anti-Arrhythmia Agents
• Adrenergic beta-Antagonists

Topics

• Humans
• Sotalol (therapeutic use)
• Atrial Fibrillation (complications, drug therapy)
• Anti-Arrhythmia Agents (therapeutic use)
• Cohort Studies
• Adrenergic beta-Antagonists (therapeutic use)