Sotalol Arrhythmias

Report:

Sinus rhythm

Borderline first degree AV block

PR 0.20”

VEBs, frequent

Runs (3-beat, 5-beat) of multiform ventricular tachycardia

Incomplete LBBB

Prolonged QT interval

Comment:

The patient’s torsades (Fig 130a) were treated by MgSO4, then xylocaine, then DC countershock in CCU. Sotalol has now replaced flecainide as leading cause of iatrogenous torsades in the hospital.

Fig 130b shows the patient’s ECG the following day. The marked T wave changes may reflect sotalol as well as syncope from torsades de pointes. Perhaps, even, cardiac “memory” of sustained LBBB-like conduction94.

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