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Br Heart J. 1984 February; 51(2): 157–162.
PMCID: PMC481476

Sotalol, hypokalaemia, syncope, and torsade de pointes.

Abstract

Thirteen patients developed syncope and a prolonged QTc interval while taking therapeutic doses of sotalol. Polymorphous ventricular tachycardia was observed in 12 patients, and criteria typical of torsade de pointes were present in 10. In 12 patients sotalol had been given with hydrochlorothiazide in a combined preparation, Sotazide, but with inadequate or no potassium supplementation. Serum potassium concentrations were reduced in eight patients. Four patients were taking other drugs known to prolong the QT interval, including disopyramide (three patients) and tricyclic antidepressants (two patients). The QT interval returned to normal in all patients after withdrawal of the drugs and correction of the hypokalaemia. Thus even in low dosage sotalol may be hazardous in the presence of hypokalaemia or when combined with drugs that also prolong the QT interval. The use of sotalol concurrently with potassium losing diuretics, such as the combined preparation Sotazide, may expose the patient to unnecessary risk and should be avoided unless the class III antiarrhythmic action of this unique beta adrenoreceptor blocking agent is also required.

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Selected References

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  • Dessertenne F. La tachycardie ventriculaire à deux foyers opposés variables. Arch Mal Coeur Vaiss. 1966 Feb;59(2):263–272. [PubMed]
  • Krikler DM, Curry PV. Torsade De Pointes, an atypical ventricular tachycardia. Br Heart J. 1976 Feb;38(2):117–120. [PMC free article] [PubMed]
  • Soffer J, Dreifus LS, Michelson EL. Polymorphous ventricular tachycardia associated with normal and long Q-T intervals. Am J Cardiol. 1982 Jun;49(8):2021–2029. [PubMed]
  • SELZER A, WRAY HW. QUINIDINE SYNCOPE. PAROXYSMAL VENTRICULAR FIBRILLATION OCCURRING DURING TREATMENT OF CHRONIC ATRIAL ARRHYTHMIAS. Circulation. 1964 Jul;30:17–26. [PubMed]
  • Strasberg B, Sclarovsky S, Erdberg A, Duffy CE, Lam W, Swiryn S, Agmon J, Rosen KM. Procainamide-induced polymorphous ventricular tachycardia. Am J Cardiol. 1981 Jun;47(6):1309–1314. [PubMed]
  • Wald RW, Waxman MB, Colman JM. Torsade de pointes ventricular tachycardia. A complication of disopyramide shared with quinidine. J Electrocardiol. 1981 Jul;14(3):301–307. [PubMed]
  • Ko PT, Gulamhusein S, Kostuk WJ, Klein GJ. Torsades de pointes, a common arrhythmia, induced by medication. Can Med Assoc J. 1982 Sep 1;127(5):368–372. [PMC free article] [PubMed]
  • Sclarovsky S, Lewin RF, Kracoff O, Strasberg B, Arditti A, Agmon J. Amiodarone-induced polymorphous ventricular tachycardia. Am Heart J. 1983 Jan;105(1):6–12. [PubMed]
  • Nathan AW, Hellestrand KJ, Bexton RS, Ward DE, Spurrell RA, Camm AJ. Electrophysiological effects of sotalol--just another beta blocker? Br Heart J. 1982 Jun;47(6):515–520. [PMC free article] [PubMed]
  • Singh BN, Vaughan Williams EM. A third class of anti-arrhythmic action. Effects on atrial and ventricular intracellular potentials, and other pharmacological actions on cardiac muscle, of MJ 1999 and AH 3474. Br J Pharmacol. 1970 Aug;39(4):675–687. [PubMed]
  • Bennett DH. Acute prolongation of myocardial refractoriness by sotalol. Br Heart J. 1982 Jun;47(6):521–526. [PMC free article] [PubMed]
  • Simon A, Berman E. Long-term sotalol therapy in patients with arrhythmias. J Clin Pharmacol. 1979 Aug-Sep;19(8-9):547–556. [PubMed]
  • Laakso M, Pentikäinen PJ, Lampainen E. Sotalol, prolonged Q-T interval, and ventricular tachyarrhythmias. Ann Clin Res. 1981 Dec;13(6):439–440. [PubMed]
  • Kontopoulos A, Filindris A, Manoudis F, Metaxas P. Satalol-induced torsade de pointes. Postgrad Med J. 1981 May;57(667):321–323. [PMC free article] [PubMed]
  • Elonen E, Neuvonen PJ, Tarssanen L, Kala R. Sotalol intoxication with prolonged Q-T interval and severe tachyarrhythmias. Br Med J. 1979 May 5;1(6172):1184–1184. [PMC free article] [PubMed]
  • Neuvonen PJ, Elonen E, Vuorenmaa T, Laakso M. Prolonged Q-T interval and severe tachyarrhythmias, common features of sotalol intoxication. Eur J Clin Pharmacol. 1981;20(2):85–89. [PubMed]
  • Smith WM, Gallagher JJ. "Les torsades de pointes": an unusual ventricular arrhythmia. Ann Intern Med. 1980 Oct;93(4):578–584. [PubMed]
  • Edvardsson N, Hirsch I, Emanuelsson H, Pontén J, Olsson SB. Sotalol-induced delayed ventricular repolarization in man. Eur Heart J. 1980 Oct;1(5):335–343. [PubMed]
  • Neuvonen PJ, Elonen E, Tanskanen A, Tuomilehto J. Sotalol and prolonged Q-Tc interval. Lancet. 1981 Aug 22;2(8243):426–426. [PubMed]
  • Lockhart EA, Thomis JA. Sotalol and the Q-Tc interval. Lancet. 1981 Oct 3;2(8249):757–758. [PubMed]
  • Echt DS, Berte LE, Clusin WT, Samuelsson RG, Harrison DC, Mason JW. Prolongation of the human cardiac monophasic action potential by sotalol. Am J Cardiol. 1982 Nov;50(5):1082–1086. [PubMed]
  • Khan MM, Logan KR, McComb JM, Adgey AA. Management of recurrent ventricular tachyarrhythmias associated with Q-T prolongation. Am J Cardiol. 1981 Jun;47(6):1301–1308. [PubMed]
  • Holland OB, Nixon JV, Kuhnert L. Diuretic-induced ventricular ectopic activity. Am J Med. 1981 Apr;70(4):762–768. [PubMed]
  • Lloyd EA, Mabin TA. Amiodarone in the treatment of patients with refractory symptomatic ventricular and supraventricular arrhythmias. A long-term follow-up study. S Afr Med J. 1983 May 14;63(20):759–763. [PubMed]
  • Nademanee K, Hendrickson J, Kannan R, Singh BN. Antiarrhythmic efficacy and electrophysiologic actions of amiodarone in patients with life-threatening ventricular arrhythmias: potent suppression of spontaneously occurring tachyarrhythmias versus inconsistent abolition of induced ventricular tachycardia. Am Heart J. 1982 Jun;103(6):950–959. [PubMed]
  • Julian DG, Prescott RJ, Jackson FS, Szekely P. Controlled trial of sotalol for one year after myocardial infarction. Lancet. 1982 May 22;1(8282):1142–1147. [PubMed]

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