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The number of heart failure patients with implantable cardioverter-defibrillators is rising. Common issues encountered in this population are high defibrillation thresholds and inappropriate shocks. In order to resolve these problems, the addition of a class III antiarrhythmic such as sotalol is often considered. Given the emerging issue of polypharmacy and medication compliance in the heart failure population, the question of the efficacy of sotalol in reducing inappropriate shocks, defibrillation thresholds, and its ability to replace conventional β-blockers is often raised. Current literature review suggests that sotalol is a useful adjunct to the contemporary heart failure regimen. It has the ability to reduce inappropriate shocks and defibrillation thresholds, but appears not to fully reproduce the pleiotropic beneficial effects of the β-blockers more commonly employed for their mortality/remodeling benefits in heart failure patients.