Sotalol versus amiodarone for postoperative junctional tachycardia following congenital heart surgery

Abstract: Background Junctional ectopic tachycardia (JET) is a common arrhythmia following congenital heart disease (CHD) surgery. There is variability in choice of antiarrhythmic therapy, with amiodarone used commonly. Intravenous (IV) sotalol is a newly available agent which may be useful for JET. Objective To evaluate the safety of efficacy of IV sotalol for postoperative JET and compare outcomes with IV amiodarone. Methods Retrospective single center study of all patients who received IV sotalol or IV amiodarone for postoperative JET at Texas Children's Hospital from 12/2015 to 12/2020. Data included antiarrhythmic efficacy, hemodynamics, and adverse effects. Successful JET control was defined as a decrease in JET rate to 20%), or conversion to sinus rhythm, with persistent control over 24 hours without requiring alternative antiarrhythmics or mechanical support. Results A total of 32 patients [age 71 days (IQR 17-221)] received IV amiodarone (n=20) or IV sotalol (n=12) for postoperative JET. Amiodarone was successful in treating JET in 75% of cases; sotalol was successful in 83%. The JET rate decreased faster over the first 90 minutes after a sotalol bolus (25 bpm per hour) than after an amiodarone bolus (8 bpm per hour) (p Conclusions For children with postoperative JET, both IV sotalol and amiodarone are safe and efficacious. IV sotalol may lead to a faster improvement in heart rate.