Objectives: The role of sotalol is well established for the maintenance of sinus rhythm after successful conversion of atrial fibrillation (AF). However, its role in pharmacologic conversion of AF is poorly defined. The purpose of this study is to compare the efficacy of sotalol to that of other antiarrhythmic agents for AF conversion. Methods: Standard methods of meta-analysis were employed. Full-text publications of clinical trials in English that compared the efficacy of sotalol to that of other antiarrhythmics or placebo/no treatment were eligible for inclusion. Results: A systematic review revealed 10 eligible publications. Sotalol was superior to placebo and/or no antiarrhythmic therapy in AF conversion, with a relative success of 24 (95% CI 4.7-119, p < 0.001). Sotalol was not significantly different from class IA antiarrhythmic drugs. Similarly, sotalol was not different from class IC antiarrhythmic drugs or amiodarone in terms of conversion efficacy. In one study, sotalol was less effective than high-dose ibutilide (2 mg), with a relative success of 0.248 (95% CI 0.128-0.481, p < 0.001). Ibutilide caused more proarrhythmia. Conclusions: Sotalol is as effective as class IA and class IC antiarrhythmic agents, and it is also as effective as amiodarone for pharmacologic conversion of AF. Only ibutilide at a high dose showed a greater conversion rate of AF.

1.
Mozaffarian D, Benjamin EJ, Go AS, et al: Heart disease and stroke statistics - 2015 update: a report from the American Heart Association. Circulation 2015;131:e29-e322.
2.
January CT, Wann LS, Alpert JS, Calkins H, Cigarroa JE, Cleveland JC Jr, Conti JB, Ellinor PT, Ezekowitz MD, Field ME, Murray KT, Sacco RL, Stevenson WG, Tchou PJ, Tracy CM, Yancy CW; ACC/AHA Task Force Members: 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. Circulation 2014;130:e199-e267.
3.
Al-Khatib SM, Lapointe NA, Chatterjee R, Crowley MJ, Dupre ME, Kong DF, Lopes RD, Povsic TJ, Raju SS, Shah BR, Kosinski A, McBroom AJ, Chobot MM, Gray R, Sanders GD: Treatment of Atrial Fibrillation. Rockville, Agency for Healthcare Research and Quality, 2013. http://www.effectivehealthcare.ahrq.gov/ehc/products/358/1559/atrial-fibrillation-report-130628.pdf (accessed May 11, 2016).
4.
Hagens VE, Ranchor AV, Van Sonderen E, Bosker HA, Kamp O, Tijssen JG, Kingma JH, Crijns HJ, Van Gelder IC; RACE Study Group: Effect of rate or rhythm control on quality of life in persistent atrial fibrillation: results from the Rate Control versus Electrical Cardioversion (RACE) Study. J Am Coll Cardiol 2004;43:241-247.
5.
Sullivan SD, Orme ME, Morais E, Mitchell SA: Interventions for the treatment of atrial fibrillation: a systematic literature review and meta-analysis. Int J Cardiol 2013;165:229-236.
6.
Kerin NZ, Jacob S: The efficacy of sotalol in preventing postoperative atrial fibrillation: a meta-analysis. Am J Med 2011;124:875.e1-e9.
7.
Campbell TJ, Gavaghan TP, Morgan JJ: Intravenous sotalol for the treatment of atrial fibrillation and flutter after cardiopulmonary bypass: comparison with disopyramide and digoxin in a randomised trial. Br Heart J 1985;54:86-90.
8.
Halinen MO, Huttunen M, Paakkinen S, Tarssanen L: Comparison of sotalol with digoxin-quinidine for conversion of acute atrial fibrillation to sinus rhythm (the Sotalol-Digoxin-Quinidine Trial). Am J Cardiol 1995;76:495-498.
9.
Hohnloser SH, van de Loo A, Baedeker F: Efficacy and proarrhythmic hazards of pharmacologic cardioversion of atrial fibrillation: prospective comparison of sotalol versus quinidine. J Am Coll Cardiol 1995;26:852-858.
