Management of Atrial Fibrillation Post Bypass Surgery with Intravenous Sotalol: A Case Study

Abstract

Intravenous sotalol has been available for many years outside of the United States, but has only recently become available in the US. The safety and feasibility of intravenous sotalol for the prevention of recurrent atrial fibrillation following bypass surgery has not been described. The present case study is of a patient with several other co-morbidities undergoing coronary artery bypass graft surgery, who post-operatively developed atrial fibrillation. The patient received intravenous sotalol and was then transitioned to oral sotalol. The patient remained hemodynamically stable, with normal QTc and without further atrial fibrillation or tachyarrhythmias in the post-operative period until discharge. Intravenous sotalol is a reasonable alternative to intravenous amiodarone in the post bypass surgery patient with better tolerability and safety profile.

Figure 1.. Figure illustrates an episode of atrial fibrillation with a rapid ventricular response rate (180 – 200 bpm) in this patient. Underlying intraventricular conduction defect consistent with a left bundle branch block is noted.