Sotalol – class IIIa

Sotalol – class IIIa

Sotalol is a class IIIa antiarrhythmic agent as per the Modernized Classification of Cardiac Antiarrhythmic Drugs [1]. The class effect is voltage dependent K+ channel blocker. Specifically, it is a HERG channel –mediated rapid K+ current (I_Kr) blocker. It has additional action on beta 1 and beta 2 receptors. Sotalol increases refractory period and decreases tendency for reentry.

The drug is useful in ventricular tachycardia without structural heart disease and in those with a remote myocardial infarction. It is also useful in atrial fibrillation with conduction through accessory pathway in WPW syndrome. It is also useful in other supraventricular arrhythmias.

Sotalol is useful in prevention of ventricular fibrillation and premature ventricular contraction.

The drug has a half life of 12 hours and a 12th hourly dosage is advised. It can cause QTc prolongation and torsades de pointes [3].

References

1. Ming Lei, Lin Wu, Derek A Terrar, Christopher L-H Huang. Modernized Classification of Cardiac Antiarrhythmic Drugs. Circulation. 2018 Oct 23;138(17):1879-1896.
2. Sana M Al-Khatib, William G Stevenson, Michael J Ackerman, William J Bryant, David J Callans, Anne B Curtis, Barbara J Deal, Timm Dickfeld, Michael E Field, Gregg C Fonarow, Anne M Gillis, Christopher B Granger, Stephen C Hammill, Mark A Hlatky, José A Joglar, G Neal Kay, Daniel D Matlock, Robert J Myerburg, Richard L Page. 2017 AHA/ACC/HRS Guideline for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol. 2018 Oct 2;72(14):e91-e220.
3. Quinn Wells, Bradley Hardin, Satish R Raj, Dawood Darbar. Sotalol-induced torsades de pointes precipitated during treatment with oseltamivir for H1N1 influenza. Heart Rhythm. 2010 Oct;7(10):1454-7.