10.
Joseph AP, Ward MR: A prospective, randomized controlled trial comparing the efficacy and safety of sotalol, amiodarone, and digoxin for the reversion of new-onset atrial fibrillation. Ann Emerg Med 2000;36:1-9.
11.
Reisinger J, Gatterer E, Heinze G, Wiesinger K, Zeindlhofer E, Gattermeier M, Poelzl G, Kratzer H, Ebner A, Hohenwallner W, Lenz K, Slany J, Kuhn P: Prospective comparison of flecainide versus sotalol for immediate cardioversion of atrial fibrillation. Am J Cardiol 1998;81:1450-1454.
12.
Singh BN, Singh SN, Reda DJ, Tang XC, Lopez B, Harris CL, Fletcher RD, Sharma SC, Atwood JE, Jacobson AK, Lewis HD Jr, Raisch DW, Ezekowitz MD; Sotalol Amiodarone Atrial Fibrillation Efficacy Trial (SAFE-T) Investigators: Amiodarone versus sotalol for atrial fibrillation. N Engl J Med 2005;352:1861-1872.
13.
Thomas SP, Guy D, Wallace E, Crampton R, Kijvanit P, Eipper V, Ross DL, Cooper MJ: Rapid loading of sotalol or amiodarone for management of recent onset symptomatic atrial fibrillation: a randomized, digoxin-controlled trial. Am Heart J 2004;147:E3.
14.
Vijayalakshmi K, Whittaker VJ, Sutton A, Campbell P, Wright RA, Hall JA, Harcombe AA, Linker NJ, Stewart MJ, Davies A, de Belder MA: A randomized trial of prophylactic antiarrhythmic agents (amiodarone and sotalol) in patients with atrial fibrillation for whom direct current cardioversion is planned. Am Heart J 2006;151:863.e1-e6.
15.
Vos MA, Golitsyn SR, Stangl K, Ruda MY, Van Wijk LV, Harry JD, Perry KT, Touboul P, Steinbeck G, Wellens HJ: Superiority of ibutilide (a new class III agent) over DL-sotalol in converting atrial flutter and atrial fibrillation. The Ibutilide/Sotalol Comparator Study Group. Heart 1998;79:568-575.
16.
Wong CK, White HD, Wilcox RG, Criger DA, Califf RM, Topol EJ, Ohman EM; GUSTO-III Investigators: Management and outcome of patients with atrial fibrillation during acute myocardial infarction: the GUSTO-III experience - global use of strategies to open occluded coronary arteries. Heart 2002;88:357-362.
17.
Paul AA, Witchel HJ, Hancox JC: Inhibition of the current of heterologously expressed HERG potassium channels by flecainide and comparison with quinidine, propafenone and lignocaine. Br J Pharmacol 2002;136:717-729.
18.
Trappe HJ, Brandts B, Weismueller P: Arrhythmias in the intensive care patient. Curr Opin Crit Care 2003;9:345-355.
19.
Gowda RM, Khan IA, Punukollu G, Vasavada BC, Sacchi TJ, Wilbur SL: Female preponderance in ibutilide-induced torsade de pointes. Int J Cardiol 2004;95:219-222.
20.
Eidher U, Freihoff F, Kaltenbrunner W, Steinbach K: Efficacy and safety of ibutilide for the conversion of monomorphic atrial tachycardia. Pacing Clin Electrophysiol 2006;29:358-362.
21.
Kowey PR, VanderLugt JT, Luderer JR: Safety and risk/benefit analysis of ibutilide for acute conversion of atrial fibrillation/flutter. Am J Cardiol 1996;78:46-52.
22.
Stambler BS, Wood MA, Ellenbogen KA, Perry KT, Wakefield LK, VanderLugt JT: Efficacy and safety of repeated intravenous doses of ibutilide for rapid conversion of atrial flutter or fibrillation. Ibutilide Repeat Dose Study Investigators. Circulation 1996;94:1613-1621.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.