Skip to main content
British Heart Journal logoLink to British Heart Journal
. 1984 Feb;51(2):157–162. doi: 10.1136/hrt.51.2.157

Sotalol, hypokalaemia, syncope, and torsade de pointes.

J K McKibbin, W A Pocock, J B Barlow, R N Millar, I W Obel
PMCID: PMC481476  PMID: 6197982

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.

Full text

PDF
160

Images in this article

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Bennett D. H. Acute prolongation of myocardial refractoriness by sotalol. Br Heart J. 1982 Jun;47(6):521–526. doi: 10.1136/hrt.47.6.521. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Dessertenne F. La tachycardie ventriculaire à deux foyers opposés variables. Arch Mal Coeur Vaiss. 1966 Feb;59(2):263–272. [PubMed] [Google Scholar]
  3. Echt D. S., Berte L. E., Clusin W. T., Samuelsson R. G., Harrison D. C., Mason J. W. Prolongation of the human cardiac monophasic action potential by sotalol. Am J Cardiol. 1982 Nov;50(5):1082–1086. doi: 10.1016/0002-9149(82)90421-0. [DOI] [PubMed] [Google Scholar]
  4. Edvardsson N., Hirsch I., Emanuelsson H., Pontén J., Olsson S. B. Sotalol-induced delayed ventricular repolarization in man. Eur Heart J. 1980 Oct;1(5):335–343. doi: 10.1093/eurheartj/1.5.335. [DOI] [PubMed] [Google Scholar]
  5. Elonen E., Neuvonen P. J., Tarssanen L., Kala R. Sotalol intoxication with prolonged Q-T interval and severe tachyarrhythmias. Br Med J. 1979 May 5;1(6172):1184–1184. doi: 10.1136/bmj.1.6172.1184. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Holland O. B., Nixon J. V., Kuhnert L. Diuretic-induced ventricular ectopic activity. Am J Med. 1981 Apr;70(4):762–768. doi: 10.1016/0002-9343(81)90530-1. [DOI] [PubMed] [Google Scholar]
  7. Julian D. G., Prescott R. J., Jackson F. S., Szekely P. Controlled trial of sotalol for one year after myocardial infarction. Lancet. 1982 May 22;1(8282):1142–1147. doi: 10.1016/s0140-6736(82)92225-5. [DOI] [PubMed] [Google Scholar]
  8. Khan M. M., Logan K. R., McComb J. M., Adgey A. A. Management of recurrent ventricular tachyarrhythmias associated with Q-T prolongation. Am J Cardiol. 1981 Jun;47(6):1301–1308. doi: 10.1016/0002-9149(81)90263-0. [DOI] [PubMed] [Google Scholar]
  9. Ko P. T., Gulamhusein S., Kostuk W. J., Klein G. J. Torsades de pointes, a common arrhythmia, induced by medication. Can Med Assoc J. 1982 Sep 1;127(5):368–372. [PMC free article] [PubMed] [Google Scholar]
  10. Kontopoulos A., Filindris A., Manoudis F., Metaxas P. Satalol-induced torsade de pointes. Postgrad Med J. 1981 May;57(667):321–323. doi: 10.1136/pgmj.57.667.321. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Krikler D. M., Curry P. V. Torsade De Pointes, an atypical ventricular tachycardia. Br Heart J. 1976 Feb;38(2):117–120. doi: 10.1136/hrt.38.2.117. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Laakso M., Pentikäinen P. J., Lampainen E. Sotalol, prolonged Q-T interval, and ventricular tachyarrhythmias. Ann Clin Res. 1981 Dec;13(6):439–440. [PubMed] [Google Scholar]
  13. Lloyd E. A., Mabin T. A. 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] [Google Scholar]
  14. Lockhart E. A., Thomis J. A. Sotalol and the Q-Tc interval. Lancet. 1981 Oct 3;2(8249):757–758. doi: 10.1016/s0140-6736(81)91088-6. [DOI] [PubMed] [Google Scholar]
  15. Nademanee K., Hendrickson J., Kannan R., Singh B. N. 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. doi: 10.1016/0002-8703(82)90556-7. [DOI] [PubMed] [Google Scholar]
  16. Nathan A. W., Hellestrand K. J., Bexton R. S., Ward D. E., Spurrell R. A., Camm A. J. Electrophysiological effects of sotalol--just another beta blocker? Br Heart J. 1982 Jun;47(6):515–520. doi: 10.1136/hrt.47.6.515. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Neuvonen P. J., Elonen E., Tanskanen A., Tuomilehto J. Sotalol and prolonged Q-Tc interval. Lancet. 1981 Aug 22;2(8243):426–426. doi: 10.1016/s0140-6736(81)90876-x. [DOI] [PubMed] [Google Scholar]
  18. Neuvonen P. J., 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. doi: 10.1007/BF00607142. [DOI] [PubMed] [Google Scholar]
  19. SELZER A., WRAY H. W. QUINIDINE SYNCOPE. PAROXYSMAL VENTRICULAR FIBRILLATION OCCURRING DURING TREATMENT OF CHRONIC ATRIAL ARRHYTHMIAS. Circulation. 1964 Jul;30:17–26. doi: 10.1161/01.cir.30.1.17. [DOI] [PubMed] [Google Scholar]
  20. Sclarovsky S., Lewin R. F., Kracoff O., Strasberg B., Arditti A., Agmon J. Amiodarone-induced polymorphous ventricular tachycardia. Am Heart J. 1983 Jan;105(1):6–12. doi: 10.1016/0002-8703(83)90270-3. [DOI] [PubMed] [Google Scholar]
  21. Simon A., Berman E. Long-term sotalol therapy in patients with arrhythmias. J Clin Pharmacol. 1979 Aug-Sep;19(8-9):547–556. doi: 10.1002/j.1552-4604.1979.tb02521.x. [DOI] [PubMed] [Google Scholar]
  22. Singh B. N., Vaughan Williams E. M. 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. doi: 10.1111/j.1476-5381.1970.tb09893.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Smith W. M., Gallagher J. J. "Les torsades de pointes": an unusual ventricular arrhythmia. Ann Intern Med. 1980 Oct;93(4):578–584. doi: 10.7326/0003-4819-93-4-578. [DOI] [PubMed] [Google Scholar]
  24. Soffer J., Dreifus L. S., Michelson E. L. Polymorphous ventricular tachycardia associated with normal and long Q-T intervals. Am J Cardiol. 1982 Jun;49(8):2021–2029. doi: 10.1016/0002-9149(82)90224-7. [DOI] [PubMed] [Google Scholar]
  25. Strasberg B., Sclarovsky S., Erdberg A., Duffy C. E., Lam W., Swiryn S., Agmon J., Rosen K. M. Procainamide-induced polymorphous ventricular tachycardia. Am J Cardiol. 1981 Jun;47(6):1309–1314. doi: 10.1016/0002-9149(81)90264-2. [DOI] [PubMed] [Google Scholar]
  26. Wald R. W., Waxman M. B., Colman J. M. Torsade de pointes ventricular tachycardia. A complication of disopyramide shared with quinidine. J Electrocardiol. 1981 Jul;14(3):301–307. doi: 10.1016/s0022-0736(81)80013-1. [DOI] [PubMed] [Google Scholar]

Articles from British Heart Journal are provided here courtesy of BMJ Publishing Group

RESOURCES