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Peer-reviewedCC BY 4.0Reviews in Cardiovascular Medicine

Outpatient Initiation of Sotalol: Reappraising Risk, Monitoring, and Modern Care Pathways

  • Rakesh Agarwal1,2
  • Dimitrios Lypourlis1,2
  1. 1Department of Cardiology, Lyell McEwin Hospital, Elizabeth Vale, SA 5112, Australia
  2. 2College of Health, Adelaide University, Adelaide, SA 5000, Australia
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Abstract

Sotalol remains an important antiarrhythmic drug for rhythm control in atrial fibrillation and other supraventricular arrhythmias. However, sotalol is traditionally initiated in the inpatient setting because of concerns regarding QT prolongation and torsades de pointes. This practice is based on early observational data collected before the availability of contemporary risk stratification, standardized protocols, and modern rhythm monitoring technologies. Over the past two decades, evidence from observational studies using device-based monitoring, protocolized outpatient clinics, and remote electrocardiographic technologies has demonstrated low rates of malignant ventricular arrhythmias in carefully selected patients. These data also highlight the importance of longitudinal surveillance, as clinically relevant QT prolongation may occur beyond the conventional inpatient monitoring window. Thus, this review examines the pharmacologic basis of sotalol-related proarrhythmia, critically reassesses the rationale for inpatient initiation, synthesizes contemporary evidence supporting outpatient strategies in carefully selected patients with protocolized monitoring, and proposes a practical, risk-stratified framework for outpatient sotalol initiation while identifying key knowledge gaps that still require prospective validation.

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Cite

BibTeXRIS
BibTeX
@article{agarwal2026outpatient,
  title = {{Outpatient Initiation of Sotalol: Reappraising Risk, Monitoring, and Modern Care Pathways}},
  author = {Rakesh Agarwal and Dimitrios Lypourlis},
  journal = {Reviews in Cardiovascular Medicine},
  year = {2026},
  month = oct,
  doi = {10.31083/rcm52301},
  url = {https://doi.org/10.31083/rcm52301},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Outpatient Initiation of Sotalol: Reappraising Risk, Monitoring, and Modern Care Pathways
AU  - Rakesh Agarwal
AU  - Dimitrios Lypourlis
PY  - 2026
DA  - 2026/10/21
JO  - Reviews in Cardiovascular Medicine
DO  - 10.31083/rcm52301
UR  - https://doi.org/10.31083/rcm52301
AB  - Sotalol remains an important antiarrhythmic drug for rhythm control in atrial fibrillation and other supraventricular arrhythmias. However, sotalol is traditionally initiated in the inpatient setting because of concerns regarding QT prolongation and torsades de pointes. This practice is based on early observational data collected before the availability of contemporary risk stratification, standardized protocols, and modern rhythm monitoring technologies. Over the past two decades, evidence from observational studies using device-based monitoring, protocolized outpatient clinics, and remote electrocardiographic technologies has demonstrated low rates of malignant ventricular arrhythmias in carefully selected patients. These data also highlight the importance of longitudinal surveillance, as clinically relevant QT prolongation may occur beyond the conventional inpatient monitoring window. Thus, this review examines the pharmacologic basis of sotalol-related proarrhythmia, critically reassesses the rationale for inpatient initiation, synthesizes contemporary evidence supporting outpatient strategies in carefully selected patients with protocolized monitoring, and proposes a practical, risk-stratified framework for outpatient sotalol initiation while identifying key knowledge gaps that still require prospective validation.
SN  - 1530-6550
SN  - 2153-8174
ER  -