2025 Southeastern Residency Conference

Title: Assessment of Intravenous Sotalol Loading Usage in a Veterans Affairs Medical Center


Authors: Justin Barnett, Rebecca Holt, and Cynthia Pohland


Background: Atrial fibrillation (AF) affects up to six million Americans, with approximately 15% of those being veterans. AF can be managed pharmacologically with rate control or rhythm control strategies. Sotalol is a non-selective beta-blocker with potent potassium channel blocking properties and can be used for pharmacological rhythm control.  Sotalol is typically initiated in a health care facility capable of creatine clearance calculation, continuous electrocardiographic monitoring, and cardiac resuscitation to ensure safety during the loading phase. Loading with oral sotalol tablets requires at least 3 days in an appropriate health care facility; however, loading with sotalol intravenous (IV) solution can be achieved in 1 day. The purpose of this quality assurance project is to assess the effects of IV versus oral sotalol loading on hospital length of stay in the James H. Quillen VA Medical Center (JHQVAMC) and to assess the facility’s initiation of sotalol in accordance with monitoring recommendations to identify areas for improvement in the medication use process. 


Methods: This project will identify patients who were initiated on sotalol in the JHQVAMC. Hospital length of stay will be determined as the time from sotalol initiation until the time of discharge. Serum electrolytes (potassium and magnesium), serum creatinine, creatinine clearance, heart rate, QTc interval, and heart rhythm will also be assessed at baseline, during sotalol loading, and after sotalol loading prior to hospital discharge. These electrocardiogram and electrolyte parameters will be evaluated for appropriateness as recommended by manufacturer package labeling, guideline recommendations, and expert opinion for sotalol monitoring. 


Results: In progress


Conclusion: In progress